Addressing Dual Disorders in a Medium-Term Admission Unit.

Due to the significant functional repercussions suffered by patients with dual disorder, we must evaluate which ones can benefit from intensive rehabilitative therapies in medium-stay psychiatric units. This was a retrospective study of patient medical records which intended to analyze sociodemographic and clinical variables and parameters related to the hospitalization and discharge of patients admitted to the Medium-Stay Unit (MSU) at the Castellón Provincial Hospital Consortium over 2 years (2017 and 2018), according to the presence or absence of dual disorders in these patients. Patients with a dual disorder represented 55.2% of the hospitalized patients. A higher proportion of them were male, were relatively younger, and had an earlier onset of mental illness, fewer associated medical pathologies, and shorter hospital admission times to the Short-Term Hospitalization Unit than those who did not present a dual disorder. A diagnosis on the schizophrenia spectrum with cannabis use or polyconsumption was the most common diagnosis; 98.2% of all the patients responded adequately to admission to the MSU. This work highlighted the need for higher doses of depot paliperidone in patients with dual disorders.

Ketamina en el tratamiento de la ideación suicida asociada a depresión resistente. A propósito de un caso / Ketamine in the treatment of suicidal ideation associated with resistant depression. A case report

En la actualidad disponemos de pocos tratamientos rápidos, efectivos y seguros para reducir la ideación suicida en la depresión y especialmente en la depresión resistente, quizá con la excepción de la terapia electroconvulsiva (TEC). La ketamina es un anestésico con propiedades antagonistas del receptor NMDA que ha demostrado producir, a dosis subanestésicas, una mejoría rápida y firme de los síntomas depresivos y de la ideación suicida. La mejoría de la ideación suicida llevada a cabo por la ketamina es independiente de la mejoría observada en la sintomatología depresiva. Por otra parte, en la mayor parte de los casos, la mejoría de la ideación suicida no se mantiene en el tiempo con una sola perfusión de ketamina y se necesitan dosis repetidas para mantener el efecto terapéutico. Presentamos un caso de ideación suicida en depresión resistente con dificultades de utilizar la TEC y con una historia previa de 18 ingresos psiquiátricos que mejora con perfusiones continuas de ketamina y con efectos adversos mínimos (AU)

There are currently very few quick, effective and safe treatments for reducing suicidal ideation in depression and especially in resistant depression, perhaps with the exception of electroconvulsive therapy (ECT). Ketamine is an anaesthetic with NMDA receptor antagonist properties that, in sub-anaesthetic doses, has demonstrated a really quick and significant improvement in depressive symptoms and suicidal ideation. The improvement in suicidal ideation produced by ketamine is independent of the improvement observed in depressive symptoms. On the other hand, in most of the cases, the improvement in the suicidal ideation is not maintained in time with a single infusion of ketamine and repeated doses are necessary to maintain the therapeutic effect. A case is presented of suicidal ideation in resistant depression with difficulties of using ECT and with a previous history of 18 psychiatric admissions. The patient improved with continuous perfusions of ketamine and minimal adverse effects (AU)

Towards a pragmatic and operational definition of relapse in schizophrenia: A Delphi consensus approach.

OBJECTIVE: To develop pragmatic and operational definitions of relapse in schizophrenia. METHODS: A two-round Delphi consensus approach was used. The final questionnaire based on seven pre-established definition relapse models developed by a panel of eight experts was presented to 33 general psychiatrists who attended an "ad hoc" meeting. RESULTS: The most frequent components of the pragmatic definition were the psychopathological severity of the psychotic spectrum (70%), more intense management of the case (68%), a previously stabilized episode (67%), and impairment in functioning and social behavior (67%). In the operational definition, reappearance of symptoms was considered indispensable by 71% of the participants, and reappearance of positive symptoms measured by clinical scales was considered recommendable by 67%. Between 46% and 53% rated worsening of severity status and worsening of functioning as indispensable or recommendable. An increase of ≥ 10 points in the positive subscale of Positive and Negative Symptom Scale was rated by 51% of the participants, a score of 6 points in the Clinical Global Impression scale (much worse) by 89%, and a reduction of ≥ 20 points in the Global Assessment of Functioning scale by 62%. CONCLUSIONS: A better understanding of the definition of relapse in schizophrenia is necessary to improve effective prevention strategies.