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.

The influence of the mass media on delusions: The Russia-Ukraine war as a delusional topic.

We present the case of a 42-year-old female patient with a diagnosis of schizophrenia who, 24 hours after the onset of the Russian invasion of Ukraine, developed a delirium on this topic. This case report illustrates how current news is processed by psychotic patients. Relevant current events can be incorporated into delusional themes due to the intensity and immediacy of information by the media.

A cycloid psychosis relapse and SARS-CoV-2 concomitant infection.

N/A.

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.

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.

Early intervention services, patterns of prescription and rates of discontinuation of antipsychotic treatment in first-episode psychosis.

AIMS: Non-compliance is still an important problem in psychotic patients. Although antipsychotic (AP) treatment leads to a decrease in psychotic relapses, there are no clear recommendations about how long treatment should be maintained after first-episode psychosis (FEP) and no indication of the rates and causes of treatment withdrawal in this group. METHODS: We evaluated a large sample of patients with FEP for 2 years to compare the time to all-cause treatment discontinuation of AP drugs and the time to the first relapse. We collected the sociodemographic and psychopathological characteristics of the sample. The number of relapses was also recorded. RESULTS: A total of 310 FEP patients were assessed across seven early intervention teams (mean age = 30.2 years; SD = 11.2). The most prevalent diagnosis at baseline was psychotic disorder not otherwise specified (36.1%), and the most commonly used APs were risperidone (26.5%) and olanzapine (18.7%). A lack of efficacy was the most frequent reason for the withdrawal of the first AP prescribed, followed by non-compliance. There were no differences in the relapse rates between different APs. Patients treated with long-acting injectable (LAI) APs presented less disengagement from services than patients treated with oral APs. CONCLUSIONS: Although there were no differences between the different APs in terms of relapse rates, LAIs had higher retention rates than oral APs in early intervention services. Compliance is still an important issue in Psychiatry, so clinicians should use different strategies to encourage it, such as the use of LAI treatments.

Coronovirus infection as a novel delusional topic.

Delusional topics tend to rapidly incorporate popular hot topical issues. Thus, the current coronavirus COVID-19 pandemic has rapidly reached delusional themes in patients with psychiatric disorders. Here we present the clinical case of a Spanish woman with bipolar disorder that included coronavirus infection in her delusional themes even faster than the real infection reached mainland Spain.

Diagnostic stability of schizophrenia: A systematic review.

The objective is to systematically review previous literature on the diagnostic stability of schizophrenia, particularly to investigate prospective and retrospective consistency. We carried out a systematic literature search in PubMed and other minor sources from 1980 to July 2017. Specifically, prospective and retrospective consistency were examined. Thirty-nine studies were included, 5 focused on schizophrenia, 23 on psychotic episodes and 11 on psychiatric disorders in general. Samples sizes range from 60 to 10 058 subjects (total N = 39 965). The majority of studies (n = 26, 66.67%) were performed in Europe and North America and they had a prospective design (n = 27, 69.23%), with a median follow-up of 3 years. Prospective and retrospective consistency means were 84.29% and 67.15% respectively. Diagnostic change was also frequently measured (n = 12, mean 31.28%). The factors more commonly associated with diagnostic stability were: male sex, older age at the study inception, older age at onset, late stages of illness, family history of mental illness, poorer functioning and longer length of stay. Schizophrenia was found to have high diagnostic stability over time, although research on this topic is mainly focused in first psychotic episodes. More standardized methods are needed to further research diagnostic stability of schizophrenia over time and its determinants.

Diagnostic Stability in Bipolar Disorder: A Narrative Review.

LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate diagnostic stability in bipolar disorder• Analyze the factors contributing to diagnostic stability OBJECTIVE: Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay. METHODS: A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form. RESULTS: Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability. CONCLUSIONS: Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.

Ecological Assessment of Clinicians' Antipsychotic Prescription Habits in Psychiatric Inpatients: A Novel Web- and Mobile Phone-Based Prototype for a Dynamic Clinical Decision Support System.

BACKGROUND: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management. OBJECTIVE: The aim of our study was to develop a novel Web- and mobile phone-based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes. METHODS: We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio. RESULTS: MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines. CONCLUSIONS: MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.

Prolonged social withdrawal disorder: a hikikomori case in Spain.

BACKGROUND: The Japanese term hikikomori means literally 'to be confined'. Social withdrawal can be present in severe psychiatric disorders; however, in Japan, hikikomori is a defined nosologic entity. There have been only a few reported cases in occidental culture. MATERIAL: We present a case report of a Spanish man with prolonged social withdrawal lasting for 4 years. DISCUSSION: This is a case of prolonged social withdrawal not bound to culture, as well as the second case of hikikomori reported in Spain. We propose prolonged social withdrawal disorder as a disorder not linked to culture, in contrast to hikikomori. CONCLUSION: Further documentation of this disorder is still needed to encompass all cases reported in Japan and around the world.

Randomized trial of clozapine vs. risperidone in treatment-naïve first-episode schizophrenia: results after one year.

In first-episode patients with psychosis, clozapine may be potentially valuable as an initial treatment seeking to limit early on clinical and cognitive deterioration. Nevertheless, until recently its restricted use has limited the study of this possibility. Our research group is developing a non-commercial, multicentric and open label study on the differential efficacy between clozapine and risperidone in first-episode schizophrenia. In this paper, we present the results related to clinical variables after a one-year follow-up. So far, we have recruited 30 patients diagnosed with schizophrenia or schizophreniform disorder with illness duration of less than two years. The patients had not received any previous treatment and they were randomized to treatment with clozapine or risperidone. Our results indicate that on average, patients on clozapine adhered to their original treatment for a longer time period than patients on risperidone. By last observation carried forward (LOCF) analysis, patients on clozapine and risperidone displayed similar clinical improvements, although marginally greater improvements in positive and total symptoms scores were found in the clozapine group. At the 12-month point we observed a marginal improvement in negative symptom scores in patients on clozapine. Subjective secondary effects, as measured with the Udvalg for KliniskeUndersøgelser (UKU) scale, correlated negatively with negative symptoms at follow-up. Our data, although preliminary, suggest that clozapine may have a slightly superior efficacy in the initial year of treatment of first-episode treatment-naïve patients with schizophrenia, and this can be explained for the most part by greater adherence to this treatment.

[Early detection of hypomania episodes in patients with affective disorder]. / Detección precoz de episodios de hipomanía en pacientes con trastorno afectivo.

INTRODUCTION: Bipolar disorder (BP) is one of the major causes of disability in the world. Epidemiological studies suggest that this disorder could be under-diagnosed owing to the difficulty in detecting hypomania episodes. The detection of present and past episodes of hypomania could help in the diagnosis and appropriate treatment of this disorder. The Hypomania Check List (HCL-32) is a questionnaire validated into Spanish and designed to detect past and present hypomania episodes in the psychiatric patient population. MATERIAL AND METHODS: A total of 128 patients over 18 years old and diagnosed with type I bipolar (BP-I) disorder (n=1), type II bipolar (BP-II) disorder (n=30), major depression (MD) (n=57), anxiety disorders (AD) (n=15) were selected, along with a control group (C) (n=25). The patients were diagnosed according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IVTR). Screening for hypomania episodes was carried out by applying the HCL-32 scale. RESULTS: The area under the ROC curve was 0.65 with a 95% confidence interval (CI) of 0.55-0.75. The chosen cut-off point of the HCL-32 was 15. The values for the sensitivity (Se), specificity (Sp), positive predictive values (PPV) and negative predictive values (NPV), and the prevalence (P) of hypomania episodes in the patients of the UP depression, for a cut-off point of 15 were: Se =71.4%, 95% CI; 57.8, 85.1, Sp =45.8%, 95% CI; 34.5-57.1, PPV=43.75%, 95% CI; 32.25-55.25), NPV:73.08%, 95% CI; 60.06-86.09) and P=67.2%. CONCLUSIONS: The HCL-32 is a very sensitive, but not very specific, screening tool. This could partly explain the high proportion of hypomania episodes detected in our sample. Unlike previous studies, our sample is heterogeneous (from different environments) and at a more severe and unstable clinical level. Future research should develop more specific measuring tools, and with greater external validation, for hypomania episodes.