Factor neurotrófico derivado del cerebro y primeros episodios psicóticos. Estudio pronóstico de un año / Brain-derived neurotrophic factor (bdnf) and first-episode psychosis. a longitudinal one-year prognosis study

Introducción. El factor neurotrófico derivado del cerebro(BDNF) es una neurotrofina que se ha relacionado con la hipótesis del neurodesarrollo de la esquizofrenia. Varios estudios confirman que los niveles de BDNF en el primer episodio psicótico (PEP) son más bajos que en los controles sanos. Sin embargo, los datos al respecto de la evolución de los niveles tras un PEP y el valor pronóstico de dichos niveles son controvertidos. Método. Se compararon los niveles séricos de BDNF al ingreso de 28 pacientes hospitalizados con PEP con 28controles sanos. También se midió el BDNF al momento del alta, a los tres, seis, nueve y doce meses. Los niveles de BDNF se presentan en ng/ml. Se buscó correlación con la sintomatología psicótica medida con la Escala de Síndrome Positivo y Negativo (PANSS) y se evaluó en valor pronóstico de los niveles basales para predecir mala funcionalidad (medida por la Evaluación Global del Funcionamiento) y/o recaída, así como el diagnóstico ulterior de un trastorno psicótico crónico. Resultados. Al ingreso, los niveles de BDNF de los pacientes fueron significativamente más bajos que los niveles de los controles sanos (18,52±4,51 vs. 26,55±3,22, p<0,001). Al altalos niveles de PEP aumentaron hasta niveles de los controles sanos (25,95±3,96 vs. 26,55±3,22, p=0,539). En las siguientes determinaciones, los niveles de BDNF en PEP disminuyeron, alcanzando los valores de ingreso y siendo significativamente más bajos que los controles sanos y los niveles al alta(pacientes: tres meses: 19,68±3,88; seis meses: 19,02±4,13;nueve meses: 17,64±5,24; doce meses:17,51±3,45 vs. controles sanos: 26,55±3,22, todos p<0,001). Se encontró una correlación negativa entre el BDNF al ingreso y las puntuaciones de la subescala de síntomas negativos de la PANSS con una tendencia hacia la significación (r=-0,303, p=0,093). ... (AU)

Introduction. The brain-derived neurotrophic factor(BDNF) is a neurotrophin that has been linked to the schizophrenia neurodevelopmental hypothesis. Several studiesconfirm that the BDNF levels in first-episode psychosis (FEP)are lower than in healthy controls (HC). However, data aboutevolution of BDNF levels after a FEP and about the prognostic value of these levels are controversial. Method. Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 HC. BDNF was also measured at discharge, three, six, nine and twelve months. BDNF levels are presented in ng/ml. We looked for correlation of BDNF levels with the psychotic symptomatology measuredwith the Positive and Negative Syndrome Scale (PANSS) andalso the prognostic value of basal levels was evaluated topredict poor functionality (measured by the Global Assessment of Functioning) and/or relapse, as well as the subsequent diagnosis of a chronic psychotic disorder. Results. At admission, patients BDNF levels were significantly lower than HC levels (18.52±4.51 vs. 26.55±3.22,p<0.001). At discharge FEP levels increase until HC levels(25.95±3.96 vs. 26.55±3.22, p=0,539). Upon the following determinations, BDNF FEP levels decreased, reaching the admission values, and being significantly lower than the HC andthe levels at discharge (patients: three months: 19.68±3.88;six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs. HC: 26.55±3.22, all p<0.001). A negative correlation was found between admission BDNF levels and the PANSS negative symptoms subscale score with a trend towards significance (r=-0.303, p=0.093). BDNF levels at admission of patients with por functionality and/orrelapse at 12 months were lower than BDNF levels of patients with goof functionality and without relapse, this difference had a trend towards significance. (15.38±4.72 vs.19.57±4.06; p=0.071). (AU)

Diálogos abiertos en un grupo multifamiliar dentro de un programa de atención a primeras crisis psicóticas / Open dialogues in a multifamily group within a program of care for first psychotic crises

Introducción: describimos la experiencia de un grupo multifamiliar, dirigido a jóvenes y su red social, afectados por primeras crisis psicóticas, en la práctica clínica real dentro del Sistema Sanitario Nacional de Salud de España, bajo la filosofía de Diálogos Abiertos, en el contexto de pandemia por COVID-19. Método: Participan 3 familias y 3 profesionales de la red de salud mental. Instrumentos: SCORE-15, SWLS, CSQ-8 y un registro de temas que aparecen en los diálogos. Resultados: tanto los 5 sujetos como las facilitadoras perciben mejoría a nivel de funcionamiento familiar y utilidad de la terapia; solo uno de los sujetos informa de mejoría a nivel de satisfacción vital al finalizar el grupo; observamos una alta satisfacción con la atención recibida en el grupo por parte de los participantes. Discusión: la fortaleza de este estudio es su validez ecológica. Los resultados obtenidos y las sinergias que se desarrollan en los encuentros dialógicos multifamiliares aquí descritos nos permiten confiar en que otras maneras de hacer más alineadas con los principios de Diálogos Abiertos, con los recursos de que disponemos en nuestro contexto sanitario, son posibles ya (AU)

Introduction: We describe the experience of a multi-family group, directed at young people affected by their first psychotic crisis and their social networks, in a real clinical environment within the Spanish national health system, based on the Open Dialogue philosophy, in the context of the COVID-19 pandemic. Method: three families and three mental health professionals took part in the study. Instruments: SCORE-15, SWLS, CSQ-8 and a list of themes that appear in the dialogues.Results: both the five subjects and the facilitators perceive an improvement in the level of family functioning and the usefulness of the therapy; only one of the subjects reports an improvement in the level of life satisfaction at the end of the group; we observe high satisfaction on the part of the participants with the care received in the group. Discussion: the strength of this study is its ecological validity. The results obtained, and the synergies developed in the multifamily meetings described here, demonstrate that different methods more aligned with the principles of Open Dialogues are now possible with the resources available in our clinical context (AU)

Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies.

INTRODUCTION: The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS: Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS: Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS: While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.

Prefrontal abnormalities, executive dysfunction and symptoms severity are modulated by COMT Val158Met polymorphism in first episode psychosis.

INTRODUCTION: Core dysfunctions proposed for psychotic disorders include prefrontal cortex (PFC) dopaminergic hypoactivity, executive function (EF) deficits and reduced gray matter in the PFC. The Val variant of COMT Val158Met polymorphism is associated with reduced dopaminergic signaling in the PFC. However, it is unclear how COMT Val158Met modulates PFC gray matter reduction, EF deficits and symptom severity at the time of the first psychotic episode. METHODS: The effect of COMT on both EF performance and prefrontal volume (PFC-VOL) was tested in 158 first episode psychosis (FEP) patients and 141 healthy controls (HC) matched for age (range 9-35 years), sex, ethnicity, handedness and COMT Val158Met distribution. EF and PFC-VOL were compared between FEP and HC groups within each polymorphism status (Met/Met versus Val carriers) to assess whether COMT influenced diagnostic differences. Next, correlations between PFC-VOL and EF performance were computed, as well as between both variables and other clinical characteristics of interest (PANSS scores, PAS infancy and premorbid IQ) in the FEP sample. RESULTS: COMT influenced the diagnostic differences mainly in PFC-VOL, but also in EF performance. FEP-Val carriers showed lower EF scores and reduced PFC-VOL compared to the HC group but also poorer EF performance than FEP Met/Met. Poorer EF performance was associated with smaller PFC-VOL, and both were related to increased severity of negative symptoms, poorer premorbid adjustment, and lower estimated premorbid IQ in FEP patients. CONCLUSIONS: Our findings suggest that COMT Val158Met polymorphism might contribute to PFC-VOL reductions, executive dysfunctions and symptom severity in FEP patients.

Prefrontal abnormalities, executive dysfunction and symptoms severity are modulated by COMT Val158Met polymorphism in first episode psychosis / Modulación de alteraciones prefrontales por el polimorfismo COMT Val158Met en los primeros episodios psicóticos

Introduction: Core dysfunctions proposed for psychotic disorders include prefrontal cortex (PFC) dopaminergic hypoactivity, executive function (EF) deficits and reduced gray matter in the PFC. The Val variant of COMT Val158Met polymorphism is associated with reduced dopaminergic signaling in the PFC. However, it is unclear how COMT Val158Met modulates PFC gray matter reduction, EF deficits and symptom severity at the time of the first psychotic episode.Methods: The effect of COMT on both EF performance and prefrontal volume (PFC-VOL) was tested in 158 first episode psychosis (FEP) patients and 141 healthy controls (HC) matched for age (range 9–35 years), sex, ethnicity, handedness and COMT Val158Met distribution. EF and PFC-VOL were compared between FEP and HC groups within each polymorphism status (Met/Met versus Val carriers) to assess whether COMT influenced diagnostic differences. Next, correlations between PFC-VOL and EF performance were computed, as well as between both variables and other clinical characteristics of interest (PANSS scores, PAS infancy and premorbid IQ) in the FEP sample.Results: COMT influenced the diagnostic differences mainly in PFC-VOL, but also in EF performance. FEP-Val carriers showed lower EF scores and reduced PFC-VOL compared to the HC group but also poorer EF performance than FEP Met/Met. Poorer EF performance was associated with smaller PFC-VOL, and both were related to increased severity of negative symptoms, poorer premorbid adjustment, and lower estimated premorbid IQ in FEP patients.Conclusions: Our findings suggest that COMT Val158Met polymorphism might contribute to PFC-VOL reductions, executive dysfunctions and symptom severity in FEP patients. (AU)

Introducción: Algunas de las alteraciones descritas en los trastornos psicóticos incluyen una hipoactividad dopaminérgica en la corteza prefrontal (CPF), déficits en la función ejecutiva (FE) y reducción de la materia gris en la CPF. La variante Val del polimorfismo COMT Val158Met se asocia con una menor disponibilidad dopaminérgica en la CPF. Sin embargo, está aún pendiente de determinar la forma en la que COMT modula la materia gris de la CPF, la FE y la gravedad de los síntomas en el momento del primer episodio psicótico (PEP).Métodos: El efecto de COMT en el rendimiento de la FE y el volumen prefrontal (VOL-CPF) se evaluó en 158 pacientes con PEP y 141 controles sanos (CS) emparejados por edad (9-35 años), sexo, etnia y distribución de COMT. La FE y el VOL-CPF se compararon entre los grupos de PEP y CS, y en función de la variante alélica del polimorfismo (Met/Met versus portadores Val) para evaluar si COMT modula las diferencias diagnósticas. Además, se llevaron a cabo correlaciones entre FE y VOL-CPF, así como entre ambas variables y las puntuaciones en la PANSS, el ajuste premórbido y el CI premórbido.Resultados: COMT moduló las diferencias diagnósticas en VOL-CPF y el rendimiento de FE. Los PEP portadores de la variante Val presentaron menores puntuaciones en FE y reducción del VOL-CPF en comparación con el grupo CS, y menor rendimiento de FE que los PEP Met/Met. Un menor rendimiento en FE se asoció con un menor VOL-CPF, y ambas variables estaban relacionadas con un incremento en la gravedad de síntomas negativos, un peor ajuste premórbido y un menor CI premórbido en pacientes con PEP.Conclusiones: Nuestros hallazgos evidencian que el polimorfismo COMT Val158Met podría contribuir a la reducción del VOL-CPF, la disfunción ejecutiva y la gravedad de los síntomas en los pacientes con PEP. (AU)

Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies / Hipoactivación precúnea e insular durante el procesamiento cognitivo en el primer episodio psicótico: revisión sistemática y metaanálisis de estudios de fMRI

Introduction: The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP.Methods: Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines.Results: Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum.Conclusions: While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation. (AU)

Introducción:Los correlatos neurales de la disfunción cognitiva en el primer episodio psicótico (PEP) aún no están claros. Esta revisión y este metaanálisis proporcionan una actualización de la localización de las anormalidades en la respuesta cerebral medida por fMRI a los procesos cognitivos en individuos con PEP.Métodos: Revisión sistemática y metaanálisis basado en vóxeles de estudios cros-seccionales de fMRI que comparen respuestas neuronales a tareas cognitivas entre individuos con PEP y controles sanos de acuerdo con las guías PRISMA.Resultados: Se incluyeron 26 estudios, que comprendían 598 individuos con PEP y 567 controles sanos. Los estudios individuales reportaban hipoactivación estadísticamente significativa en la corteza prefrontal dorsolateral (6 estudios), el lóbulo frontal (8 estudios), el cíngulo (6 estudios) y la ínsula (5 estudios). El metaanálisis mostró hipoactivación estadísticamente significativa en la ínsula anterior izquierda, el precúneo y el cuerpo estriado bilateral.Conclusiones: Si bien los estudios tienden a resaltar la hipoactivación frontal durante las tareas cognitivas en PEP, nuestros resultados metaanalíticos muestran que el precúneo izquierdo y la ínsula presentan principalmente una activación aberrante en PEP que puede estar asociada con la atribución de saliencia a estímulos externos y relacionada con déficits en la percepción y la regulación. (AU)

Primer episodio psicótico en un paciente con síndrome de Noonan. A propósito de un caso / First psychotic episode in a patient with Noonan syndrome. A case report

El síndrome de Noonan es una enfermedad genética caracterizada por alteraciones fenotípicas faciales, baja estatura, malformaciones cardiacas y de la pared torácica, retraso del neurodesarrollo, infertilidad y discrasias sanguíneas. Su diagnóstico es clínico, con posterior confirmación genética. A nivel psicopatológico, los pacientes afectados por este síndrome presentan, sobre todo, problemas cognitivos, de retraso en el lenguaje y de atención en la infancia y problemas relacionados con la esfera afectiva en la edad adulta. Presentamos el caso de un varón de 39 años con un primer episodio psicótico, con sintomatología positiva en primer plano, en el contexto de un diagnóstico previo de síndrome de Noonan. (AU)

First psychotic episode in a patient with Noonan syndrome. A case report Noonan syndrome is a genetic disease characterised by phenotypic facial abnormalities, short stature, heart and chest wall malformations, delayed neurodevelopment, infertility, and blood dyscrasias. Diagnosis is clinical, with subsequent genetic confirmation. At the psychopathological level, patients with this syndrome present cognitive problems, delayed language development and attention problems in childhood, and impaired affective functioning in adulthood. We present the case of a 39-year-old male with a first psychotic episode, with prominently positive symptoms, in the context of a previous diagnosis of Noonan syndrome. (AU)

Clinical remission in a cohort of first-episode psychosis: Data from the PEPs study / Remisión clínica en una cohorte de primer episodio psicótico: datos del estudio PEPs

Introduction: Patients that achieve clinical remission after a first episode of psychosis (FEP) present fewer relapses, lower consumption of health care resources and a better quality of life even twenty years later. This study aimed to determine the variables related to remission on a multicenter cohort of Spanish patients and its repercussions in functional outcomes. Methods: 244 FEP patients aged 7–35 years were included in this longitudinal prospective follow-up study. Remission was defined according to the Remission in Schizophrenia Working Group criteria. Demographic, premorbid, clinic, and functionality data were assessed at baseline and in four visits throughout two-years. Results: 162 subjects (66.4%) met remission criteria. These subjects were characterized by being older and earlier responders, they presented better premorbid adjustment, more insight, better functional outcome, and lower negative symptomatology in comparison to non-remitted. Discussion: Although remission rates and predictors described in the literature are very heterogeneous, the remission rate in our sample was similar to those previously reported. Early response to the treatment, level of insight, and negative symptoms severity were significant predictors of remission. Baseline and two-years follow-up functionality were significantly better in subjects in remission as well. Proposed remission criteria have an adequate discriminatory capacity for functional and symptomatic outcomes in this FEP sample framed in the PEPs Project. (AU)

Introducción: Los pacientes que logran remisión clínica tras un primer episodio psicótico (PEP) presentan menor recidiva, menor consumo de recursos sanitarios y mejor calidad de vida, incluso 20 años después. El objetivo de este estudio fue determinar las variables relacionadas con la remisión en una cohorte multicéntrica de pacientes españoles, así como sus repercusiones en los resultados funcionales. Métodos: En este estudio longitudinal de seguimiento prospectivo, se incluyó a 244 pacientes de PEP con edades comprendidas entre los siete y los 35 años. Se definió la remisión, de acuerdo con los criterios del Grupo de Trabajo para la Remisión en Esquizofrenia. Los datos demográficos, premórbidos, clínicos y de funcionalidad fueron evaluados basalmente, y durante las cuatro visitas a lo largo de dos años. Resultados: Ciento sesenta y dos sujetos (66,4%) cumplieron los criterios de remisión. Dichos sujetos se caracterizaron por ser respondedores mayores y tempranos, tener mejor ajuste premórbido, mayor percepción, mejor resultado funcional y menor sintomatología negativa, en comparación con los sujetos sin remisión. Discusión: Aunque las tasas de remisión y los factores predictivos descritos en la literatura son muy heterogéneos, la tasa de remisión en nuestra muestra fue similar a la tasa previamente reportada. La respuesta temprana al tratamiento, el nivel de percepción y la gravedad de los síntomas negativos fueron factores predictivos significativos de la remisión. De igual modo, la funcionalidad basal y a los dos años de seguimiento fueron significativamente mejores en los sujetos con remisión. Los criterios de remisión propuestos tienen una capacidad discriminatoria adecuada para los resultados funcionales y sintomáticos en esta muestra de PEP, enmarcada dentro del proyecto PEPs. (AU)

Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies.

INTRODUCTION: The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS: Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS: Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS: While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.

Características de pacientes con diagnóstico de primer episodio psicótico internados en un hospital universitario

RESUMEN Introducción: la esquizofrenia y otros trastornos psicóticos constituyen la mayor parte de los diagnósticos realizados en el Departamento de Emergencias y Admisión del Servicio de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción, seguidos por los trastornos depresivos y los trastornos de ansiedad. Objetivo: determinar las características de los pacientes con diagnóstico de primer episodio psicótico, siendo esta información relevante en el contexto de la atención que pueda brindarse a los mismos y a la información epidemiológica que proporciona. Metodología: estudio observacional, descriptivo, con muestreo no probabilístico, temporalmente retrospectivo. Se incluyó las historias clínicas de pacientes del Servicio de Psiquiatría del Hospital de Clínicas, de ambos sexos, que hayan sido hospitalizados con síntomas de un primer episodio psicótico entre 2014 y 2019. Resultados: se analizaron las historias clínicas de 143 pacientes. El 62,8% era del sexo femenino. La edad media fue 31 ± 13 años. El 48,9% tenía historial de diagnósticos psiquiátricos en su familia. El 66,43% era de nivel económico medio, el 32,17% nivel bajo y el 1,4% nivel alto. El pensamiento desorganizado fue el síntoma más frecuente (86%) encontrado en el examen del estado mental. Conclusiones: la mayoría de los pacientes con diagnóstico de primer episodio psicótico provenía del Departamento Central de Paraguay, residía en zonas urbanas, era del sexo femenino, era de nivel económico medio, aproximadamente la mitad con antecedentes de trastornos mentales en la familia y presentaba casi dos meses de evolución de la enfermedad. El pensamiento (ideas delirantes), el afecto, la introspección, el humor, el lenguaje y la sensopercepción (alucinaciones) fueron los indicadores más frecuentemente alterados del examen mental.

ABSTRACT Introduction: Schizophrenia and other psychotic disorders make up the majority of diagnoses made in the Emergency and Admission Department of the Psychiatry Service of the "Hospital de Clínicas" of the National University of Asunción, followed by depressive disorders and anxiety disorders. Objective: The objective of the present study was to determine the characteristics of the patients diagnosed with a first psychotic episode. This information is relevant in the context of the care that can be provided to patients and the epidemiological information provided. Methodology: This was an observational, descriptive study, with non-probabilistic sampling, temporarily retrospective. The medical records of male and female patients of the Psychiatry Service of the "Hospital de Clínicas" who have been hospitalized with symptoms of a first psychotic episode were included. Results: The medical records of 143 patients were analyzed, 62.8% of them was female. The mean age was 31.5 ± 13.6 years, 48.9% had a history of psychiatric diagnoses in their family, 66.43% had medium economic level, 32.17% low level and 1.4% high level. distortion in thinking was the most frequent symptom (86%) found in the mental state exam. Conclusions: The majority of patients diagnosed with the first psychotic episode came from the Central Department of Paraguay, resided in urban areas, were female, had medium economic status, approximately half had a history of mental disorders in the family and had almost two months of disease evolution. Thought (delusions), affection, introspection, humor, language, and perception (hallucinations) were the most frequently altered indicators of the mental examination.

When the healthcare does not follow the evidence: The case of the lack of early intervention programs for psychosis in Spain. / Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España.

There is now sufficient evidence to support the importance of interventions in the early stages of psychosis. The delay in the detection and treatment of the first-episode psychosis is related to a lower and slower recovery, as well as a higher risk of relapse. Despite this fact, early intervention units or teams are still not regularly implemented in mental health service settings in Spain. In this opinion article, a review is presented of the main arguments for defending the need to implement these programs and strategies in order to achieve this aim. There are a number of programs for early intervention for psychosis currently working in other countries, with a therapeutic program that includes pharmacological and psychosocial interventions, together with public awareness, information dissemination, and family-professional collaboration activities. Published literature on the experience of these programs indicates that early intervention is not only effective in terms of the improvement of health status, but is also economically efficient. The main steps and recommendations needed to implement such early intervention programs in our country are described.

Electroconvulsoterapia en el primer episodio de esquizofrenia: impacto en la evolución / Electroconvulsoterapia in the first episode of schizophrenia: impact on evolution

La esquizofrenia es una patología que evolucionade forma crónica, proclive al deterioro, siendo este último variable de acuerdo con comorbilidades presentes y adherencia al tratamiento integral. Genera alteraciones cognitivas e influye negativamente en el desempeño de quienes la padecen, causando detrimento global de los pragmatismos. La electroconvulsoterapia es una opción terapéutica ampliamente utilizada en nuestro país para tratar sintomatología del humor y episodios psicóticos agudos, entre otros. En la actualidad se sabe que la detección e intervención precoz de un episodio psicótico agudo —el cual puede corresponder al primer episodio psicótico de esquizofrenia —mejora el pronóstico a largo plazo. El objetivo es demostrar si existe un vínculo entre la indicación de electroconvulsoterapia durante el primer episodio psicótico de esquizofrenia y la duración del intervalo libre de internación. Este es un estudio de tipo analítico, observacional, retrospectivo (cohorte histórica) que busca aumentar las evidencias en este amplio campo de investigación. Observamos que el tiempo libre de internación luego de la primera hospitalización no tuvo relación con el hecho de si recibieron electroconvulsoterapia o no; sin embargo, al realizar el análisis de potencia estadístico surge que los resultados no son concluyentes. Se destaca el importante porcentaje de patología dual en este grupo de usuarios: un 39%.

Schizophrenia is a chronic disease, prone todeterioration, the latter being variable accordingto comorbidities and treatment adherence. It generates cognitive impairment and adverselyaffects overall performance, causing deterioration of pragmatisms. Electroconvulsive therapy is awidely used therapeutic option in our countryfor acute affective and psychotic episodes. It iswell known that early detection and interventionof an acute psychotic episode —which maycorrespond to the first psychotic episode of schizophrenia— improves long-term prognosis.This study intended to show whether there is alink between early indication of electroconvulsive therapy during the first episode and timeto relapse and hospital readmission. This is ananalytical, observational, retrospective (historical cohort) study, which aims to increase theevidence in this broad research field. As a resultthere was no link between time to relapse and electro convulsive therapy in the first episode; nevertheless after a post hoc analysis resultsare not conclusive. Dual diagnosis stands outin this group and corresponds to 39%.

Predictors of short-term course in Mexican first-episode psychosis patients / Predictores de curso temprano en pacientes mexicanos con primer episodio psicótico

Background and objectives The identification of prognostic factors in patients with schizophrenia and related psychotic disorders should enhance our understanding of the aetiology of these disorders and improve their treatment. The first years following an initial episode of psychosis are a <

Antecedentes y objetivos La identificación de factores pronósticos en pacientes con esquizofrenia y otros trastornos psicóticos relacionados podría facilitar la comprensión de la etiología de estos trastornos así como mejorar los tratamientos existentes. Los primeros años a partir del primer episodio psicótico son un <

Revisión actualizada de la relación BDNF, cognición y esquizofrenia/psicosis / BDNF, cognition and schizophrenia/psychosis: an updated review

El Factor Neurotrófico Derivado del Cerebro (BDNF) se ha relacionado con los síntomas cognitivos de la esquizofrenia, lo que se ha documentado en revisiones previas. Sin embargo, recientemente el foco de la investigación neurobiológica ha pasado de estudiar la esquizofrenia como enfermedad a estudiar las psicosis como grupo. El objetivo de esta investigación fue realizar una revisión actualizada de las publicaciones de los últimos cinco años (2013 a 2018) respecto a BDNF y síntomas cognitivos, tanto en esquizofrenia como en psicosis en general. Para esto se revisaron en PubMed los artículos con las palabras clave BDNF, cognitive y schizophrenia, y luego se repitió este proceso con la palabra psychosis. Como resultado, en el desarrollo del artículo se describe la manera en que distintos estudios, tanto en seres humanos como en modelos animales, dan cuenta de la relación entre BDNF y cognición, y de cómo influyen en ella elementos importantes como por ejemplo el género o el ejercicio. Sin embargo, se constata que aún la mayor parte de la investigación respecto a BDNF y síntomas cognitivos en psicosis se realiza en torno a la esquizofrenia como enfermedad. Por lo tanto, es necesario ampliar el estudio de la relación entre BDNF y síntomas cognitivos a cuadros psicóticos de distintos estadios y orígenes

Brain Derived Neurotrophic Factor (BDNF) has been linked to cognitive symptoms of schizophrenia, which has been documented in previous reviews. However, recently the focus of neurobiological research has moved from studying schizophrenia as a disease to studying psychosis as a group. The main aim of this research was to carry out an updated review of all relevant publications in the last 5 years (2013 to 2018) regarding BDNF and cognitive symptoms, both in schizophrenia and in psychosis. In order to achieve this, the keywords BDNF, cognitive and schizophrenia were reviewed in PubMed, and then this process was repeated with the word psychosis. As a result, in this article we describe the way in which different studies, both in human beings and in animal models, account for the relation between BDNF and cognition, and for the way in which important elements such as gender or exercise influence it. However, we found that still most of the research regarding BDNF and cognitive symptoms in psychosis is done around schizophrenia as a disease. Therefore, it is necessary to expand the study of the relationship between BDNF and cognitive symptoms to psychotic illnesses of different stages and origins

Impacto de la duración de la psicosis no tratada en pacientes con primer episodio psicótico: estudio de seguimiento a un año / Impact of the duration of untreated psychosis among patients with a first episode: a one year follow-up study

Antecedentes: El retraso en la atención especializada conlleva a implicaciones pronósticas en los pacientes con trastornos psicóticos. La duración de la Psicosis No Tratada (DPNT) es un parámetro importante con valor pronóstico. Una DPNT larga se asocia con un peor pronóstico clínico. Objetivo: Determinar la DPNT en un grupo de pacientes con primer episodio psicótico y determinar su influencia en los índices de recuperación y recaída a un año de seguimiento. Material y métodos: Se incluyeron 66 pacientes en su primer episodio psicótico que agrupados en psicosis afectivas y no afectivas. El diagnóstico se efectuó con el SCAN. Se registró la DPNT y se evaluó la severidad de los síntomas psicóticos y afectivos con instrumentos validados en nuestro medio. Resultados: Se observó mejoría sindromática global en los grupos diagnósticos. Los pacientes con DPNT larga presentaron menor ajuste psicosocial global y menor índice de recuperación. La suspensión del tratamiento fue el principal predictor de las recaídas. Conclusiones: la DPNT es un importante factor asociado al pronóstico. El modelo de los estudios de detección temprana permite reducir el tiempo que tarda en tratarse la psicosis, e identificar oportunamente a los pacientes que han tenido el primer episodio psicótico.

BACKGROUND: The delay on the onset of specific treatment has several prognostic implications for psychotic patients. Duration of untreated psychosis (DUP) has been considered a prognostic variable. A longer DUP has been associated with a poor clinical outcome. OBJECTIVE: To determine the DUP in a sample of first-episode psychotic patients and its relationship with recovery and relapse on a one-year follow-up study. MATERIAL AND METHODS: A sample of 66 first-episode psychotic patients was recruited and divided according to their diagnoses in affective and non-affective psychoses. Diagnoses were obtained with SCAN and DUP was registered for each patient. A clinical assessment for psychotic and affective symptoms was performed using standardized instruments. RESULTS: All patient studied showed clinical improvement during follow-up. Patients with a longer DUP showed poorer psychosocial adjustment and lower recovery indexes. Treatment suspension was the main variable associated with relapse. CONCLUSIONS: DUP is an important prognostic variable. Early detection programs are required to decrease the period between illness onset, diagnosis and treatment in first-episode psychotic patients.

Disfunción estructural del lóbulo temporal en pacientes con un primer episodio psicótico de esquizofrenia

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Abstract: Magnetic resonance imaging (MRI) has been useful in revealing subtle structural differences in the brains of schizophrenic patients compared with healthy controls. MR structural analyses have revealed a number of brain abnormalities including ventricular enlargement, total brain volume reduction, and regional reductions in brain volume in frontal, parietal and temporal regions. However, it is still unknown whether the brain abnormalities observed with MRI in schizophrenia are confounded by chronicity or whether there is a continual degenerative process. Evaluation of the brain structure during the first episode of psychosis (FEP) is a powerful strategy for investigating these fundamental questions. The first-episode design avoids the confusion of chronicity of illness, longstanding substance abuse, and the effects of treatment. Structural MRI studies of patients experiencing a first-episode psychosis have revealed a similar pattern of brain abnormalities as in samples of chronic patients, although deficits may be less extensive. The temporal lobe, a brain structure traditionally implicated in the pathophyisiology of schizophrenia, has been examined often in first-episode studies. Many studies have reported significant abnormalitites in the medial areas and superior temporal gyri. However, most studies examining the whole temporal lobe have been unable to show such significant abnormalities. In the light of the increasing amount of ambiguous findings regarding structural temporal lobe abnormalities in patients with schizophrenia experiencing their first-episode of psychosis, a quantitative review of the existing literature was needed to better characterize the temporal lobe deficits observed with MRI in those patients. Thus we conducted a systematic review of structural MRI studies of patients with first-episode schizophrenia in which volume measurements of temporal lobe structures were reported. Using meta-analytical methods, we carried out an analysis of the temporal lobe volumes in these FEP patients and the comparison subjects. In addition to solving the problems of traditional narrative reviews, a meta-analysis provides tools for integrating quantitative data from multiple studies, improving the overall effect size of variables of interest, and increasing statistical power. Eighteen studies were identified as suitable for the present analysis. These studies included 575 FEP patients and 738 control subjects. The average number of patients across studies was 32. The majority of patients in the studies were male (62%) and the average age of patients was 27 years old. In terms of structural brain findings, and assuming a volume of 100% in the comparison group, we found that the mean temporal volume of subjects with FEP was smaller (95%), as well as the analysis of regional structures such as left amygdala (95%), hippocampus-amygdala (left 92%, right 94%), hippocampus (left 85%, right 96%), and left temporal lobe (97%). Right temporal lobe volume was slightly greater (104%) and there was no difference in the volume of the right amygdala. Although this review was focused on evaluating the findings on temporal lobe deficits in patients with a first episode of psychosis, other brain region volumes were analyzed. The whole brain volume (95%) and frontal lobe volume (right 98%, left 99%) were lower in patients than in the comparison subjects. It is important to consider several potential limitations of this study. The first one has to do with the methodology employed to analyze structural MRI data. The method of choice in investigating the distribution of subtle cerebral pathology in schizophrenia has been an examination of anatomically defined regions of interest (ROI) within the brain. This method has some limitations, including the manual tracing of ROI on successive brain slices, a time consuming process that does not easily allow for the comparison of many brain regions or for the examination of volume differences in large samples of subjects. Furthermore, the question of validity is relevant as the ROI is investigator-determined and depends on the complex interindividual variability of the brain. The other method used in two studies included in this review is the voxel-based morphometry (VBM). This is an automated statistical method for examining structural MR images of the brain. VBM methodology makes voxel-wise comparisons of the local concentrations of grey matter between two groups of subjects and offers a more rapid and extensive survey of grey matter abnormalities in patients than ROI analysis. An important limitation of this methodology is that it has less regional sensitivity compared to the ROI technique and that these differences have to be considered in the interpretation of the results. Secondly, although our review only considered studies with patients experiencing a first episode of psychosis in schizophrenia (and not affective psychotic disorders), the fact that different investigators used somewhat different criteria when making their diagnoses could have introduced a potential bias in our inclusion process. Thus, it is possible that our results can not be generalized to the full population of first-episode patients. For instance, although most of the studies included used either DSM-IV diagnostic criteria (16 studies) or the Research Diagnostic Criteria (2 studies), variability may arise because many authors did not consider previous psychotic episodes in which patients were treated with antipsychotic medications for less than 30 days. In conclusion, this meta-analysis suggests that schizophrenic patients present temporal lobe differences, mainly diminished volume values in mesial temporal lobe structures during the initial presentation of a first episode of their illness. However, our results indicated that there was also evidence of global volume changes and regional volume decreases in the frontal lobes of these patients. This data, derived from patients in the early courses of their illness, is compatible with developmental hypotheses of schizophrenic abnormalities and with the view of schizophrenia as a neuropsychiatric disorder with marked deficits in the temporal lobes. However, the central questions in schizophrenia research regarding which brain abnormalities are independent of psychosis and which evolve before and after psychosis begins still remain unanswered. We think that these questions can be addressed by longitudinal neuroimaging studies beginning in the prodromal phase of the illness or by evaluating high-risk subjects during the critical period of transition to first-episode psychosis.