Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders.

INTRODUCTION: Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. METHODS: Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). RESULTS: Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. CONCLUSIONS: Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.

Ag2 S Biocompatible Ensembles as Dual OCT Contrast Agents and NIR Ocular Imaging Probes.

Ag2 S nanoparticles (NPs) emerge as a unique system that simultaneously features in vivo near-infrared (NIR) imaging, remote heating, and low toxicity thermal sensing. In this work, their capabilities are extended into the fields of optical coherence tomography (OCT), as contrast agents, and NIR probes in both ex vivo and in vivo experiments in eyeballs. The new dual property for ocular imaging is obtained by the preparation of Ag2 S NPs ensembles with a biocompatible amphiphilic block copolymer. Rather than a classical ligand exchange, where surface traps may arise due to incomplete replacement of surface sites, the use of this polymer provides a protective extra layer that preserves the photoluminescence properties of the NPs, and the procedure allows for the controlled preparation of submicrometric scattering centers. The resulting NPs ensembles show extraordinary colloidal stability with time and biocompatibility, enhancing the contrast in OCT with simultaneous NIR imaging in the second biological window.

Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors.

OBJECTIVE: Poor insight is a major problem in psychosis, being detrimental for treatment compliance and recovery. Previous studies have identified various correlates of insight impairment, mostly in chronic samples. The current study aimed to determine clinical, neurocognitive, metacognitive, and socio-cognitive predictors of insight in first-episode psychosis. METHODS: Regression analyses of different insight dimensions were conducted in 190 patients with first-episode psychosis. Measures of clinical symptoms, neurocognition, metacognition, social cognition, and 'jumping to conclusions' bias were entered as predictors. RESULTS: Delusions, disorganisation, and certain negative symptoms were associated with unawareness in various domains, while depression was associated with greater awareness of illness. Deficit in theory of mind and self-reflective processes, as well as a 'jumping to conclusions' bias, contributed to poor insight. Several neuropsychological scores also contributed to this but their contribution was no longer observed in regression analyses that included all the previously identified clinical and cognitive predictors. A measure of perseverative errors was still associated with unawareness and misattribution of symptoms. CONCLUSION: In models that account for 28 % to 50 % of the variance, poor insight in first-episode psychosis is mainly associated with delusions and certain negative symptoms. At the cognitive level it does not appear to result from neuropsychological impairment but rather from altered reasoning bias and dysfunction in metacognitive processes. Therapeutic strategies specifically directed at these mechanisms could help improve the evolution of insight in first episode psychosis.

Exploring the relationship of insight with psychopathology and gender in individuals with schizophrenia spectrum disorders with structural equation modelling.

To model the influence of psychopathology on insight deficits in schizophrenia spectrum patients with a gender-stratified analysis. Five hundred sixteen patients (65.1% men) with schizophrenia spectrum disorders were evaluated in four centres of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using different PANSS factors. Insight and its three main dimensions were assessed by means of the Scale of Unawareness of Mental Disorder: awareness of the disease (SUMD-1), of the effect of medication (SUMD-2) and of the social consequences of the disease (SUMD-3). Structural equation models (SEMs) were used to fix the model in the total sample and by gender. Additional analyses included age, duration of illness (DOI) and education status (ES). There were no significant differences between men and women in the three main dimensions of insight. The SEMs in the total sample showed a modest fitting capacity. Fitting improved after a gender-stratified analysis (particularly in women). In men, positive and excited symptoms were associated with poorer insight in all SUMD dimensions, whereas depressive symptoms were associated with better insight. ES in men was also associated with better SUMD-2 or SUMD-3. In contrast, in women, symptoms did not have a negative effect on SUMD-1 or SUMD-2. However, positive symptoms were associated with a poorer SUMD-3, whereas depressive symptoms were associated with better SUMD-3. Moreover, education level was also associated with a better SUMD-3. A gender approach improved the comprehension of the model, supporting the relevance of gender analysis in the study of insight.

Palbociclib and ribociclib in breast cancer: consensus workshop on the management of concomitant medication.

Drug-drug interactions are of significant concern in clinical practice in oncology, particularly in patients receiving Cyclin-dependent kinase (CDK) 4/6 inhibitors, which are typically exposed to long-term regimens. This article presents the highlights from the 'First Workshop on Pharmacology and Management of CDK4/6 Inhibitors: Consensus about Concomitant Medications'. The article is structured into two modules. The educational module includes background information regarding drug metabolism, corrected QT (QTc) interval abnormalities, management of psychotropic drugs and a comprehensive review of selected adverse effects of palbociclib and ribociclib. The collaborative module presents the conclusions of the five working groups, each of which comprised five experts from different fields. From these conclusions positive lists of drugs for treating common comorbid conditions that can be safely administered concomitantly with palbociclib and/or ribociclib were developed.

Insight and suicidality in psychosis: A cross-sectional study.

AIMS: We aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. METHODS: 143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. RESULTS: Those subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of "disturbed thinking and loss of control over the situation" and "having a vague feeling that something is wrong") were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. CONCLUSIONS: Suicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.

A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors.

OBJECTIVE: 1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables. METHODS: 248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables. RESULTS: Around 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors. CONCLUSIONS: Results confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self-reflection or strategic metacognition.

Insight and gender in schizophrenia and other psychoses.

This study aimed to evaluate gender differences in the deficit of insight in psychosis and determine influences of clinical, functional, and sociodemographic variables. A multicenter sample of 401 adult patients with schizophrenia and other psychotic disorders who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Positive and Negative Syndrome Scale Lindenmayers' Factors. Insight and its dimensions were assessed by means of the Scale of Unawareness of Mental Disorder. Significant differences were apparent neither between men and women in the three dimensions of insight, nor in the total awareness, nor in the total attribution subscales. However, statistically significant differences were found in awareness and attribution of particular symptoms. Women showed a worse awareness of thought disorder and alogia and a higher misattribution of apathy. Higher cognitive and positive symptoms, early stage of the illness, and having been married explained deficits of insight dimensions in women. In men, other variables such as lower functioning, higher age, other psychosis diagnosis, and, to a lower extent, higher scores in cognitive, positive, and excitative symptoms, explained deficits of insight dimensions. These data could help to design gender-specific preventive and therapeutic strategies.

Toward the solid-phase synthesis of heparan sulfate oligosaccharides: evaluation of iduronic acid and idose building blocks.

Glycan arrays have been established as the premier technical platform for assessing the specificity of carbohydrate binding proteins, an important step in functional glycomics research. Access to large libraries of well-characterized oligosaccharides remains a major bottleneck of glycan array research, and this is particularly true for glycosaminoglycans (GAGs), a class of linear sulfated polysaccharides which are present on most animal cells. Solid-supported synthesis is a potentially powerful tool for the accelerated synthesis of relevant GAG libraries with variations in glycan sequence and sulfation pattern. We have evaluated a series of iduronic acid and idose donors, including a couple of novel n-pentenyl orthoester donors in the sequential assembly of heparan sulfate precursors from monosaccharide building blocks in solution and on a polystyrene resin. The systematic study of donor and acceptor performance up to the trisaccharide stage in solution and on the solid support have resulted in a general strategy for the solid-phase assembly of this important class of glycans.

Spanish adaptation of the Markova and Berrios Insight scale.

INTRODUCTION: The aim of this study was to adapt the Markova and Berrios Insight scale in Spanish and to analyze its psychometric properties and relationships to the severity of the psychotic symptoms. METHODOLOGY: A translation-backtranslation of the original scale was elaborated and a panel of professionals participated to assess conceptual equivalence and naturality. This is a 30-item self-administered scale with response options Yes/No. A total of 170 psychotic patients were assessed according to DSM-IV-TR diagnostic criteria. Confirmatory factor analysis validated the structure originally proposed. Internal consistency was evaluated using Cronbach's Alpha Coefficient and the Intraclass Correlation Coefficient (ICC). We calculated the association between variables with Spearman's rank correlation coefficient. RESULTS: The 4-factors structure originally proposed by Markova and Berrios was verified. Cronbach's alpha coefficient value for the whole scale was 0.824, indicating good internal consistency. The ICC value was 0.855. There were no statistically significant relationships between severity of psychotic symptoms and the lack of insight. CONCLUSIONS: The Spanish adaptation of the Markova and Berrios Insight Scale has good internal and external reliability. It is simple and easy to perform and very sensitive to change.

Adaptación al castellano de la escala de Insight de Marková y Berrios / Spanish adaptation of the Markova and Berrios Insight scale

Introducción. El objetivo de este estudio fue realizar la adaptación al castellano de la escala de Insight de Markováy Berrios, así como analizar sus propiedades psicométricas y su relación con la gravedad de la sintomatología psicótica. Metodología. Se utilizó un método de traducción-retrotraducción y la participación de un panel de profesionales para valorar equivalencia conceptual y naturalidad. Se trata de una escala de autoaplicación de 30 ítems con opciones de respuesta Sí/No. Fueron valorados 170 pacientes psicóticos según criterios DSM-IV-TR. Mediante análisis factorial confirmatorio se validó la estructura propuesta originalmente. La consistencia interna se evaluó a través del Coeficiente Alfa de Cronbach y el Coeficiente de correlación intraclase (CCI). La asociación entre las variables se analizó con el coeficiente de correlación de Spearman. Resultados. La estructura de 4 factores propuesta originalmente se verifica en gran medida. El valor del Coeficiente alfa de Cronbach para toda la escala fue de 0.824 indicando una buena consistencia interna. El valor del CCI fue de 0.855.No se observaron relaciones estadísticamente significativas entre la gravedad de la sintomatología psicótica y el déficit de insight valorado con la escala de Marková y Berrios. Conclusiones. La versión castellana de la Escala de Insightde Marková y Berrios presenta validez de constructo, buena consistencia interna, buena validez externa, es sencilla ,de fácil aplicación y de fiabilidad temporal (AU)

Introduction. The aim of this study was to adapt the Markova and Berrios Insight scale in Spanish and to analyze its psychometric properties and relationships to the severity of the psychotic symptoms. Methodology. A translation-backtranslation of the original scale was elaborated and a panel of professionals participated to assess conceptual equivalence and naturality. This is a 30-item self-administered scale with response options Yes/No. A total of 170 psychotic patients were assessed according to DSM-IV-TR diagnostic criteria. Confirmatory factor analysis validated the structure originally proposed. Internal consistency was evaluated using Cronbach’s Alpha Coefficient and the Intraclass Correlation Coefficient (ICC).We calculated the association between variables with Spearman’s rank correlation coefficient. Results. The 4-factors structure originally proposed by Markova and Berrios was verified. Cronbach’s alpha coefficient value for the whole scale was 0.824, indicating good internal consistency. The ICC value was 0.855. There were no statistically significant relationships between severity of psychotic symptoms and the lack of insight. Conclusions. The Spanish adaptation of the Markova and Berrios Insight Scale has good internal and external reliability. It is simple and easy to perform and very sensitive to change (AU)

Changes in the prescription of psychotropic drugs in the palliative care of advanced cancer patients over a seven-year period.

CONTEXT: Psychiatric disorders are frequently underdiagnosed and undertreated in advanced cancer patients. OBJECTIVES: To assess changes in the prescription of psychotropic drugs in terminally ill patients. METHODS: All patients with advanced disease receiving palliative care between 2002 and 2009 were eligible. The consumption of benzodiazepines, antipsychotics, and antidepressants for the years 2002, 2006, and 2009 was compared. Data on the percentage and profile of psychotropic drugs prescribed were collected. RESULTS: The study population included 840 patients (241 in 2002, 274 in 2006, and 325 in 2009). The percentage of patients treated with psychotropic drugs increased from 82.2% in 2002 to 90.2% in 2009 (P = 0.006) and the mean number of drugs per patient from 1.66 in 2002 to 2.16 in 2006 (P = 0.003), and to 2.35 in 2009 (P<0.001). Benzodiazepines were prescribed to 72.6% of patients in 2002 and 84% in 2009 (P = 0.001), with lorazepam and midazolam as the most frequently used medications. The use of antipsychotics increased from 26.1% in 2002 to 37.2% in 2006 (P = 0.007) and to 40% in 2009 (P = 0.001), with haloperidol and risperidone as the most commonly prescribed. Antidepressants were prescribed to 17.8% in 2002, 28.1% in 2006 (P = 0.006), and 27.1% in 2009 (P = 0.010), with mirtazapine, citalopram, escitalopram, and duloxetine as the most frequent. CONCLUSION: Between 2002 and 2009, there was a significant increase in the use of psychotropic drugs and a change in the profile of drugs prescribed.

Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients.

BACKGROUND: Poor insight and impairment in Theory of Mind (ToM) reasoning are common in schizophrenia, predicting poorer clinical and functional outcomes. The present study aimed to explore the relationship between these phenomena. METHODS: 61 individuals with a DSM-IV diagnosis of schizophrenia during a stable phase were included. ToM was assessed using a picture sequencing task developed by Langdon and Coltheart (1999), and insight with the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993). Multivariate linear regression analysis was carried out to estimate the predictive value of insight on ToM, taking into account several possible confounders and interaction variables. RESULTS: No direct significant associations were found between any of the insight dimensions and ToM using bivariate analysis. However, a significant linear regression model which explained 48% of the variance in ToM was revealed in the multivariate analysis. This included the 5 insight dimensions and 3 interaction variables. Misattribution of symptoms--in aware patients with age at onset >20 years--and unawareness of need for medication--in patients with GAF >60--were significantly predictive of better ToM. CONCLUSION: Insight and ToM are two complex and distinct phenomena in schizophrenia. Relationships between them are mediated by psychosocial, clinical, and neurocognitive variables. Intact ToM may be a prerequisite for aware patients to attribute their symptoms to causes other than mental illness, which could in turn be associated with denial of need for medication.

Theory of mind deficits in chronic schizophrenia: evidence for state dependence.

There is evidence that people with schizophrenia show specific deficits in theory of mind (ToM). However, it is a matter of debate whether these are trait or state dependent, and the nature of the relationship between ToM deficits and particular symptoms is controversial. This study aimed to shed further light on these issues by (1) examining ToM abilities in 61 individuals with chronic schizophrenia during a stable phase as compared with 51 healthy controls matched by gender, age, educational level and current IQ, and (2) exploring the relationship between ToM and symptoms. Second order verbal stories and a non-verbal picture-sequencing task were used as ToM measures. Results showed no differences in ToM performance between patients and controls on either measure. Subsequent subgrouping of patients into remitted and non-remitted showed a worse performance of non-remitted patients only on second order ToM tasks. Specific ToM deficits were found associated with delusions. Association with negative symptoms was found to be less specific and accounted for by illness chronicity and general cognitive impairment. The results from the present study are in line with models which hypothesise that specific ToM deficits in schizophrenia are state dependent and associated with delusions. Such associations may also be task specific.

Aspectos de la accesibilidad que influyen en el uso de métodos de planificación familiar de las mujeres en edad fértil. Achuapa, Departamento de León, Nicaragua. Período Marzo - Abril 2006 / Aspects of the accessibility that influence in the use of methods of familiar planning of the women in fertile age. Achuapa, Department of Leon, Nicaragua. Period March - April 2006

Estudio descriptivo y de corte transversal sobre los aspectos de la accesibilidad que influyen en el uso de métodos de planificación familiar delas mujeres en edad fértil, Achuapa, departamento de León.

Discharge against medical advice at a general hospital in Catalonia.

Some studies on discharge against medical advice (AMA) in general hospitals report a prevalence between 0.7-7% with 11-42% of this population identified as psychiatric patients. To study the sociodemographic and psychopathological features of patients who leave AMA, we performed a retrospective case-control comparison study of length of hospitalization and presence of psychiatric disturbances on patients who left AMA from the University General Hospital in Catalan Spain over a two-year period. An analysis of the hospital epidemiological discharge register and retrospective chart review for presence of psychiatric disturbances found that AMA prevalence was 0.34%, the total discharge number in the 2-year period being 41,648. AMA rates by medical department were 0.44% for the internal medicine department; 0.24% for surgery; 0.26% for orthopedic surgery, 0.32% for obstetrics-gynecology and 0.93% for rehabilitation. The mean age for AMA patients was 38.63 years, with a higher number of men (59.9%). A total of 45.8% AMA discharges were from the internal medicine department. No significant differences were found in the average length of hospitalization between the AMA and control groups. The presence of psychiatric pathology was significantly higher among the AMA group (P<.05). The prevalence of AMA at our hospital was low in comparison to the rates reported in the literature. The patient at high risk for AMA discharge is a young man with a history of psychiatric pathology, mainly narcotic dependence.

Actuación de enfermería en la medición de la presión intraabdominal en pacientes operados graves / Nursing performance in the measurement of intrabdominal pressure in grave operated patients

Se realizó un estudio sobre el problema del aumento de la presión intraabdominal en el paciente operado en estado crítico, con el objetivo de demostrar la labor de enfermería en la detección de la misma en los servicios de atención al paciente grave del Hospital "Manuel Fajardo Rivero" de Santa Clara, en el período de enero a diciembre de 2002. Se utilizaron como variables principales las características sociodemográficas, intervención quirúrgica inicial, principales complicaciones, promedio de presión intraabdominal asociado a la mortalidad, y causa directa de muerte. Para conocer el grado de asociación entre las variables se calculó el coeficiente de correlación de Pearson y se aplicó la distribución t de Student, como prueba de significación. La peritonitis generalizada fue la complicación Intraabdominal más frecuente (45,4 por ciento) y fue la causa que más elevó las cifras de presión intraabdominal. El síndrome de disfunción orgánica múltiple fue la causa directa de muerte que predominó en nuestro estudio. La labor de enfermería en el procedimiento de medición de la presión intraabdominal es de capital importancia, pues el enfermero es la persona capaz de avizorar cualquier empeoramiento progresivo y gradual de este tipo de paciente

Actuación de enfermería en la medición de la presión intraabdominal en pacientes operados graves / Nursing performance in the measurement of intrabdominal pressure in grave operated patients

Se realizó un estudio sobre el problema del aumento de la presión intraabdominal en el paciente operado en estado crítico, con el objetivo de demostrar la labor de enfermería en la detección de la misma en los servicios de atención al paciente grave del Hospital "Manuel Fajardo Rivero" de Santa Clara, en el período de enero a diciembre de 2002. Se utilizaron como variables principales las características sociodemográficas, intervención quirúrgica inicial, principales complicaciones, promedio de presión intraabdominal asociado a la mortalidad, y causa directa de muerte. Para conocer el grado de asociación entre las variables se calculó el coeficiente de correlación de Pearson y se aplicó la distribución t de Student, como prueba de significación. La peritonitis generalizada fue la complicación Intraabdominal más frecuente (45,4 por ciento) y fue la causa que más elevó las cifras de presión intraabdominal. El síndrome de disfunción orgánica múltiple fue la causa directa de muerte que predominó en nuestro estudio. La labor de enfermería en el procedimiento de medición de la presión intraabdominal es de capital importancia, pues el enfermero es la persona capaz de avizorar cualquier empeoramiento progresivo y gradual de este tipo de paciente(AU)

Técnica de Waaler-rose con eritrocitos formalinizados para la determnianción del factor reumatoide / Waaler-rose technique with formolized erythrocytes for the determination of rheumatoid factor

La técnica de Waaler-Rose donde se emplean eritrocitos de carnero formalinizados y sensibilizados con la fracción IgG de un antisuero de conejo anti-eritrocitos de carnero (WRECFS), se desarrolló sobre láminas portaobjetos, método propuesto por Milgrom y Tönder (1964) para la determinación del factor reumatoideo. Se compararon obtenidos mediante esta técnica y la prueba del Látex, en un grupo de pacientes con el diagnóstico de artritis reumatoide (AR) y en donantes de sangre sanos. El porcentaje de positividad de las técnicas ensayadas y de la prueba del Látex en pacientes con AR, fue de 47,7 y 50,8, respectivamente, y en donantes, de 0 y 1,5. Se encontró una correlación positiva y con coeficiente de correlación * = 0,88, p < 0,005 entre ambas pruebas, valores todos similares a los comunicados por otros autores