Burden and satisfaction experienced in relatives and patients during home hospitalisation in psychiatry.

The role of caregivers is essential during home hospitalization since they act as co-therapists, being the level of responsibility experienced by them higher than usual.

Sobrecarga experimentada y satisfacción en familiares y pacientes durante una hospitalización domiciliaria en psiquiatría / Burden and satisfaction experienced in relatives and patients during home hospitalisation in psychiatry

Introducción: El rol de los cuidadores es esencial durantela hospitalización domiciliaria ya que ejercen de coterapeutas,siendo el nivel de responsabilidad que experimentan mayora la habitual. El objetivo de este estudio es evaluar lasobrecarga experimentada en los cuidadores principalesy también determinar el nivel de satisfacción percibida enlos cuidadores principales y en los pacientes atendidos ennuestra unidad de hospitalización domiciliaria (HADMar).Metodología. Estudio prospectivo observacional. Se hanincluido todos los pacientes que han ingresado en HADMarentre mayo de 2020 y abril de 2021. Se han recogido datossocio-demográficos y clínicos de la muestra. Para evaluar elgrado de sobrecarga se ha utilizado la escala de Zarit al finaldel ingreso en los cuidadores principales. Para determinar lasatisfacción percibida se ha administrado la escala CRES-4 alfinal del ingreso tanto a los cuidadores como a los pacientesatendidos.Resultados. 182 pacientes han sido atendidos. Del total,144 cuidadores principales han respondido la escala de Zarit,siendo la puntuación media de 49,59 (correspondiente asobrecarga ligera). 152 cuidadores han respondido la escalaCRES-4, obteniendo una puntuación media de 241,75 (sobreun máximo posible de 300). 158 pacientes han respondido laescala CRES-4 y la puntuación media ha sido 242,57. (AU)

Introduction: The role of caregivers is essential duringhome hospitalization since they act as co-therapists, beingthe level of responsibility experienced by them higher thanusual. The objective of this study is to evaluate the burdenexperienced in the main caregivers and also to determine thelevel of satisfaction perceived in the main caregivers and in thepatients attended in our home hospitalization unit (HADMar).Methodology. Prospective observational study. Allpatients admitted to HADMar between May 2020 and April2021 have been included. Socio-demographic and clinicaldata have been collected from the sample. To assess thedegree of burden, the Zarit scale was used at the end ofadmission in the main caregivers. To determine the perceivedsatisfaction, the CRES-4 scale was administered at the end ofadmission to both the caregivers and the patients attended.Results. 182 patients have been attended. Of them, 144main caregivers answered the Zarit scale, being the meanscore 49.59 (corresponding to mild burden). 152 caregivers answered the CRES-4 scale, obtaining a mean score of241.75 (out of a possible maximum of 300). 158 patientsanswered the CRES-4 scale and the mean score was 242.57. (AU)

Unidad de hospitalización domiciliaria en Barcelona: resultados clínicos y funcionales después de tres años de experiencia / No disponible

No disponible

Unidad de Hospitalización Domiciliaria del Hospital del Mar. Equipo de atención psiquiátrica domiciliaria en el área de Barcelona / Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona

Introducción: A pesar del desarrollo de la hospitalización domiciliaria en España durante los últimos años, es llamativa la escasez de literatura. El siguiente estudio pretende exponer los datos obtenidos por la Unidad de Hospitalización a Domicilio de Psiquiatría del Hospital del Mar (HADMar). HADMar es un programa de hospitalización domiciliaria creado hace 2años, que recibe pacientes procedentes de servicios comunitarios y hospitalarios con un seguimiento limitado en el tiempo. Al alta, el paciente es derivado a la unidad de referencia ambulatoria apropiada para cada caso. Material y métodos: Se seleccionó a todos los pacientes visitados desde 2015 hasta la actualidad. Se llevó a cabo un estudio descriptivo que define las características sociodemográficas de la muestra. Las variables clínicas estudiadas fueron la gravedad de los síntomas, el riesgo de suicidio y los cambios en la funcionalidad. Resultados: Un total de 135 pacientes fueron incluidos en la muestra. La edad media de los pacientes fue de 44,6 años y no hubo diferencias entre ambos sexos. De ellos, 26 pacientes tenían un historial de intentos autolíticos y el 11,1% vivían solos. El 51,1% fueron diagnosticados de un trastorno psicótico. La puntuación media en la escala GEP en la variable gravedad de los síntomas psiquiátricos fue 2,39 y el riesgo medio de suicidio 0,49. La puntuación de EEAG al alta era mayor que al ingreso. Conclusiones: Los resultados obtenidos en nuestro estudio son consistentes con resultados reportados en estudios previos. Los equipos de hospitalización domiciliaria han demostrado ser una alternativa a la hospitalización tradicional. Sin embargo, se necesitan más estudios que apoyen estos resultados

Introduction: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. Material and methods: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. Results: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. Conclusions: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results

Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona. / Unidad de Hospitalización Domiciliaria del Hospital del Mar. Equipo de atención psiquiátrica domiciliaria en el área de Barcelona.

INTRODUCTION: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. MATERIAL AND METHODS: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. RESULTS: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. CONCLUSIONS: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.

Systematic review of depression in patients with multiple sclerosis and its relationship to interferonß treatment.

BACKGROUND: Multiple sclerosis is a chronic disease considered the major cause of neurological disability in young adults worldwide. While depression is considered a determinant factor of impaired quality of life and poorer prognosis among patients with multiple sclerosis, it is very often dismissed and undertreated by physicians. Depression has been related to treatment with some immunomodulatory drugs, such as IFNß. Data from patients who committed suicide during the pivotal study of interferon used as a disease modifying treatment in multiple sclerosis support this association. Moreover, there is plenty of evidence of neuropsychiatric toxicity caused by the use of IFNα as a treatment for other medical conditions. Although this link still remains relatively unknown, the presence of warnings regarding the possible relationship between depression and IFNß led to restriction in medical indications in these patients. The purpose of this paper is to try to understand the reasons for an increased prevalence in depression in multiple sclerosis and to examine the impact that IFNß treatment has on their mood. METHODS: We performed a literature search on MEDLINE and Google Scholar databases applying PRISMA guidelines for systematic reviews. Studies were included if the participants were diagnosed with MS and prescribed IFNß as the main treatment. We excluded non-english and full-text non available papers, as well as the articles where mental health was assessed exclusively as a feature of quality of life. The sample includes articles from 1980 to 2014, although filtration by year of publication was not applied and contains data from IFNß-1a and IFNß-1b. The Cochrane Collaboration Tool assessing risk of bias was used to determine the quality of the studies. RESULTS: Ten studies met full criteria for inclusion and final data extraction. The articles have heterogeneity regarding the samples, the methodology used and the expression of the results. Only three studies support the evidence of a relationship between depression and interferon, which is statistically significant in some patients at the beginning of the treatment. They suggest that only patients on IFNß treatment with a past history of depression may develop a major depression episode during the first six months. The remaining articles reviewed (including BENEFIT, BEYOND, and LTF trials) suggest the absence of an association. CONCLUSION: The reviewed studies conclude that there is not a clear relationship between IFNß and depression. A history of depression is a risk factor for developing depression during the first 6 months of treatment, nevertheless, it is not sufficient to contraindicate it. The development of new strategies is crucial for early detection of depressive symptoms. An adequate treatment can both improve the mood and deal with the neurological disease by increasing treatment adherence and interfering with inflammation. Chronic destructive brain changes and serotonergic depletion due to inflammatory factors have been proposed as the underlying cause of depression in these patients. It is suggested that these patients would have fewer functional reserve remaining to deal with stressful life events, which could precipitate a depressive disorder.

Systematic assessment of environmental risk factors for bipolar disorder: an umbrella review of systematic reviews and meta-analyses.

OBJECTIVES: The pathophysiology of bipolar disorder is likely to involve both genetic and environmental risk factors. In our study, we aimed to perform a systematic search of environmental risk factors for BD. In addition, we assessed possible hints of bias in this literature, and identified risk factors supported by high epidemiological credibility. METHODS: We searched the Pubmed/MEDLINE, EMBASE and PsycInfo databases up to 7 October 2016 to identify systematic reviews and meta-analyses of observational studies that assessed associations between putative environmental risk factors and BD. For each meta-analysis, we estimated its summary effect size by means of both random- and fixed-effects models, 95% confidence intervals (CIs), the 95% prediction interval, and heterogeneity. Evidence of small-study effects and excess of significance bias was also assessed. RESULTS: Sixteen publications met the inclusion criteria (seven meta-analyses and nine qualitative systematic reviews). Fifty-one unique environmental risk factors for BD were evaluated. Six meta-analyses investigated associations with a risk factor for BD. Only irritable bowel syndrome (IBS) emerged as a risk factor for BD supported by convincing evidence (k=6; odds ratio [OR]=2.48; 95% CI=2.35-2.61; P<.001), and childhood adversity was supported by highly suggestive evidence. Asthma and obesity were risk factors for BD supported by suggestive evidence, and seropositivity to Toxoplasma gondii and a history of head injury were supported by weak evidence. CONCLUSIONS: Notwithstanding that several environmental risk factors for BD were identified, few meta-analyses of observational studies were available. Therefore, further well-designed and adequately powered studies are necessary to map the environmental risk factors for BD.

Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.

Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.

Controversias sobre los niveles plasmáticos de clozapina: revisión a propósito de un caso / Controversies regarding plasmatic levels of clozapine: review and a case report

La clozapina es el fármaco de primera elección en el manejo de la esquizofrenia resistente al tratamiento, y no existe ninguna alternativa terapéutica que haya demostrado mayor eficacia en estos pacientes. Por ello es importante optimizar el tratamiento con clozapina en la esquizofrenia resistente. Una de las herramientas clínicas de las que se dispone es la monitorización de los niveles plasmáticos del fármaco, ya que permite asegurar que el paciente está dentro del rango terapéutico y disminuye el riesgo de efectos adversos. La evidencia disponible concluye en establecer un límite inferior alrededor de los 350 ng/ml. Sin embargo, la cuestión del límite superior del intervalo es más compleja y no existe un acuerdo sobre la concentración sanguínea de clozapina que se asocia a toxicidad. Presentamos un caso clínico de un paciente con esquizofrenia resistente en tratamiento con clozapina, en el cual la monitorización de niveles plasmáticos pudo influir en las decisiones terapéuticas (AU)

Clozapine should be considered as first-line treatment in individuals with a diagnosed treatment-resistant schizophrenia. Despite alternative treatments and augmentation strategies available, there is no consistent evidence that none of these options produce substantive clinical gains when clozapine-treated patients demonstrate a suboptimal clinical response. It is therefore important that we optimize clozapine treatment in these patients. One of the clinical tools to assist in this has been therapeutic drug monitoring of plasmatic levels, because it provides drug concentrations associated with highest probability of response and a low risk of side effects. A number of studies have addressed the therapeutic range of clozapine's plasmatic level, and reviews of this topic have generally agreed that the lower threshold is around 350 ng/ml. In contrast, the issue of an upper threshold is more complex and there is no agreed for an upper limit associated with clozapine toxicity. We report a case of a patient with the diagnosis of treatment-resistant schizophrenia treated with clozapine in which we think that therapeutic drug monitoring of clozapine plasmatic could influence treatment decisions (AU)

Síndrome neuroléptico maligno con mínima elevación de creatina cinasa: breve revisión a propósito de un caso / Neuroleptic malignant syndrome with slight elevation of creatine kinase in serum: a brief review

No disponible

Management of adverse effects of mood stabilizers.

Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

Leucopenia y neutropenia de rápida evolución inducidas por olanzapina / Leucopenia and neutropenia rapidly evolving induced by olanzapine

Algunos antipsicóticos se asocian a discrasias sanguíneas. El psicofármaco que más produce agranulocitosis es la clozapina (0,5-2% de los pacientes). La olanzapina es un antipsicótico de segunda generación con estructura química similar a la clozapina que tiene un riesgo de leucopenia/neutropenia de 1/10.000 pacientes tratados. Presentamos el caso de un paciente de 32 años sin antecedentes somáticos ni psiquiátricos, hospitalizado por un primer episodio psicótico. En la analítica previa al ingreso no había alteraciones en el hemograma (leucocitos totales 8,92x103/ul, neutrófilos totales 6,99x103/ul). A los tres días de haber iniciado tratamiento con olanzapina 20mg/día el recuento leucocitario había disminuido a 2,46x103/ul (neutrófilos totales 0,64x103/ ul). Tras sustituir la olanzapina, inicialmente por risperidona y posteriormente por zuclopentixol intramuscular, el recuento leucocitario fue aumentando progresivamente. A los doce días de la retirada, el hemograma se había normalizado (leucocitos totales 5,73x103/ul) (AU)

Some antipsychotics drugs are associated with blood dyscrasias. The psychotropic medication most frequently associated with agranulocytosis is clozapine (0,5-2% of patients). Olanzapine is a second-generation antipsychotic with a chemical structure similar to clozapine, with a risk of neutropenic reactions of 1/10.000 treated patients. We report the case of a 32-yearold man without medical or psychiatric records, who was admitted due to a first psychotic episode. In a blood test previous to hospitalization, complete blood cell count was normal (white blood cell count 8,92x103/ul, neutrophilic count 6,99x103/ul). Three days after initiation of olanzapine 20mg/day, WBC count had fallen to 2,46x103/ul (neutrophilic count 0,64x103/ul). After replacing olanzapine, initially for risperidone and later for intramuscular zuclopentixol, WBC count gradually increased. On the twelfth day of olanzapine withdrawal, complete blood cell count had normalized (WBC count 5,73x103/ul) (AU)