Coexistence of different delusional misidentification syndromes in clinical practice: A case series.

OBJECTIVE: The objective of this study is to analyse the coexistence of several delusional misidentification syndromes in a clinical sample. METHODS: Over one year, a sample of six patients presenting two or more types of delusional misidentification syndromes was selected. All these patients were admitted to the psychiatric inpatient unit of a Spanish hospital. RESULTS: Despite the different diagnoses, the patients included presented different types of delusional misidentification syndromes, both hyperidentification and hypoidentification. Antipsychotic treatment was not very effective against these delusional misidentification syndromes. CONCLUSIONS: The coexistence of several delusional misidentification syndromes indicates that the aetiopathogenesis of the different types is similar. It is a field with important clinical implications, due to the poor response to treatment, as well as the possible medico-legal implications.

Coexistencia de distintos síndromes de falsos reconocimientos delirantes en la práctica clínica: serie de casos

Objetivo: El objetivo de este estudio es analizar la coexistencia de varios síndromes de falsos reconocimientos delirantes en una muestra clínica. Métodos: A lo largo de 1 ano, se seleccionó una muestra de 6 pacientes con 2 o más tipos de falsos reconocimientos delirantes durante el mismo episodio. Todos ellos se encontraban hospitalizados en la unidad de hospitalización psiquiátrica en un hospital de España. Resultados: A pesar de los distintos diagnósticos, los pacientes incluidos presentaban diferentes tipos de falsos reconocimientos delirantes, tanto de hiperidentificación como de hipoidentificación. El tratamiento antipsicótico fue escasamente eficaz contra estos síndromes de falsos reconocimientos delirantes. Conclusiones: La coexistencia de varios síndromes de falsos reconocimientos delirantes indica que la etiopatogenia de los distintos tipos es similar. Se trata de un campo con importantes implicaciones tanto clínicas, por la baja respuesta al tratamiento, como las posibles médico-legales.

Objective: The objective of this study is to analyze the coexistence of several delusional misidentification syndromes in a clinical sample. Methods: Over one year, a sample of six patients presenting two or more types of delusional misidentification syndromes was selected. All these patients were admitted to the psychiatric inpatient unit of a Spanish hospital. Results: Despite the different diagnoses, the patients included presented different types of delusional misidentification syndromes, both hyperidentification and hypoidentification. Antipsychotic treatment was not very effective against these delusional misidentification syndromes Conclusions: The coexistence of several delusional misidentification syndromes indicates that the aetiopathogenesis of the different types is similar. It is a field with important clinical implications, due to the poor response to treatment, as well as the possible medico-legal implications.

Comparative study of the pencil-and-paper and digital formats of the Spanish DARS scale.

The Dimensional Anhedonia Rating Scale (DARS) is a novel questionnaire to assess anhedonia of recent validation. In this work, we aim to study the equivalence between the traditional paper-and-pencil and the digital format of DARS. Sixty-nine patients filled the DARS in a paper-based and digital versions. We assessed differences between formats (Wilcoxon test), validity of the scales [Kappa and intraclass correlation coefficients (ICCs)], and reliability (Cronbach's alpha and Guttman's coefficient). We calculated the comparative fit index and the root mean squared error (RMSE) associated with the proposed one-factor structure. Total scores were higher for paper-based format. Significant differences between both formats were found for three items. The weighted Kappa coefficient was approximately 0.40 for most of the items. Internal consistency was greater than 0.94, and the ICC for the digital version was 0.95 and 0.94 for the paper-and-pencil version (F = 16.7, p < 0.001). Comparative Adjustment Index was 0.97 for the digital DARS and 0.97 for the paper-and-pencil DARS, and RMSE was 0.11 for the digital DARS and 0.10 for the paper-and-pencil DARS. We concluded that the digital DARS is consistent in many respects with the paper-and-pencil questionnaire, but equivalence with this format cannot be assumed without caution.

Comparative study of paper-and-pencil and electronic formats of the Snaith-Hamilton Pleasure Scale.

The gold standard for measuring anhedonia is the Snaith-Hamilton Pleasure Scale (SHAPS). To date, there are no validated electronic versions of this questionnaire. We aim to study the equivalence between the traditional paper-and-pencil format and a digital version of the SHAPS. A group of 67 patients completed both SHAPS formats, and differences between formats were assessed. McNemar's test showed no significant differences between the two systems. The Kappa coefficient was over 40% for most items, and reliability was above 0.8, showing good to excellent levels of internal consistency. Thus, we have demonstrated a close equivalence between paper-and-pencil and electronic SHAPS.

Diagnostic Stability in Bipolar Disorder: A Follow-up Study in 130,000 Patient-Years.

Objective: Diagnostic stability is the degree to which a diagnosis remains unchanged during time. Our main objective was to evaluate the diagnostic stability of bipolar disorder (BD) in psychiatric outpatient consultations and determine the socio-demographic variables influencing its stability.Methods: The Cumulative Register of Cases of the Community of Madrid provided data on all outpatient visits conducted at Madrid's Community Mental Healthcare Centers between 1980-2009. Diagnoses were made according to ICD-9/ICD-10 criteria. Two indices were measured: temporal consistency (maintenance of the diagnosis over time) and diagnostic constancy (presence of BD diagnosis in at least 75% of visits). κ coefficient measured the agreement between diagnoses in the first and last evaluations (prospective and retrospective consistency).Results: 14,557 patients were diagnosed with BD for at least 1 evaluation and had at least 10 visits and 1 year of follow-up. At first evaluation, 3,988 patients were diagnosed with BD (prospective consistency 50.8%), and at last evaluation 5,396 patients were diagnosed with BD (retrospective consistency 37.5%). A total of 2,026 patients were diagnosed with BD at their first and last evaluations (prospective consistency 18.3%).Conclusions: This longitudinal study conducted in community mental health centers reflects common diagnostic practices in outpatient settings over a 30-year period (130,000 patient-years). Delay of > 10 years was found to achieve diagnostic stability. Frequent diagnostic shifts were found in relation to BD, the most common being with other affective disorders. Anxiety was also a common misdiagnosis. Greater stability was associated with having been diagnosed after hospitalization, having an age at onset > 25 years, and having an age at diagnosis < 24 years.

Coexistence of Different Delusional Misidentification Syndromes in Clinical Practice: A Case Series. / Coexistencia de distintos síndromes de falsos reconocimientos delirantes en la práctica clínica: serie de casos.

OBJECTIVE: The objective of this study is to analyse the coexistence of several delusional misidentification syndromes in a clinical sample. METHODS: Over one year, a sample of six patients presenting two or more types of delusional misidentification syndromes was selected. All these patients were admitted to the psychiatric inpatient unit of a Spanish hospital. RESULTS: Despite the different diagnoses, the patients included presented different types of delusional misidentification syndromes, both hyperidentification and hypoidentification. Antipsychotic treatment was not very effective against these delusional misidentification syndromes CONCLUSIONS: The coexistence of several delusional misidentification syndromes indicates that the aetiopathogenesis of the different types is similar. It is a field with important clinical implications, due to the poor response to treatment, as well as the possible medico-legal implications.

Clinical Note: Bipolar disorder in Cerebrotendinous Xanthomatosis: a case report.

Cerebrotendinous X anthomatosis (CTX) is a rare autosomal recessive disorder presenting with possible psychiatric manifestations that, once established, are difficult to control. We present the case of a 29-year-old woman diagnosed with CTX who developed bipolar disorder. Owing to difficulties in pharmacological management, the patient underwent electroconvulsive therapy (ECT), which lead to a favorable outcome. Little is known about the treatment of psychiatric symptoms of CTX, un uncommon disorder, though ECT may be an effective and safe approach.

Nota Clínica: Trastorno bipolar en xantomatosis cerebrotendinosa: a propósito de un caso / Clinical Note: Bipolar disorder in Cerebrotendinous Xanthomatosis: a case report

La xantomatosis cerebrotendinosa (XCT) es una rara enfermedad autosómica recesiva que puede cursar con manifestaciones psiquiátricas cuyo tratamiento puede resultarcomplejo. Presentamos el caso de una mujer de 29 años, diagnosticada de XCT, que desarrolló un trastorno bipolar queno respondió a tratamiento farmacológico, precisando terapia electroconvulsiva (TEC), cuyo resultado fue positivo. Alser la XCT una enfermedad rara, existe poca evidencia sobreel abordaje farmacológico de la sintomatología psiquiátricaque puede aparecer en el curso de la enfermedad. En estesentido, planteamos que la TEC pueda ser una opción de tratamiento segura y eficaz. (AU)

Cerebrotendinous X anthomatosis (CTX) is a rare autosomal recessive disorder presenting with possible psychiatricmanifestations that, once established, are difficult to control. We present the case of a 29-year-old woman diagnosedwith CTX who developed bipolar disorder. Owing to difficulties in pharmacological management, the patient underwentelectroconvulsive therapy (ECT), which lead to a favorableoutcome. Little is known about the treatment of psychiatricsymptoms of CTX, un uncommon disorder, though ECT maybe an effective and safe approach. (AU)

Early administration of aripiprazole long-acting injectable in acute inpatients with schizophrenia: a clinical report.

Fifty-one patients suffering an acute episode of schizophrenia and treated with aripiprazole long-acting injectable (ALAI) were chosen to elaborate an observational study in two in-patient units in Spain, in order to examine the effects of early administration during a hospital admission. When treatment with ALAI is administered in the first week of admission (in 31 patients, 60.78%), hospitalization time is significantly reduced, 12.1 days on average. It can be concluded that ALAI is an effective treatment for these patients. Analysis in economic terms and comparison with other LAI antipsychotics are interesting lines for further research.

Feasibility of a Virtual Reality-Based Psychoeducational Tool (VRight) for Depressive Patients.

E-health is opening new prospects in the management of mental disorders. Virtual reality (VR)-based interventions, which provide a safe nonjudging environment, may improve symptoms awareness in patients with depressive disorders. This study aimed to explore the feasibility of a novel VR software, the VRight, in depressive patients. Adult outpatients with depressive disorders presenting to our mental health clinic during December 2018 were invited to participate in the study. Participants completed a satisfaction survey at the end of the session, including questions about user-friendliness and about usefulness of the software. The Patient Health Questionnaire-9 (PHQ-9) was administered to participants before and after the VR-based intervention to assess depressive symptoms severity. We explored the correlation between the score difference and the variables: age, gender, and initial score. Twenty-eight patients (71.4 percent women, mean age: 51.18 ± 16.13 years) were recruited. Thirteen subjects had major depressive disorder (46.4 percent). Most of the patients (n = 26) were satisfied with the VR experience, which they found to be helpful. PHQ-9 score difference and the initial score correlated positively at a significant level. There was no significant correlation between score difference and age or gender. VRight was well accepted among depressive patients, showing high levels of satisfaction. The VRight could contribute to increase depressive symptoms awareness, which is of clinical relevance given the association of greater insight with positive outcomes in depression. Further studies are needed to confirm the effectiveness of VRight as a psychoeducational tool in clinical practice.

Spanish adaptation of the Dimensional Anhedonia Rating Scale (DARS).

BACKGROUND: Anhedonia is defined as the lack of enjoyment, engagement in, or energy for life's experiences. Only two scales to measure anhedonia have been adapted for use in Spanish-speaking populations. The aim of this study was to determine the reliability and validity of the Dimensional Anhedonia Rating Scale (DARS) following translation and adaptation for Spanish population. METHOD: The study sample included 134 patients over 18 years of age with a range of psychiatric diagnoses. Those with substance use, decompensated medical conditions, illiteracy, or lack of fluency in Spanish were excluded. The structure of the Spanish adaptation was evaluated through factor analysis. Internal reliability was assessed through Cronbach's alpha and validity was measured using Pearson's correlation between total scores for DARS and its subscales and SHAPS score. RESULTS: A strong internal consistency was observed (Cronbach alpha = 0.92 for total scale score and 0.91-0.92 for subscale scores). Similarly, a significant and strong correlation between total scores for DARS and SHAPS was found (r = 0.51, p < 0.01). LIMITATIONS: The heterogeneous distribution of diagnoses included in the study may limit our results. CONCLUSIONS: The Spanish DARS maintains the psychometric properties of the original questionnaire, with strong internal consistency and adequate validity. DARS is a specific questionnaire for evaluating anhedonia, incorporating elements that reflect motivation, interest, and effort, and one which offers possible advantages over other anhedonia scales.