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1.
Artigo em Inglês | MEDLINE | ID: mdl-33197507

RESUMO

BACKGROUND: Electroconvulsive therapy (ECT) is considered the most effective treatment for major depressive disorder (MDD). In recent years, the pursuit of the neurobiological mechanisms of ECT action has generated a significant amount of functional magnetic resonance imaging (fMRI) research. OBJECTIVE: In this systematic review, we integrated all fMRI research in patients with MDD receiving ECT and, importantly, evaluated the level of convergence and replicability across multiple fMRI metrics. RESULTS: While according to most studies changes in patients with MDD after ECT appear to be widely distributed across the brain, our multimetric review revealed specific changes involving functional connectivity increases in the superior and middle frontal gyri as the most replicated and across-modality convergent findings. Although this modulation of prefrontal connectivity was associated to ECT outcome, we also identified fMRI measurements of the subgenual anterior cingulate cortex as the fMRI signals most significantly linked to clinical response. CONCLUSION: We identified specific prefrontal and cingulate territories which activity and connectivity with other brain regions is modulated by ECT, critically accounting for its mechanism of action.

2.
BMJ Open ; 10(10): e036561, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004387

RESUMO

INTRODUCTION: Intimate partner violence (IPV) is the most common and alarming form of violence against women, affecting around 30% of all women around the world. Using an integrative methodology, we approach IPV as a form of chronic exposure to severe stress that alters the stress-response system of exposed women. The aim of this study is to test the hypothesis that sustained exposure to IPV in women confers a vulnerability-to-stress profile characterised by higher neuroendocrine and behavioural responsiveness associated with a selective attentional processing bias towards threat. METHODS AND ANALYSIS: Women between 21 and 50 years old from the area of Barcelona (Spain) will be invited to participate. A sample of 82 women exposed to IPV and 41 women not exposed to IPV will be included and assessed for attentional bias and response to acute stress in a laboratory condition (the Trier Social Stress Task). The study will include quantitative and qualitative measures of cognitive performance, neuroendocrine activity and face-to-face interviews to obtain an integrative description of the stress-response profile of these women. Results are expected to help build resilience strategies with a long-lasting impression on women's healthy functioning. ETHICS AND DISSEMINATION: The study has obtained the approval of the local Ethics Committee ('Comité de Ética de Investigación Parc Taulí de Sabadell'; 2 018 551 V.1.2 June 2018). Besides the communication of results in peer-reviewed papers and scientific congresses, the project will inform guidelines and recommendations through policy-dialogues and workshops with relevant regional and national representatives for future work and prevention strategies. Participants will be invited to be an active part in the dissemination strategy focussed on raising awareness of coping limitations and abilities that women themselves will be able to identify throughout the study. TRIAL REGISTRATION DETAILS: The study has been registered at the ClinicalTrails.gov database (Identifier number: NCT03623555; Pre-results).

3.
Artigo em Inglês | MEDLINE | ID: mdl-33086584

RESUMO

Sleep plays a crucial role in cognitive processes. Sleep and wake memory consolidation seem to be regulated by glucocorticoids, pointing out the potential role of the hypothalamic-pituitary-adrenal (HPA) axis in the relationship between sleep quality and cognitive abilities. Trait anxiety is another factor that is likely to moderate the relationship between sleep and cognition, because poorer sleep quality and subtle HPA axis abnormalities have been reported in people with high trait anxiety. The current study aimed to explore whether HPA axis activity or trait anxiety moderate the relationship between sleep quality and cognitive abilities in healthy individuals. We studied 203 healthy individuals. We measured verbal and visual memory, working memory, processing speed, attention and executive function. Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Trait anxiety was assessed with the State-Trait Anxiety Inventory. HPA axis measures included the cortisol awakening response (CAR), diurnal cortisol slope and cortisol levels during the day. Multiple linear regression analyses explored the relationship between sleep quality and cognition and tested potential moderating effects by HPA axis measures and trait anxiety. Poor sleep quality was associated with poorer performance in memory, processing speed and executive function tasks. In people with poorer sleep quality, a blunted CAR was associated with poorer verbal and visual memory and executive functions, and higher cortisol levels during the day were associated with poorer processing speed. Trait anxiety was a moderator of visual memory and executive functioning. These results suggest that subtle abnormalities in the HPA axis and higher trait anxiety contribute to the relationship between lower sleep quality and poorer cognitive functioning in healthy individuals.

4.
Crit Care ; 24(1): 618, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087171

RESUMO

BACKGROUND: ICU patients undergoing invasive mechanical ventilation experience cognitive decline associated with their critical illness and its management. The early detection of different cognitive phenotypes might reveal the involvement of diverse pathophysiological mechanisms and help to clarify the role of the precipitating and predisposing factors. Our main objective is to identify cognitive phenotypes in critically ill survivors 1 month after ICU discharge using an unsupervised machine learning method, and to contrast them with the classical approach of cognitive impairment assessment. For descriptive purposes, precipitating and predisposing factors for cognitive impairment were explored. METHODS: A total of 156 mechanically ventilated critically ill patients from two medical/surgical ICUs were prospectively studied. Patients with previous cognitive impairment, neurological or psychiatric diagnosis were excluded. Clinical variables were registered during ICU stay, and 100 patients were cognitively assessed 1 month after ICU discharge. The unsupervised machine learning K-means clustering algorithm was applied to detect cognitive phenotypes. Exploratory analyses were used to study precipitating and predisposing factors for cognitive impairment. RESULTS: K-means testing identified three clusters (K) of patients with different cognitive phenotypes: K1 (n = 13), severe cognitive impairment in speed of processing (92%) and executive function (85%); K2 (n = 33), moderate-to-severe deficits in learning-memory (55%), memory retrieval (67%), speed of processing (36.4%) and executive function (33.3%); and K3 (n = 46), normal cognitive profile in 89% of patients. Using the classical approach, moderate-to-severe cognitive decline was recorded in 47% of patients, while the K-means method accurately classified 85.9%. The descriptive analysis showed significant differences in days (p = 0.016) and doses (p = 0.039) with opioid treatment in K1 vs. K2 and K3. In K2, there were more women, patients were older and had more comorbidities (p = 0.001) than in K1 or K3. Cognitive reserve was significantly (p = 0.001) higher in K3 than in K1 or K2. CONCLUSION: One month after ICU discharge, three groups of patients with different cognitive phenotypes were identified through an unsupervised machine learning method. This novel approach improved the classical classification of cognitive impairment in ICU survivors. In the exploratory analysis, gender, age and the level of cognitive reserve emerged as relevant predisposing factors for cognitive impairment in ICU patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier:NCT02390024; March 17,2015.

5.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32950409

RESUMO

OBJECTIVE: We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. METHODS: Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. RESULTS: People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized ß=0.365, p=0.018) and people with psychotic disorders (ß=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (ß=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (ß=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. CONCLUSIONS: Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32756418

RESUMO

Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life-paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods-while constituting vulnerable time periods for the mother-require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.


Assuntos
Antipsicóticos , Promoção da Saúde , Esquizofrenia , Adulto , Idoso , Antipsicóticos/uso terapêutico , Feminino , Humanos , Longevidade , Pessoa de Meia-Idade , Gravidez , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Resultado do Tratamento
7.
Front Psychiatry ; 11: 636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32733292

RESUMO

Introduction: Cognitive deficits are a cause of functional disability in psychotic disorders. Cognitive remediation therapy (CRT) might be applied to improve these deficits. We conducted a pilot study to explore whether thyroid hormones might predict the response to CRT in patients with recent-onset psychosis (ROP). Methods: Twenty-eight stable ROP outpatients (9 women) were randomized to receive computerized CRT (N=14) or treatment as usual (TAU) (N=14), over three months. Both cognitive and thyroid functions were assessed at the baseline and after those three months to all patients. A full cognitive battery (CANTAB) was administered before and after the treatment. Serum levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured. FT4 concentrations were recoded into a dichotomic variable (FT4 group) based on the median of the sample (1.2 ng/dL). Data were analyzed on an intention-to-treat basis with linear mixed models. Afterwards, we offered CRT to all participants from the TAU group and seven enrolled CRT, reassessing them when finished. Secondary analyses were repeated in a sample of 14 participants who completed the CRT (either from the beginning or after the TAU period) and attended at least one third of the sessions. Results: The linear mixed models showed a significant time x CRT x FT4 group effect in two cognitive tasks dealing with executive functions and sustained attention (participants with higher FT4 concentrations worsened executive functions but improved sustained attention after CRT). In the secondary analysis including all patients assigned to CRT, higher FT4 concentrations were associated with a poorer response in verbal memory but a better response in spatial working memory. Conclusions: Free thyroxine concentrations moderate the response to a CRT in patients with early psychosis.

8.
Data Brief ; 31: 105904, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32642517

RESUMO

The data presented in this paper describe supplementary material to the article entitled "Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: a systematic review and meta-analysis" [1]. Although raw data was published on the original article, additional raw data has been included in the current paper (new tables with socio-demographic and clinical characteristics of the samples of the studies included in the systematic review). Supplementary data also include the PICO scheme of the systematic review, PRISMA checklist, flow diagram, an explanation of the method for obtaining prolactin concentrations from published figures when data was only available in figures, list of the selected studies, risk of bias summary of all five randomized clinical trials evaluating the addition of aripiprazole for lowering prolactin (included in the meta-analysis in the original article). Extra analyses, figures and R code of the meta-analysis have been also included. Meta-analysis of randomized clinical trials (RCTs) considering aripiprazole addition for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia were conducted with two softwares: 1) R and the metaphor package (for the meta-analysis of the primary outcome [prolactin reduction]); 2) MedCalc version 18.11 (for the meta-analysis of the secondary outcome [withdrawal rates]). Data from a sensitivity analysis (repeating the meta-analysis with only placebo-controlled RCTs) has been also included in the current article.

9.
BMJ Open ; 10(7): e037365, 2020 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-32660952

RESUMO

INTRODUCTION: Suicide attempts represent an important public health burden. Centralised electronic health record (EHR) systems have high potential to provide suicide attempt surveillance, to inform public health action aimed at reducing risk for suicide attempt in the population, and to provide data-driven clinical decision support for suicide risk assessment across healthcare settings. To exploit this potential, we designed the Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study. Using centralised EHR data from the entire public healthcare system of Catalonia, Spain, the CSRC-Epi study aims to estimate reliable suicide attempt incidence rates, identify suicide attempt risk factors and develop validated suicide attempt risk prediction tools. METHODS AND ANALYSIS: The CSRC-Epi study is registry-based study, specifically, a two-stage exposure-enriched nested case-control study of suicide attempts during the period 2014-2019 in Catalonia, Spain. The primary study outcome consists of first and repeat attempts during the observation period. Cases will come from a case register linked to a suicide attempt surveillance programme, which offers in-depth psychiatric evaluations to all Catalan residents who present to clinical care with any suspected risk for suicide. Predictor variables will come from centralised EHR systems representing all relevant healthcare settings. The study's sampling frame will be constructed using population-representative administrative lists of Catalan residents. Inverse probability weights will restore representativeness of the original population. Analysis will include the calculation of age-standardised and sex-standardised suicide attempt incidence rates. Logistic regression will identify suicide attempt risk factors on the individual level (ie, relative risk) and the population level (ie, population attributable risk proportions). Machine learning techniques will be used to develop suicide attempt risk prediction tools. ETHICS AND DISSEMINATION: This protocol is approved by the Parc de Salut Mar Clinical Research Ethics Committee (2017/7431/I). Dissemination will include peer-reviewed scientific publications, scientific reports for hospital and government authorities, and updated clinical guidelines. TRIAL REGISTRATION NUMBER: NCT04235127.

10.
Eur Psychiatry ; 63(1): e74, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32571441

RESUMO

BACKGROUND.: This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). METHODS.: A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. RESULTS.: TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38-2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01-1.65) were associated with TRD risk. CONCLUSIONS.: Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.

11.
Genes Brain Behav ; 19(8): e12683, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32573093

RESUMO

Seasonal changes in mood and diurnal preference are two well-characterized chronobiological phenotypes in major depressive disorder (MDD) and bipolar disorder (BD). The biological mechanisms regulating physiological changes related to seasonality and chronotype involve several genes known as "clock" or circadian genes. Our goal was to study the relationship between the polygenic risk score (PRS) obtained from a set of clock genes and chronobiological traits in patients with mood disorders. The sample included 445 patients with mood disorders (256 MDD; 189 BD). Seasonality was assessed using the Seasonal Pattern Assessment Questionnaire (SPAQ), and chronotype was assessed using the Horne and Östberg Morningness-Eveningness Questionnaire. We selected 248 single nucleotide polymorphisms located within 19 genes. PRS for both MDD and BD was calculated using the Psychiatric Genetics Consortium latest datasets as discovery samples. Another PRS was calculated using results from a genome-wide association study focusing on chronotype. SPAQ results were significantly associated with MDD-PRS (p = 0.037) and chronotype-PRS (p = 0.019), which also showed a significant interaction with age (p = 0.039). No significant association was observed between the measured PRS and chronotype. Our results reflect that small effect variants associated with MDD and chronotype within clock genes are associated with seasonality traits in patients with mood disorders, further explaining the mechanism through which the circadian system might influence mood disorder clinical presentation. Future studies measuring PRS from specific gene sets and focusing on biological endophenotypes will help to elucidate the pathways from genetic variations to clinical outcome.

12.
Schizophr Res ; 222: 88-96, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32507371

RESUMO

Different therapeutic strategies are used for lowering prolactin concentrations in patients with psychotic disorders with antipsychotic-induced hyperprolactinaemia. We aimed to examine the evidence from open-label studies and randomized clinical trials (RCTs) that studied four prolactin-lowering therapeutic strategies in people with psychotic disorders and hyperprolactinaemia: 1) switching to prolactin-sparing antipsychotics; 2) adding aripiprazole; 3) adding dopamine agonists; and 4) adding metformin. RCTs were included in a meta-analysis. Effect sizes (Hedges' g) of prolactin reductions with each strategy were calculated. Withdrawal rates were also considered. We identified 26 studies. Nine studies explored switching antipsychotic treatment to aripiprazole (n = 4), olanzapine (n = 1), quetiapine (n = 2), paliperidone palmitate (n = 1) or blonanserin (n = 1). Twelve studies tested the addition of aripiprazole. Six studies explored the addition of cabergoline (n = 3), bromocriptine (n = 2) or terguride (n = 1). We also found one meta-analysis testing the addition of metformin to antipsychotic treatment but no other individual studies. A meta-analysis could only be performed for the addition of aripiprazole, the strategy with the best level of evidence. Five RCTs testing the addition of aripiprazole yielded a significant reduction in prolactin concentration compared to placebo (N = 3) or maintaining antipsychotic treatment (N = 2): Hedges' g was -1.35 (CI 95%: -1.93 to -0.76, p < 0.001). The three placebo-controlled RCTs for aripiprazole addition showed similar withdrawal rates for aripiprazole (10.1%) and placebo (11.5%), without significant differences in the meta-analysis. Our study suggests that, in terms of levels of evidence, adding aripiprazole is the first option to be considered for lowering prolactin concentrations in patients with schizophrenia and hyperprolactinaemia.

13.
Psychol Med ; : 1-9, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32476636

RESUMO

BACKGROUND: Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. METHODS: In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. RESULTS: Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). CONCLUSIONS: The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.

14.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(3): 121-127, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193878

RESUMO

INTRODUCCIÓN: En el marco de una estrategia para implementar un nuevo programa clínico para la depresión en atención primaria, desarrollamos un curso online con clases videograbadas dirigido a los médicos y enfermeras que van a introducir el programa en su práctica clínica. SUJETOS Y MÉTODOS: La evaluación del curso se realizó mediante un cuestionario estandarizado a los alumnos y un análisis temático de los contenidos de un foro de discusión. RESULTADOS: En la encuesta, los alumnos mostraron satisfacción respecto a sus expectativas, valorando positivamente el formato y el diseño general, los contenidos y su utilidad práctica, sin diferencias significativas según el perfil profesional. En el análisis cualitativo del foro se detectaron potencialidades del programa y del curso, destacando la percepción de que se abordaba una necesidad asistencial relevante. También se señalaron insuficiencias del curso y del programa, y obstáculos externos que pueden dificultar o impedir la implementación: falta de tiempo, inestabilidad en los equipos o exceso de trabajo y requerimientos en el día a día. CONCLUSIONES: Hemos ensayado un eficaz formato online para la formación de profesionales. La evaluación del curso ha sido satisfactoria. El feedback de los alumnos permitirá modelar y perfeccionar futuras ediciones del curso y el propio programa


INTRODUCTION: Within the framework of a strategy to implement a new clinical program for depression in primary care, we developed an online course with videotaped lectures targeted at doctors and nurses who will introduce the program into their clinical practice. SUBJECTS AND METHODS: The evaluation of the course was carried out by a standardized questionnaire for students and a thematic analysis of the contents of a discussion forum. RESULTS: In the survey, the students showed satisfaction regarding their expectations, positively valuing the format and the general design, the contents and their practical utility, without significant differences according to professional profile. In the qualitative analysis of the forum potentialities of the program and the course were detected, highlighting the perception that a relevant care need was addressed. There were also shortcomings of the course and the program, and external obstacles that may hinder or impede implementation: lack of time, instability in the staff, or excessive work and requirements on a day-to-day basis. CONCLUSIONS: We have tested an effective online format for the training of professionals. The evaluation of the course has been satisfactory. The feedback of the students will allow us to model and improve future editions of the course and the program itself


Assuntos
Humanos , Educação a Distância/métodos , Atenção Primária à Saúde , Depressão/epidemiologia , Educação Médica/métodos , Inquéritos e Questionários , Medicina de Família e Comunidade/educação , Educação em Enfermagem
15.
World J Psychiatry ; 10(4): 34-45, 2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32399397

RESUMO

Delusional disorder (DD) has been traditionally considered a relatively rare and treatment-resistant psychotic disorder. In the last decade, increasing attention has focused on therapeutic outcomes of individuals affected by this disorder. The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research: (1) For which patients with DD do antipsychotic medications work best (the moderators of response); and (2) What variables best explain the relationship between such treatments and their effectiveness (the mediators of response). We searched PubMed and Google Scholar databases for English, German, French and Spanish language papers published since 2000. We also included a few classic earlier papers addressing this topic. Variables potentially moderating antipsychotic response in DD are gender, reproductive status, age, duration of illness, the presence of comorbidity (especially psychiatric comorbidity) and its treatment, brain structure, and genetics of neurochemical receptors and drug metabolizing enzymes. Antipsychotic and hormonal blood levels during treatment, as well as functional brain changes, are potential mediating variables. Some, but not all, patients with DD benefit from antipsychotic treatment. Understanding the circumstances under which treatment works best can serve to guide optimal management.

16.
Artigo em Inglês | MEDLINE | ID: mdl-32197928

RESUMO

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation and cognitive deficits are two well-characterized endophenotypes present in different serious mental illnesses (SMIs), including major depressive disorder, bipolar disorder and schizophrenia. Our aim was to study the influence of genetic and epigenetic variations in HPA axis-related genes on cognitive performance in clinical samples, including patients with major mood disorders and schizophrenia. A systematic search was performed using PubMed (Medline), PsycINFO and Scopus databases. The systematic review identified 12 studies dealing with HPA-related genes and cognition in samples including patients with SMIs, focusing on single nucleotide polymorphism (SNP) variants, while no studies analysing epigenetic variations were found. The results suggest different and specific effects on the cognitive performance of SNP variants in the HPA axis-related genes studied, as well as interactions with traumatic experiences. There was high heterogeneity in the studied samples, genes analysed, and cognitive tasks evaluated. The relationship between HPA-related genes and cognition in SMIs is still largely unknown, and further studies including larger samples and epigenetic variations are needed.

17.
J Affect Disord ; 268: 201-205, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32174478

RESUMO

BACKGROUND: Suicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program. METHODS: Observational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care. RESULTS: A total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning. LIMITATIONS: Adherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts. CONCLUSIONS: Although the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.

18.
Psicosom. psiquiatr ; (12): 46-54, ene.-mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193133

RESUMO

En las últimas décadas, los movimientos migratorios han hecho que cada vez acudan más pacientes de otras culturas en nuestras consultas. Muchas veces, síntomas definidos como psicóticos o delirantes se explican, en parte, por un componente cultural. No hay duda de que la cultura influye en cómo las personas experimentan sus emociones, en cómo y en qué términos las expresan, y dónde buscan ayuda. Los síndromes vinculados a la cultura, son síndromes psiquiátricos estrechamente relacionados con determinados aspectos culturales en su formación o manifestación psicopatológica, abarcando ciertas manifestaciones conductuales, afectivas y cognitivas observadas en culturas específicas. Las manifestaciones clínicas que presentan suelen ser diferentes de las de los trastornos psiquiátricos que se encuentran en las clasificaciones occidentales existentes. En esta revisión se describirán las características de los síndromes vinculados a la cultura, veremos si están limitados a sociedades específicas o son las áreas culturales las que definen los criterios, si se deben considerar síndromes variantes de trastornos considerados como "universales" (neuróticos, afectivos, psicóticos o de personalidad), si todos los trastornos están "ligados a la cultura" y si son estables en el tiempo, así como sus manifestaciones clínicas y el manejo de los cuadros más frecuentes


In the last decades,the occurrence of migratory movements has led us to attend more and more patients from other cul-tures in our mental health outpatient services. Many times, those symptoms considered psychotic or delusional may probably have a cultural component. There is no doubt that culture influences how people experience their emotions, how they express them and where they seek help.Culture bound syndromes are psychiatric syndromes related to cultural aspects in their formation or psychopathological manifestation. They cover behavioural, affective and cognitive manifestations frequently observed in specific cultures. The clinical features are usually different from those similar psychiatric disorders found in Western classifications.In this review, we will describe the characteristics of cultural bound syndromes. We will see whether they are limited to specific areas or not, whether they may be considered as "universal" disorders (neurotic, affective, psychotic or personality disorders), and ifthey are "linked to culture" and if they are stable over time. Finally, we will describe their clinical manifestations and we will recommend some issues for the management of the most common symptom


Assuntos
Humanos , Comparação Transcultural , Transtornos Mentais/etiologia , Síndrome , Transtornos de Ansiedade/psicologia , Transtornos Dissociativos/psicologia , Transtornos Mentais/psicologia , Transtornos Psicóticos/psicologia
19.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 13(1): 5-10, ene.-mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194429

RESUMO

INTRODUCCIÓN: La terapia electroconvulsiva de continuación/mantenimiento (TEC-c/m) es una opción terapéutica tras la TEC aguda. Aunque es ampliamente usada, tanto su duración como la evolución de los pacientes tras su discontinuación no están bien establecidas. El objetivo del estudio fue evaluar la tasa de recidivas y los factores clínicos asociados a la misma tras discontinuar la TEC-c/m. MATERIAL Y MÉTODOS: Evaluación retrospectiva de 73 pacientes a los que se les discontinuó la TEC-c/m. El tiempo de evaluación mínimo fue de un año. Se consideró recidiva la necesidad de ingreso o de nueva tanda aguda de TEC. La tasa de recidivas se determinó como porcentaje y el tiempo estimado hasta la recidiva se analizó a través de un análisis de supervivencia. Posibles asociaciones entre la recidiva y variables clínicas se analizaron mediante análisis univariado y multivariado de Cox. RESULTADOS: Treinta y seis pacientes (49,3%) recidivaron. El 61,1% lo hizo durante el primer año tras la discontinuación de la TEC-c/m (36,1% durante los primeros 6 meses). El tiempo estimado hasta la recidiva fue de 38,67 meses. El 50% de los pacientes que recayeron precisaron una nueva tanda aguda de TEC y el 44,4% reiniciaron TEC-c/m posteriormente. Los pacientes con un intervalo entre sesiones inferior a un mes y aquellos con más episodios previos presentaron mayor riesgo de recidiva. CONCLUSIONES: Ante la discontinuación de la TEC-c/m debe considerarse el riesgo de recidiva. Tras la discontinuación, casi la mitad de los pacientes recidivaron, la mayoría en el primer año. Es recomendable realizar un seguimiento estrecho tras la discontinuación de la TEC-c/m y no es aconsejable su retirada cuando se administra con intervalos entre sesiones inferiores a un mes. Se requieren nuevos estudios para identificar grupos de riesgo para la recidiva


INTRODUCTION: Continuation and maintenance electroconvulsive therapy (c/m-ECT) is a therapeutic option after an acute ECT course. Although it is widely used, both duration and the outcome of patients when ECT-c/m is discontinued is not yet well established. The aim of the study was to evaluate the recurrence rate and associated clinical factors when c/m-ECT is discontinued. MATERIALS AND METHODS: Retrospective evaluation of 73 patients who were discontinued from c/m-ECT. The minimum evaluation time was one year. The need of hospital admission or a new acute course of ECT was considered a relapse. The recurrence rate was calculated as a percentage and the estimated time to recurrence was analyzed through a survival analysis. Possible associations between clinical variables and recurrence were analyzed by univariate and multivariate Cox analysis. RESULTS: Thirty-six patients (49.3%) relapsed: 61.1% of them relapsed during the first year after the c/m-ECT discontinuation (36.1% during the first 6 months). The estimated time to recurrence was 38.67 months. Fifty percent of patients who relapsed required a new acute course of ECT and 44.4% of them restarted c/m-ECT. Patients with an interval between sessions of less than one month and those with more previous episodes showed a higher risk of recurrence. CONCLUSIONS: The risk of recurrence should be considered before the discontinuation of c/m-ECT. After the discontinuation, almost half of the patients relapsed, most of them within the first year. Close monitoring should be conducted in these patients and the discontinuation is not recommended when it is administered at intervals between sessions of less than a month. Further studies are required to identify risk groups for relapse


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Eletroconvulsoterapia , Transtornos Mentais/terapia , Suspensão de Tratamento , Idade de Início , Análise de Variância , Transtorno Bipolar/terapia , Transtorno Depressivo Maior/terapia , Seguimentos , Estimativa de Kaplan-Meier , Recidiva , Estudos Retrospectivos , Fatores de Risco , Esquizofrenia/terapia , Fatores de Tempo , Resultado do Tratamento
20.
Behav Sci (Basel) ; 10(2)2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32033456

RESUMO

The relationship between religiosity and different components of empathy was explored in schizophrenia patients. A total of 81 stable schizophrenia patients and 95 controls from the nearby community completed self-reported questionnaires assessing religiosity and empathy (through the Interpersonal Reactivity Index, IRI). Patients with schizophrenia showed higher religiousness than controls and they presented less perspective-taking and empathic concern but increased personal distress in IRI scores. Regression analyses unveiled an association between religiosity and perspective-taking in schizophrenics after adjusting for age, gender, and psychotic symptoms. In conclusion, religiosity in patients with schizophrenia may be linked to variations in perspective- taking as a component of empathy.

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