Autobiographical memory in schizophrenia: The role of metacognition.

BACKGROUND: Autobiographical memory is an important component of declarative memory, which refers to the ability to recall personal events that happened in the past. This requires that the person senses or experiences himself/herself in the past (i.e., conscious recollection). For people with schizophrenia, conscious recollection can be particularly difficult, resulting in difficulty accessing detailed, specific autobiographical information. Our hypothesis is that the ability to monitor and think about one's cognitive processes (metacognition) is a requisite for conscious recollection, and that it mediates the association between having schizophrenia and recalling fewer specific, personal memories. METHODS: Participants were 30 adults with schizophrenia and 30 matched healthy controls. The main assessment instruments were the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Autobiographical Memory Test (AMT). Severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Cognitive performance was measured with the Screen for Cognitive Impairment in Psychiatry (SCIP). Mediation analysis was conducted following Baron and Kenny's procedure. RESULTS: People with schizophrenia had more semantic associations and fewer specific memories than controls in the AMT. Metacognition (MAS-A total score) partially mediated the association between having schizophrenia and recalling fewer specific past events, even after controlling for cognitive impairment as a potential confounding source. CONCLUSIONS: Metacognitive ability, which can be improved with available programs, intervenes in the process of accessing autobiographical memories in people with schizophrenia. Practical implications of this finding are discussed.

Normalización forzada y síntomas psicóticos inducidos por etosuximida / Forced normalization and psychotic symptoms induced by ethosuximide

INTRODUCCIÓN: Entre las psicosis interictales destaca la normalización forzada, fenómeno por el que a la psicosis le antecede la normalización del registro electroencefalográfico. Se presenta el caso de un episodio psicótico en un paciente epiléptico tras introducción de etosuximida. CASO CLÍNICO: El paciente, varón de 19 años, acudía a urgencias por un cuadro de dos meses de evolución de angustia, insomnio, ideas delirantes de referencia y percepciones delirantes. El paciente tenía un diagnóstico previo de epilepsia y unos meses antes había empezado a tomar etosuximida, normalizándose su registro electroencefalográfico. El cuadro remitió tras la retirada del fármaco. DISCUSIÓN: Se considera que el caso es compatible con la descripción clásica de normalización forzada. En la literatura se describen otros casos de psicosis secundaria a etosuximida, pero muchos cuadros tienen características confusionales. Otros antiepilépticos también se han relacionado con este fenómeno

INTRODUCTION: Among interictal psychoses, forced normalization stands out as a phenomenon that consists of the occurrence of psychosis following the normalization of the electroencephalographic record. We describe a psychotic episode in an epileptic patient after introduction of ethosuximide. CLINICAL CASE: The patient, a 19-year-old man, went to the emergency department due to a two-month history of anxiety, insomnia, delusional ideas of reference and delusional perceptions. The patient had a previous diagnosis of epilepsy. A few months back he had started taking ethosuximide, normalizing his electroencephalographic record. The symptoms remitted after withdrawal of the drug. DISCUSSION: The case supports the classic description of forced normalization. Other cases of psychosis secondary to ethosuximide have been described in the literature, but many of the cases had confusional features. Other anticonvulsant drugs have also been linked to this phenomenon

Psychiatrists as internists: some considerations following a COVID-19 redeployment experience / Psiquiatras como internistas: algunas reflexiones tras una experiencia de reconversión en COVID-19

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Efectividad de una intervención no sedativa para prevenir las reacciones ansiosas y claustrofóbicas en la resonancia magnética / Effectiveness of a non-sedative intervention to prevent anxious and claustrophobic reactions in magnetic resonance imaging

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Uso de perampanel en insomnio resistente al tratamiento / Use of perampanel in treatment-resistant insomnia

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Hyperventilation and electroconvulsive therapy: A literature review.

BACKGROUND: Hyperventilation has been proposed as an augmentation strategy in electroconvulsive therapy (ECT) in accordance with its proconvulsant effect. OBJECTIVE: This study reviews the existing literature on the application of hyperventilation in ECT, its efficacy, and tolerance. METHODS: A systematic search was performed in PubMed and EMBASE databases. Search terms ('electroconvulsive therapy' and 'hyperventilation', 'ventilation', 'hyperoxygenation', 'hyperoxia', 'hypocapnia') were used to retrieve works from 1966 to June 2016. Works that described hyperventilation manoeuvres in ECT settings and their clinical repercussion were included in the review. RESULTS: A total of 17 observational and experimental studies were selected. An important heterogeneity in study designs, samples and ECT conditions, was detected. Findings support a positive influence of hyperventilation on seizure duration, which is the main study variable across different works. Effects of hyperventilation on seizure threshold and quality parameters have been less thoroughly studied. Systematic recording of clinical outcomes and adverse effects of hyperventilation is uncommon. CONCLUSIONS: The literature suggests that hyperventilation may be an effective and safe technique to enhance ECT, but many aspects remain to be studied. Further investigations, especially controlled clinical trials, are necessary and should result in a specific and reliable hyperventilation protocol for ECT settings.

Retraso diagnóstico en un caso de porfiria aguda intermitente con síntomas psicóticos / Diagnostic delay in a case of acute intermittent porphyria with psychotic symptoms

La porfiria aguda intermitente (PAI) es la forma más frecuente de entre las porfirias agudas. Aunque la presentación típica cursa con ataques de dolor abdominal, en algunos casos aparecen síntomas mentales. Presentamos el caso de una PAI en un paciente varón de 34 años que llevaba 10 años diagnosticado de esquizofrenia paranoide. La atipicidad de los síntomas psicóticos y la concurrencia, durante el último episodio, de clínica neurológica y autonómica, sugirieron el diagnóstico de porfiria. El cuadro se trató exitosamente con la administración de glucosa, lo que permitió la retirada del tratamiento antipsicótico. El diagnóstico se confirmó posteriormente mediante prueba genética. La PAI es una entidad infradiagnosticada por la inespecificidad de su expresión clínica y por las dificultades técnicas en el diagnóstico. La PAI puede ser fácilmente confundida con una enfermedad psiquiátrica, con consecuencias deletéreas. Los profesionales de salud mental deberían conocerla, así como las dificultades que entraña su diagnóstico (AU)

Acute intermittent porphyria (AIP) is the most frequent form of acute porphyria. Although the typical clinical presentation is with abdominal pain, mental symptoms are also present in some cases. The case is presented of a 34-year-old male patient with AIP, who had been diagnosed with paranoid schizophrenia for 10 years. The atypicality of the psychotic symptoms and the concurrence, with neurological and autonomic signs during the last episode, suggested the diagnosis of porphyria. The episode was successfully treated with the administration of glucose, which enabled the antipsychotic treatment to be withdrawn. The diagnosis was later confirmed by genetic testing. AIP is an under-diagnosed condition due to the non-specificity of its clinical expression and the technical difficulties of the diagnosis. AIP can be easily mistaken for a psychiatric illness, with detrimental consequences. Mental health professionals should be aware of this, as well as about the difficulties involved in its diagnosis (AU)

Incidence and risk factors of acute akathisia in 493 individuals with first episode non-affective psychosis: a 6-week randomised study of antipsychotic treatment.

INTRODUCTION: Acute akathisia is a neuropsychiatric syndrome with a negative effect on illness outcome. Its incidence in patients treated with antipsychotics has shown to be highly variable across studies. OBJECTIVES: Our goals were to investigate prevalence, risk factors for the development of acute akathisia, and differences in incidence between antipsychotics in a sample of 493 first episode non-affective psychosis patients. METHODS: This is a pooled analysis of three prospective, randomized, flexible-dose, and open-label clinical trials. Patients were randomized assigned to different arms of treatment (haloperidol, quetiapine, olanzapine, ziprasidone, risperidone, or aripiprazole). Akathisia was determined using the Barnes Akathisia Scale at 6 weeks after antipsychotic initialization. Univariate analyses were performed to identify demographic, biochemical, substance use, clinical, and treatment-related predictors of acute akathisia. Considering these results, a predictive model based of a subsample of 132 patients was constructed with akathisia as the dependent variable. RESULTS: The overall incidence of akathisia was 19.5%. No differences in demographic, biochemical, substance use, and clinical variables were found. Significant incidence differences between antipsychotics were observed (Χ 2 = 68.21, p = 0.000): haloperidol (57%), risperidone (20%), aripiprazole (18.2%), ziprasidone (17.2%), olanzapine (3.6%), and quetiapine (3.5%). The predictive model showed that the type of antipsychotic (OR = 21.3, p = 0.000), need for hospitalization (OR = 2.6, p = 0.05), and BPRS total score at baseline (OR = 1.05, p = 0.03) may help to predict akathisia emergence. CONCLUSIONS: Among second generation antipsychotics, only olanzapine and quetiapine should be considered as akathisia-sparing drugs. The type of antipsychotic, having been hospitalized, and a more severe symptomatology at intake seem to predict the development of acute akathisia.

An approach to the new psychoactive drugs phenomenon / Una aproximación al fenómeno de las nuevas drogas psicoactivas

Abstract Background. The new psychoactive drugs (NPD) are those that represent a danger to public health and are not prohibited by conventions on international narcotics. The concept also includes new contexts and new routes of consumption as well as novel ways of distribution, notably Internet. The risks associated with NPD consumption are largely unknown to users and to health care providers. Objective. To integrate the existing evidence regarding the main NPD in terms of description, epidemiology, psychopharmacology, medical complications and psychoactive effects. Method. To review relevant and updated clinical information on NPD obtained from specialized books and indexed scientific journals (PubMed/Medline, Google Scholar, Scopus), as well as official documents edited by international organizations dedicated to the epidemiologic analysis of drug abuse and Internet websites and forums managed by psychoactive substance users. Results. Aspects of clinical and pharmacological interest are described comprehensively, together with epidemiological data and risks associated to the consumption of the most relevant NPD: synthetic cannabinoids, synthetic cathinones, NBOMe series, indoleamines, piperazines, hallucinogenic mushrooms (Psilocybe SP.), synthetic opioids, plant products (khat, kratom, Salvia divinorum, ayahuasca) and dissociative anesthetics. Discussion and conclusion. The emergence of the NPD is a phenomenon on the rise with important consequences for public health. Learning about new trends in drug consumption and its potential risks should be essential for the medical professional. New research is needed in order to understand the phenomenon of the NPD and its pharmacological, clinical and legal implications.

Resumen Antecedentes. Las nuevas drogas psicoactivas (NDP) son aquellas que, aun cuando representan un peligro para la salud pública, no están prohibidas por los acuerdos internacionales sobre narcóticos. La noción incluye también nuevos contextos de usos, nuevas formas de administración y nuevas vías de distribución, entre las que destaca Internet. Los riesgos asociados al consumo de NDP son en gran medida desconocidos por los usuarios y el personal de salud. Objetivo. Integrar la información existente sobre las principales NDP en cuanto a su descripción, psicofarmacología, epidemiología, efectos psicoactivos y complicaciones médicas descritas. Método. Revisión de la información actualizada de relevancia clínica sobre las NDP obtenida de libros especializados y revistas científicas indexadas (PubMed/Medline, Google Scholar, Scopus); de documentos oficiales de organismos internacionales dedicados a la epidemiología del consumo de drogas, y de portales y foros en Internet gestionados por usuarios de sustancias psicoactivas. Resultados. Se describen de manera detallada aspectos de interés clínico y farmacológico, así como datos epidemiológicos y riesgos asociados al consumo de las NDP más relevantes: cannabinoides sintéticos, catinonas sintéticas, serie de los NBOMe, indolaminas, piperazinas, hongos alucinógenos (Psilocybe sp.), opioides sintéticos, productos vegetales (khat, kratom, Salvia divinorum, ayahuasca) y anestésicos disociativos. Discusión y conclusión. El surgimiento de las NDP es un fenómeno en auge con importantes consecuencias en la salud pública. Se hace imprescindible para el profesional médico conocer las nuevas tendencias en el consumo y los riesgos potenciales del mismo. Son necesarias también nuevas investigaciones para comprender el fenómeno de las NDP y sus implicaciones farmacológicas, clínicas y legales.

Psychopathology Related to Energy Drinks: A Psychosis Case Report.

Energy drinks (ED) are nonalcoholic beverages that have caffeine as their most common active substance. The rapid expansion of ED consumption has created concern in the scientific community as well as in the public opinion. We report a psychotic episode probably triggered by ED abuse in a young adult without previous psychotic disorders. We have reviewed the literature regarding the relationship between caffeine, energy drinks, and psychopathology. Few articles have been published about mental health effects of energy drinks and caffeine abuse. Nevertheless, this relationship has been suggested, specifically with anxiety disorders, manic episodes, suicide attempts, psychotic decompensation, and substance use disorder. ED consumption could represent a global public health problem because of the potential severe adverse effects in mental and physical health. To our knowledge, this article is probably the first case of psychosis related to ED abuse in an individual without previous psychotic disorders.

Severe Psychosis, Drug Dependence, and Hepatitis C Related to Slamming Mephedrone.

Background. Synthetic cathinones (SCs), also known as "bath salts," are ß-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion. Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described.