Pain sensitivity in patients with schizophrenia: a systematic review and meta-analysis.

BACKGROUND: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some research suggests the existence of a possible hyposensitivity, while others describe a hypersensitivity to pain in people with schizophrenia. In summary, the studies present contradictory results.

Sensibilidad al dolor en pacientes con esquizofrenia: una revisión sistemática y metaanálisis / Pain sensitivity in patients with schizophrenia: a systematic review and meta-analysis

Introducción: En personas diagnosticadas de esquizofrenia se han observado alteraciones en la percepción del dolor.Algunas investigaciones sugieren la existencia de una posiblehiposensibilidad, mientras que otras describen una hipersensibilidad al dolor en personas con esquizofrenia. En definitiva, los estudios presentan resultados contradictorios.Método. Se ha llevado a cabo una revisión sistemática deestudios experimentales y comparativos en 5 bases de datosdiferentes, incluyendo aquellos estudios que evalúan el dolorinducido de manera experimental mediante métodos físicosy comparando los resultados con un grupo control sano. Posteriormente, se ha llevado a cabo un metaanálisis comparando los pacientes con esquizofrenia con los controles sanos,utilizando un modelo de efectos aleatorios.Resultados. Finalmente fueron seleccionados nueve estudios, con un total de 186 participantes diagnosticados deesquizofrenia y 186 controles sanos. En el metaanálisis no seobservaron diferencias significativas en la comparación deanálisis general entre pacientes con esquizofrenia y controlessanos. No obstante, cuando el tipo de estímulo fue estudiadopor separado (mecánico, térmico o eléctrico), se observarondiferencias significativas a favor de una mayor sensibilidad aldolor en los pacientes con esquizofrenia en los estudios queevaluaron el dolor con presión mecánica o isquemia, perono en aquellos que utilizaron métodos térmicos o eléctricos.Conclusiones. El resultado global de nuestra revisión sistemática no respalda la existencia de una alteración en lasensibilidad al dolor en los sujetos con esquizofrenia, aunque un análisis de subgrupos sugiere que cuando el estímulodel dolor es causado por métodos mecánicos, las personascon esquizofrenia presentan una hipersensibilidad al doloren comparación con los controles sanos. Aunque estos resultados son datos novedosos, se requieren más estudios para replicar los resultados. (AU)

Background: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some researchsuggests the existence of a possible hyposensitivity, while othersdescribe a hypersensitivity to pain in people with schizophrenia.In summary, the studies present contradictory results.Methods. A systematic review of experimental andcomparative studies has been conducted in 5 differentdatabases, including those studies that measure pain experimentally inducing it with physical methods and thatcompares the results with a healthy control group. Afterwards, a meta-analysis was carried out comparing thepatients with schizophrenia to the healthy controls, usingthe random effects model.Results. Nine studies were finally selected, with a totalof 186 participants diagnosed with schizophrenia and 186healthy controls. In the meta-analysis, no significative differences were observed in the general analysis. But when thetype of stimuli was studied separately (mechanical, thermal, or electrical), significative differences in favor of a highersensitivity in the patients with schizophrenia were observedin the studies that measured pain with mechanical pressure or ischemia, not in those that used thermal or electricalmethods.Conclusions. The global result of our systematic reviewdoes not support the existence of an alteration in pain sensitivity in subjects with schizophrenia, although a subgroup analysissuggests that when pain stimulation is caused by mechanicalmethods, people with schizophrenia present hypersensitivity topain compared to healthy controls. Although these results arenovel data, more studies are required to replicate these results. (AU)

Efficacy of vitamin D in the treatment of depression: a systematic review and meta-analysis.

Vitamin D is a fat-soluble vitamin that performs multiple functions in the body. In addition to regulating calcium and phosphate levels in the body and contributing to bone mineralization, it participates in various brain and neurocognitive processes. In fact, the deficiency of this vitamin has also been linked to various psychiatric disorders, including depression.

Use of long acting injectable aripiprazole before and through pregnancy in bipolar disorder: a case report.

BACKGROUND: Long-acting injectable (LAI) antipsychotics for psychotic disorders provide advantages in treatment compliance, but data on their use in pregnancy are very limited. We present a clinical case of aripiprazole LAI use in pregnancy. CASE PRESENTATION: A 43-year-old woman diagnosed with bipolar disorder, with several relapses due to treatment interruption while trying to conceive. Finally, aripiprazole LAI treatment was planned by mutual agreement between doctor and the patient, who took aripiprazole LAI before and during pregnancy. She gave birth at 40 weeks to a 3500 g baby girl with no congenital malformations, who was healthy at 5 months after delivery. CONCLUSION: As far as we know, this is the first case report on aripiprazole LAI use during pregnancy. Although we exercise caution in drawing conclusions from a single case, and each case should be weighed up individually, aripiprazole LAI could be a therapeutic option in similar circumstances.

Adicción al tarot: a propósito de un caso / Tarot addiction: about a case

Las denominadas adicciones psicológicas, conductuales o sin sustancia han despertado un interés creciente en los últimos años debido a los problemas que el uso de las nuevas tecnologías plantea en nuestra sociedad. En la actualidad el DSM-5 sólo reconoce el "Juego Patológico", pero cada vez son más los autores que defienden el reconocimiento de otros comportamientos abusivos como el uso de Internet, la telefonía móvil, los juegos online, el sexo, las compras o el ejercicio físico entre otras. En este sentido, la OMS ha propuesto en el borrador de la CIE-11 el reconocimiento del trastorno por juego digital o video juego (gaming disorder). El caso que presentamos trata de una adicción menos conocida: la adicción a consultas del tarot, a través de líneas telefónicas de pago, en una paciente con diagnóstico de trastorno límite de la personalidad y con antecedentes de abuso a sustancias (benzodiazepinas). La escasez de datos publicados en la bibliografía acerca de este tipo de comportamiento nos ha motivado a publicar el caso que les presentamos

So-called psychological, behavioral or substance-free addictions have aroused growing interest in recent years due to the problems posed by the use of new technologies in our society. Currently the DSM-5 only recognizes the Gambling Disorder, but more and more authors defend the recognition of other abusive behaviors such as the use of the Internet, mobile telephony, online games, shopping, sex, exercise and physical exercise, among others. In this respect, in the draft of the ICD-11 the WHO has proposed the recognition of digital games or video-games disorder (Gaming Disorder). The case we present deals with a lesser-known addiction: fortune-telling addiction or addiction to tarot, consulting through calls to pay-telephone lines, in a patient with a diagnosis of borderline personality disorder and with a history of substance abuse (benzodiazepines). The scarcity of data published in the literature about this type of behavior encouraged us to publish the case now being presented

Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire.

BACKGROUND: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. OBJECTIVE: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. METHODS: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients' interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). RESULTS: In this study, 84.8% (89/105) of the patients had access to the internet and 88.6% (93/105) owned an electronic internet device. In total, 71.3% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). CONCLUSIONS: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7% (23/80) of the studied patients rejected the use of internet interventions and 38.2% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments.

Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

Involuntary outpatient treatment (iot) for severe mental patients: current situation in Spain.

Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent's states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries.

Situacion en España del tratamiento ambulatorio involuntario (TAI) para enfermos mentales graves / Involuntary outpatient treatment (IOT) for severe mental patients: current situation in Spain

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adherencia al tratamiento y, por tanto, prevenirlas recaídas y el deterioro de las personas con enfermedad mental grave. Además de las posiciones manifestadas a favor y en contra con la introducción del TAI, los estudios publicados en la literatura médica obtienen también resultados contradictorios. En la mayoría de los países de nuestro entorno, se han producido cambios legislativos que regulan su aplicación. En la actualidad no existe en España una normativa legal, sin embargo, es posible su aplicación en el ámbito local de algunas ciudades españolas. En este artículo se pretende hacer una revisión del TAI en los países de nuestro entorno y España (AU)

Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent’s states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries (AU)

Discinesia tardía inducida por neurolépticos. A propósito de un caso / Neuroleptic-induced tardive dyskinesia. A case report

La discinesia tardía inducida por neurolépticos es un trastorno motor asociado a tratamientos prolongados o dosis altas de antagonistas dopaminérgicos. Con los antipsicóticos atípicos ha disminuido la frecuencia y gravedad de estos efectos secundarios, sin embargo no han desaparecido y hay que tenerlos en cuenta en la evaluación y seguimiento de los pacientes en tratamiento con antipsicóticos. En este artículo presentamos para discusión un caso clínico en el que aparece discinesia tardía tras utilización de antipsicóticos clásicos durante años y de atípicos en los últimos (AU)

Neuroleptic-induced tardive dyskinesia is a motor disorder associated with long-term or high-dose use of dopamine antagonists. The use of atypical antipsychotics has decreased the frequency and severity of these side effects. However have not disappeared and must be taken into account in the assessment and monitoring of patients treated with antipsychotics. In this paper we present a case for discussion (AU)

[Evaluation of the efficacy of involuntary outpatient treatment in reducing the use of mental health services in hospital]. / Evaluación de la eficacia del tratamiento ambulatorio involuntario para reducir la atención hospitalaria.

OBJECTIVE: To determine whether psychiatric patients in involuntary outpatient treatment (IOT) show reduced use of mental health services in hospital compared with a control group not subject to a judicial order. METHOD: We compared a group of patients in IOT (n=38) with a control group (n=38), selected from involuntarily hospitalized patients during the same period. Patients in the control group had similar sociodemographic, clinical and psychiatric characteristics to the group with IOT. We analyzed the number of emergencies, inpatient admissions and length of hospital stay during a follow-up period of 6 months after the beginning of the judicial order in the IOT group or after hospital discharge in the control group. RESULTS: No significant differences were found between the IOT and the control group in hospital use (number of emergencies, inpatient admissions and mean length of hospital stay). CONCLUSIONS: These results question the efficacy of IOT to reduce the use of hospital services.

Psicosis cicloide: a propósito de un caso / Cycloid psychosis: apropos of a case

El concepto de psicosis cicloide se ha modificado con los años. A pesar de estos cambios conceptuales, en la actualidad este trastorno todavía conduce con cierta frecuencia a errores diagnósticos a causa de la dificultad que entraña su identificación clínica. En este artículo se presenta una breve revisión del concepto de psicosis cicloide. A continuación se expone el caso clínico de un paciente varón con varios ingresos en la Sala de Agudos del Hospital Clínico Universitario de Valencia, finalmente diagnosticado de psicosis cicloide (AU)

The concept of cycloid psychosis (CP) has been modified over the years. Despite these conceptual changes, at present this illness still often leads to diagnostic mistakes, due to the difficulty of its clinical identification. We present a brief review of the concept of CP and report the case of a male patient who was admitted several times to the Acute Unit of Hospital Clinico Universitario of Valencia and was finally diagnosed with CP (AU)

Sindrome de Diogenes: a proposito de un caso / Diogenes syndrome: apropos of a case

Introducción: El síndrome de Diógenes no está reconocido en los manuales diagnósticos internacionales como entidad diagnóstica y además puede aparecer en distintas enfermedades. Sin embargo el término ha tenido éxito y es utilizado con frecuencia, sobre todo, por los medios de comunicación. La prevalencia sería de 1,7/1.000 ingresos hospitalarios en mayores de 65 años. Clínica: Las personas afectadas por este síndrome presentan un descuido severo del autocuidado (higiene, alimentación y salud), se aíslan y abandonan el contacto con la sociedad. Viven entre gran suciedad doméstica y acumulan objetos y basura en la casa. Diagnóstico diferencial: La conducta de acumulación puede aparecer en el trastorno de personalidad obsesivo-compulsivo, en el coleccionismo o como otras causas. Tratamiento: En lo posible hay que evitar la hospitalización y se debe favorecer las medidas y el seguimiento ambulatorios. Los pacientes con este síndrome tienen un 46% de mortalidad en los 5 años siguientes. Caso clínico: Mujer de 67 años, que vive con su esposo y un hijo. Diagnosticada de esquizofrenia paranoide de más de 30 años de evolución y varios ingresos psiquiátricos, con seguimiento terapéutico irregular y que recibe el diagnóstico de síndrome de Diógenes. Discusión: El diagnóstico de síndrome de Diógenes podría informar de la situación psicosocial de la paciente, alertando del problema para que intervengan los servicios sociosanitarios y a la espera de hacer una evaluación diagnóstica

Introduction: Diogenes syndrome is not recognized in international diagnostic manuals as a diagnostic entity and can be present in several disorders. Nevertheless, the term Diogenes syndrome is frequently used in the media and other settings because of the social alarm it generates. The prevalence of this syndrome is 1.7/1000 hospital admissions in persons aged more than 65 years old. Clinical features: People with Diogenes syndrome show severe self-care deficit (hygiene, eating and health) and social isolation and usually live in domestic squalor surrounded by a clutter of objects and garbage. Differential diagnosis: Hoarding can be observed in obsessive-compulsive personality disorder, in collectionism, and in other disorders. Treatment: Hospitalization should be avoided when possible and outpatient treatment should be provided. Outcome: mortality among patients diagnosed with this syndrome is 46% within 5 years. Case report: A 67-year-old woman who lived with her husband and son and who had received a diagnosis of paranoid schizophrenia more than 30 years previously with various hospital admissions and irregular follow-up was diagnosed with Diogenes syndrome. Discussion: A diagnosis of Diogenes syndrome could provide information about the patient's psychosocial situation, alerting medical and social services to the need for intervention and evaluation

Tratamiento ambulatorio involuntario: opinión de las personas implicadas / Involuntary outpatient treatment: the views of those involved

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adhesión al tratamiento y, por tanto, prevenir el deterioro de las personas con enfermedad mental grave y el peligro para sí mismas y los demás. La aplicación del TAI no está exenta de polémica, con defensores que consideran que es una forma de conseguir la cumplimentación terapéutica, y opositores que encuentrar en este tipo de medidas una vulneración de los derechos fundamentales de la persona y que conllevan un aumento de la coerción y el estigma del paciente psiquiátrico. En este trabajo se ha realizado un estudio de carácter descriptivo que trata de recoger la opinión que tienen la personas implicadas en el TAI. La población de estudio está compuesta por todos los pacientes que estaban en tratamiento obligatorio ambulatorio en la ciudad de Valencia al inicio del estudio – octubre-, sus familiares y psiquiatras encargados de su seguimiento ambulatorio. En los resultados destaca que la gran mayoría de los psiquiatras y familiares (93-83%) opinan que el TAI ha sido beneficioso para el tratamiento del paciente, incluso se ha apreciado una mejoría global de la clínica tras su instauración. Respecto a la opinión de los pacientes, más de la mitad (54%) también consideran que el TAI es una medida beneficiosa para su tratamiento

Involuntary outpatient treatment (IOT) aims to improve compliance with treatment and so prevent the deterioration of patients with severe mental illness and reduce the risk to themselves and other people. IOT is not free of controversy. Those who defend it regard it as a way of ensuring that treatment is carried out, while opponents consider it a violation of the basic rights of the individual, leading to an increase in the coercion and stigmatisation of psychiatric patients. This article is a descriptive study, for which we have attempted to collect the opinions of people involved in IOT. The group studied was made up of all the patients in Involuntary Outpatient Treatment in the city of Valencia at the beginning of the project –October 2005-. Their reltives and their outpatient unit psychiatrists. The results show that the great majority of psychiatrists and relatives (93-83%) think that IOT has been beneficial for patient´s treatment. There has even been an overall clinical improvement since it was introduced. As for the opinion of the patients, over half of them (54%) also consider that IOT has been a beneficial measure for their treatment

Tratamiento ambulatorio involuntario para personas con trastorno mental severo. Resultados de un estudio en la ciudad de Valencia / Involuntary outpatient treatment for persons with severe mental illness. Results of a study in the city of Valencia, Spain

El tratamiento ambulatorio involuntario (TAI) es una forma de tratamiento no voluntario aplicado en la comunidad, que pretende asegurar el cumplimiento terapéutico en pacientes que sufren una enfermedad mental grave, sin conciencia de enfermedad y en los que el abandono del tratamiento supone un riesgo alto de recaída, con aparición de conductas disruptivas y violentas, así como hospitalizaciones repetidas y urgencias frecuentes. En este artículo se presentan los resultados de un estudio observacional-retrospectivo, realizado en la ciudad de Valencia sobre una población de 38 pacientes sometidos a esta medida de tratamiento judicializado. Describimos el diagnóstico psiquiátrico, quién solicita la medida y por qué motivo. Comparamos el número de urgencias e ingresos y la estancia media de los ingresos realizados en los 6 meses antes y después de la introducción de la autorización judicial. Finalmente, analizamos las incidencias acontecidas en este período

Involuntary outpatient treatment is non-voluntary treatment applied in the community to ensure therapeutic compliance in patients with severe mental illness and little insight, in whom noncompliance involves a high risk of relapse, with disruptive and violent behaviors, or frequent hospitalizations and emergency care. In this article we present the results of an observational, retrospective study in 38 patients undergoing involuntary outpatient treatment in the city of Valencia. We describe the psychiatric diagnosis, the persons seeking this treatment and the reasons for seeking it. We compare the number of emergencies and admissions and the average length of stay of admissions in the 6 months before and after the introduction of court authorization. Finally we analyze the events occurring during this period of time

Hidrocefalia normotensiva y síntomas psiquiátricos / Normal pressure hydrocephalus and psychiatric symptoms

La hidrocefalia normotensiva (HNT) es una enfermedad que se produce por una alteración en la circulación del líquido cefalorraquídeo, que provoca una dilatación ventricular sin un aumento de la presión intracraneal. La clínica típica es neurológica y es la causa más frecuente de demencia reversible, pero además de los síntomas cognitivos, que son casi constantes, se asocia con cierta frecuencia a enfermedad psiquiátrica, principalmente de carácter afectivo y psicótico. En este artículo, se hace una revisión de la bibliografía y se presenta un caso clínico de HNT que se inició con un cuadro psicótico, un síndrome de Ekbom, consistente en un delirio parasitario acompañado de alucinaciones táctiles y visuales zoomórficas. Posteriormente aparecieron la clínica neurológica: cefalea, alteraciones de la marcha, incontinencia de esfínteres y déficit cognitivo, entre otros. Aunque los síntomas delirantes y alucinatorios habían mejorado con tratamiento antipsicótico parenteral, la resolución total de la clínica se produjo tras la cirugía ventriculoperitoneal

Normal pressure hydrocephalus (NPH) is an abnormal accumulation of cerebrospinal fluid (CSF) that causes the ventricles in the brain to enlarge without increasing intracranial pressure. Typical symptoms are neurological, the most common of which is reversible dementia. However, there are also cognitive symptoms which are almost constant and are often associated with psychiatric disorders, usually of an affective or psychotic type. In this article we review the literature on the topic and report a case of NPH presenting with psychotic symptoms: Ekbom's syndrome accompanied by both tactile and visual hallucinations relating to invasion of the body by insects. The patient subsequently developed neurological symptoms consisting of headaches, gait disturbance, sphincter incontinence, and cognitive deficit, among others. Although the hallucinations decreased with parenteral antipsychotics, the symptoms were finally resolved by ventricular-peritoneal surgery

Tratamiento ambulatorio involuntario (TAI) para personas con enfermedad mental grave / Involuntary outpatient treatment for people with severe mental disorders

El tratamiento ambulatorio involuntario (TAI) pretende mejorar la adhesión al tratamiento y, por tanto, prevenir el deterioro de las personas con enfermedad mental grave y el peligro para sí mismas y los demás. Además de las posiciones manifestadas a favor y en contra con la introducción del TAI, los estudios publicados en la literatura médica obtienen también resultados contradictorios. La mayoría de los estudios observacionales encuentran una mejoría de los pacientes; sin embargo, las limitaciones metodológicas disminuyen la confianza en los resultados. Se han publicado 2 estudios aleatorizados en los que sólo se encuentra mejoría cuando la medida involuntaria se acompaña de servicios comunitarios de seguimiento intensivo. En este artículo se hace una revisión sobre el tema del TAI, incluida la situación actual en España

Involuntary outpatient treatment is believed to increase adherence, thereby preventing deterioration and harm to people with severe mental illness or to others. Involuntary treatment remains controversial. In addition to arguments for and against the introduction of involuntary outpatient treatment, the results of published studies are contradictory. Most observational studies report patient improvement, although methodological limitations cast doubt on these results. Two randomized studies suggest that outpatient commitment is only effective when linked to the provision of intensive community services. In this article we review this topic, including the current situation in Spain