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Harefuah ; 160(1): 8-12, 2021 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-33474872


INTRODUCTION: In patients with schizophrenia the most impaired competence is cognition. However, the sociodemographic and medical contributors to the various neurocognitive deficits have yet to be determined. OBJECTIVES: To assess the impact of age, physical diseases, anticholinergic medications, gender and level of education on psychotic inpatients' cognitive capabilities. METHODS: This is a retrospective chart review. Participants: 249 (153 men and 96 women) inpatients with psychosis (schizophrenia or schizoaffective disorders) who underwent cognitive evaluation using occupational therapy tools, namely, Shulman's Clock Drawing Test (SCDT) and the Neurobehavioral Cognitive Status Examination (NCSE). RESULTS: Significant linear relationship was found between age (p<0.001), presence of relevant physical diseases (p<0.05) and level of education (p<0.001) and between cognitive performance. Anticholinergic medications and gender did not affect cognitive capabilities. CONCLUSIONS: Age, physical diseases and education, but not anticholinergics, seem to impact cognitive capabilities of inpatients with psychosis. DISCUSSION: The study indicates higher sensitivity of the Neuro-Behavioral-Cognitive Status Test than that of the Clock Drawing Test, when physical illnesses are present. Aditionally, according to the results of both tests, one may assume that a high level of education constitutes a protective element from cognitive deterioration in schizophrenia.

Transtornos Psicóticos , Esquizofrenia , Cognição , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Transtornos Psicóticos/diagnóstico , Estudos Retrospectivos , Psicologia do Esquizofrênico
Nonlinear Dynamics Psychol Life Sci ; 25(1): 1-18, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308387


The analysis of handwriting has been used in several contexts. For example, handwriting has shown to be of value in the study of motor symptoms in neurological and mental disorders. In the present work, the geometric analysis of handwriting patterns is proposed as a tool to evaluate motor symptoms in psychotic disorders. Specifically, we have employed the lacunarity, a measure of the heterogeneity of a spatial structure. Forty-two patients with a psychotic disorder and 35 matched healthy controls participated in the study. Participants were asked to copy some patterns with a pen on a white paper. The results showed that lacunarity was significantly higher in handwritten patterns from patients than from controls. In addition, we found higher values of lacunarity in handwritten patterns from patients with severe motor symptoms in comparison with patients with mild or absent motor symptoms. Lacunarity of handwritten patterns was significantly correlated with clinical scores of rigidity. In conclusion we argue that the heterogeneity of handwritten patterns could be used as a simple and objective measure of motor symptoms.

Escrita Manual , Transtornos Motores , Transtornos Psicóticos , Humanos , Transtornos Motores/diagnóstico , Transtornos Motores/fisiopatologia , Transtornos Motores/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/fisiopatologia
Lancet Digit Health ; 2(5): e229-e239, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-33328055


BACKGROUND: Many individuals who will experience a first episode of psychosis (FEP) are not detected before occurrence, limiting the effect of preventive interventions. The combination of machine-learning methods and electronic health records (EHRs) could help address this gap. METHODS: This case-control development and validation study is based on EHR data from IBM Explorys. The IBM Explorys Platform holds standardised, longitudinal, de-identified, patient-level EHR data pooled from different health-care systems with distinct EHRs. The present EHR-based studies were retrospective, matched (1:1), case-control studies compliant with RECORD, STROBE, and TRIPOD statements. The study included individuals in the IBM Explorys database who at some point between 1990 and 2018 had a diagnosis of FEP followed by schizophrenia, and psychosis-free matched control individuals from a random subsample of the full cohort. For every individual in the FEP cohort, the individual in the control cohort was matched to have a similar date for inclusion in the database and a similar total observation time. Individuals in the FEP cohort had their index date defined as the first diagnosis of psychosis or the first prescription of antipsychotic medication. Individuals in the control cohort had their index date defined to occur the same number of days after inclusion in the database as their matching FEP individual. The FEP and control cohorts were both randomly split into development and validation datasets in a ratio of 7:3. The subset of individuals in the validation dataset who had all their health-care encounters at providers that were not seen in the development dataset made up the external validation subset. A novel recurrent neural network model was developed to predict the risk of FEP 1 year before the index date by employing demographics and medical events (in the categories diagnoses, prescriptions, procedures, encounters and admissions, observations, and laboratory test results) dynamically collected in the EHR as part of clinical routine. We named the recurrent neural network Dynamic ElecTronic hEalth reCord deTection (DETECT). The main outcomes were accuracy and area under receiver operating characteristic curve (AUROC). Decision-curve analyses and dynamic patient journey plots were used to evaluate clinical usefulness. FINDINGS: The FEP and control cohorts each comprised 72 860 individuals. 102 030 individuals (51 015 matching pairs) were randomly allocated to the development dataset and the remaining 43 690 to the validation dataset. In the validation dataset, 4770 individuals had all their encounters outside of the 118 790 health-care providers that were encountered in the development dataset. The data from these individuals made up the external validation subset. The median follow-up (observation time before index date) was 6·0 years (IQR 3·0-10·4). In the development dataset, DETECT's prognostic accuracy was 0·787 and AUROC was 0·868. In the validation dataset, DETECT's prognostic accuracy was 0·774 and AUROC was 0·856. In the external test subset, DETECT's balanced prognostic accuracy was 0·724 and AUROC was 0·799. Prevalence-adjusted decision-curve analyses suggested that DETECT was associated with a positive net benefit in two different scenarios for FEP detection. INTERPRETATION: DETECT showed adequate prognostic accuracy to detect individuals at risk of developing a FEP in primary and secondary care. Replication and refinement in a population-based setting are needed to consolidate these findings. FUNDING: Lundbeck.

Análise de Dados , Registros Eletrônicos de Saúde , Aprendizado de Máquina , Modelos Biológicos , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto , Área Sob a Curva , Estudos de Casos e Controles , Estudos de Coortes , Gerenciamento de Dados , Bases de Dados Factuais , Conjuntos de Dados como Assunto , Assistência à Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 199-207, dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1145501


La encefalitis límbica es una enfermedad infrecuente y potencialmente grave, que puede o no ser paraneoplásica y se caracteriza por déficit de la memoria reciente, alteraciones psiquiátricas y convulsiones. De origen autoinmunitario, está asociada a anticuerpos séricos e intratecales contra antígenos neuronales intracelulares y de superficie, con especial afectación de zonas límbicas. En este artículo se revisan aspectos históricos y epidemiológicos, patogenia, síndromes más frecuentes y mejor delimitados, histopatología y estudios complementarios. Se repasan también las dificultades del diagnóstico diferencial y la necesidad de descartar siempre un tumor subyacente. La detección de autoanticuerpos neuronales es importante para el diagnóstico, la planificación terapéutica y el pronóstico. La inmunoterapia y, si corresponde, el tratamiento de la neoplasia son cruciales para lograr una recuperación neurológica sustancial. La encefalitis límbica es una entidad probablemente subdiagnosticada, con un pronóstico más favorable si se trata de forma temprana. El actual conocimiento de su patogenia puede además aportar claridad para la mejor comprensión de otros síndromes neurológicos y psiquiátricos que puedan compartir mecanismos autoinmunitarios, como algunos trastornos psicóticos y epilepsias farmacorresistentes. (AU)

Limbic encephalitis is a rare and potentially serious disease, which may or may not be paraneoplastic and is characterized by recent memory deficits, psychiatric disturbances and seizures. Of autoimmune origin, it is associated with serum and intrathecal antibodies against intracellular and surface neuronal antigens, with special involvement of limbic areas. This article reviews historical and epidemiological aspects, pathogenesis, more frequent and better defined syndromes, histopathology and complementary studies. The difficulties of differential diagnosis and the need to always rule out an underlying tumor are also reviewed. Detection of neuronal autoantibodies is important for diagnosis, therapeutic planning and prognosis. Immunotherapy and, if appropriate, neoplasm treatment, are crucial to achieve substantial neurological recovery. Limbic encephalitis is probably an underdiagnosed entity, with a more favorable prognosis if treated early. The current knowledge of its pathogenesis may also provide clarity for a better understanding of other neurological and psychiatric syndromes that may share autoimmune mechanisms, such as some psychotic disorders and drug-resistant epilepsies. (AU)

Humanos , Autoanticorpos/metabolismo , Doenças Autoimunes/patologia , Síndromes Paraneoplásicas do Sistema Nervoso/patologia , Encefalite Límbica/patologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etiologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/etiologia , Doenças Autoimunes/terapia , Literatura de Revisão como Assunto , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/etiologia , Síndromes Paraneoplásicas do Sistema Nervoso/terapia , Encefalite Límbica/diagnóstico , Encefalite Límbica/etiologia , Encefalite Límbica/história , Encefalite Límbica/terapia , Epilepsia/diagnóstico , Epilepsia/etiologia
Psychiatr Danub ; 32(3-4): 320-324, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370728


From January 2022, the WHO member countries shall start implementing the mortality and morbidity statistics (MMS) version of the eleventh revision of the International Classification of Diseases (ICD-11). Regarding mental, behavioural or neurodevelopmental disorders, there are substantial changes from ICD-10 to ICD-11. The subchapter for schizophrenia or other primary psychotic disorders has changed due to a revised structure, new diagnostic criteria, and the introduction of dimensional elements (i.e., course and symptom qualifiers). The aim of this manuscript is twofold. First, we review changes from ICD-10 to ICD-11 in the classification and diagnosis of schizophrenia or other primary psychotic disorders, including findings from recent field studies. Second, we provide an overview of approaches to the implementation of ICD-11 in clinical practice. Critical elements for transition from ICD-10 to ICD-11 include the use of digital tools, education and training, stakeholder involvement, national adaptations, and continuous evaluation.

Classificação Internacional de Doenças , Transtornos Psicóticos/classificação , Transtornos Psicóticos/diagnóstico , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , Humanos
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130587


A previously fit and well 37-year-old male healthcare worker presented with confusion, psychotic symptoms and a suicide attempt in the context of a new COVID-19 diagnosis. Following surgical interventions and an extended admission to the intensive care unit, he made a good recovery in terms of both his physical and mental health. A number of factors likely contributed to his presentation, including SARS-CoV-2 infection, severe insomnia, worry, healthcare worker-related stress, and the unique social and psychological stressors associated with the COVID-19 pandemic. This case highlights the need to further characterise the specific psychiatric sequelae of COVID-19 in community settings, and should remind general medical clinicians to be mindful of comorbid psychiatric symptoms when assessing patients with newly diagnosed COVID-19.

Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tentativa de Suicídio/prevenção & controle , Adulto , Infecções por Coronavirus/psicologia , Humanos , Masculino , Enfermeiros/psicologia , Estresse Ocupacional/complicações , Estresse Ocupacional/diagnóstico , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/psicologia , Prognóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Medição de Risco , Transtornos de Estresse Pós-Traumáticos/complicações , Estresse Psicológico , Resultado do Tratamento , Reino Unido
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5575-5579, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019241


The diagnosis and treatment of psychiatric disorders depends on the analysis of behavior through language by a clinical specialist. This analysis is subjective in nature and could benefit from automated, objective acoustic and linguistic processing methods. This integrated approach would convey a richer representation of patient speech, particularly for expression of emotion. In this work, we explore the potential of acoustic and prosodic metrics to infer clinical variables and predict psychosis, a condition which produces measurable derailment and tangentiality in patient language. To that purpose, we analyzed the recordings of 32 young patients at high risk of developing clinical psychosis. The subjects were evaluated using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS) criteria. To analyze the recordings, we examined the variation of different acoustic and prosodic metrics across time. This preliminary analysis shows that these features can infer negative symptom severity ratings (i.e., SIPS-Btotal), obtaining a Pearson correlation of 0.77 for all the subjects after cross-validated evaluation. In addition, these features can predict development of psychosis with high accuracy above 90%, outperforming classification using clinical variables only. This improved predictive power ultimately can help provide early treatment and improve quality of life for those at risk for developing psychosis.

Transtornos Psicóticos , Fala , Acústica , Adolescente , Humanos , Sintomas Prodrômicos , Transtornos Psicóticos/diagnóstico , Qualidade de Vida
Inf. psiquiátr ; (241): 9-13, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-197440


En el año 2017, el Plan director de Salud Mental y Adicciones de Catalunya, puso en marcha el Programa PAE-TPI (Programa de Atención Específica al Trastorno Psicótico Incipiente) después de unos años de corroborar la eficacia de los programas pilotos implementados desde el año 2007 en el territorio catalán. Este programa, es la propuesta de un método organizativo y de un proceso activo de gestión de la psicosis focalizada en la comunidad. Se basa en la detección precoz y la atención individualizada en la que, el vínculo, es uno de los puntos fuertes. Este artículo recoge la puesta en marcha y la preparación previa así como el tipo de intervención propuesta y realizada. También se aportarán datos descriptivos derivados del primer año de asistencia clínica. El programa abarca el área geográfica de Terrassa y Sant Cugat del Vallés

In 2017, the Master Plan for Mental Health and Addictions of Catalonia, launched the PAE-TPI Program (Program for Specific Attention to Incipient Psychotic Disorder) after a few years of corroborating the effectiveness of the pilot programs implemented since 2007 in the Catalan territory. This program is the proposal of an organizational method and a process active management of community-focused psychosis. Is based on the early detection and individualized attention in which the reliance is one of the strengths. This article includes the start-up and previous preparation as well as the type of intervention proposed and carried out. Descriptive data derived from the first year of clinical care will also be provided. The program covers the geographical area of Terrassa and Sant Cugat del Vallés

Humanos , Serviços de Saúde Mental/organização & administração , Transtornos Psicóticos/terapia , Implementação de Plano de Saúde , Intervenção Médica Precoce/organização & administração , Transtornos Psicóticos/diagnóstico , Continuidade da Assistência ao Paciente/organização & administração , Qualidade de Vida
Inf. psiquiátr ; (241): 15-33, jul.-sept. 2020. mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-197441


La atención a las personas que han desarrollado o pueden llegar a desarrollar una psicosis incipiente debe realizarse de forma precoz. Por ello, la detección es el paso fundamental, seguida del diagnóstico, tratamiento y recuperación de la persona. Todas estas intervenciones transversales son realizadas por diferentes profesionales sanitarios y no sanitarios ubicados en dispositivos diferentes y de entidades proveedoras dispares, lo cual requiere la creación de alianzas y trabajo en red bajo el paraguas de una Unidad Funcional que permita situar a la persona en el centro para que pueda recibir la atención más necesaria en cada momento siguiendo su proyecto vital. Dicha Unidad Funcional debe ser territorial, transversal y comunitaria. En este artículo mostramos el proceso que se ha seguido en la creación de las unidades funcionales del Programa de Atención Específica al Trastorno Psicótico Incipiente (PAE- TPI), así como las comisiones de seguimiento y los resultados preliminares para cada uno de los sectores de referencia de Benito Menni CASM (L'Hospitalet, Sant Boi y Vallès Oriental)

Attention to people who have developed or may develop an incipient psychosis should be done early. Therefore, detection is the fundamental step, followed by diagnosis, treatment and recovery of the person. All these cross-cutting interventions are carried out by different health and non-health professionals, who work in different services and from different providers. The creation of a Functional Unit have two main aims: to reach a professional networking as well as to offer a personalized intervention and a long term monitoring to the target patients of the program. This Functional Unit must be territorial, transversal and community based. In this article we show the process that has been followed in order to create the functional units and the monitoring work commissions of the "Program of Specific Attention to the Incipient Psychotic Disorder", as well as inform about the preliminary results of the three reference population areas assisted by Benito Menni CASM (L'Hospitalet, Sant Boi and Vallès Oriental)

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Assistência Centrada no Paciente/organização & administração , Intervenção Médica Precoce/organização & administração , Transtornos Psicóticos/terapia , Serviços de Saúde Mental/normas , Estratégias , Intervenção Médica Precoce/métodos , Transtornos Psicóticos/diagnóstico , Pessoal de Saúde/organização & administração , Nível de Saúde , Prestação Integrada de Cuidados de Saúde/organização & administração , Psicometria
Inf. psiquiátr ; (241): 35-44, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197442


Los Programas de Atención Específica a los Trastornos Psicóticos Iniciales (PAE-TPI) se han generalizado en los servicios de salud mental, siendo hoy en día algo imprescindible. El Programa de Atención de Trastornos Psicóticos Incipientes de Sagrat Cor se desarrolló a finales de 2017 en el marco estratégico definido en el Pla de Salut del Departament de Salut de la Generalitat de Catalunya. Ante un primer episodio psicótico un paciente es necesaria una intervención precoz que evite el deterioro psicosocial y prevenga las recaídas, y esta sólo puede sustentarse en un diagnóstico precoz. En el medio actual, los servicios de Atención Primaria constituyen la puerta de entrada al entorno sanitario y la Atención Primaria debería ser capaz de detectar los trastornos psicóticos lo más precoz posible, pero la realidad es que aún resulta un nivel de detección insuficiente. Desde el PAE-TPI de Sagrat Cor se han implementado estrategias a incrementar la capacidad de detección precoz de la psicosis desde Atención Primaria basadas en una doble intervención de informativa y formativa

Programs of Specific Attention to Initial Psychotic Disorders (PAE-TPI) have become widespread in mental health services, being today something essential. The Program of Attention of Incipient Psychotic Disorders of Sagrat Cor was developed at the end of 2017 in the strategic framework defined in the Salut Department of the Department of Health of the Generalitat de Catalunya. Before a first psychotic episode a patient is needed an early intervention that prevents psychosocial deterioration and prevents relapses, and this can only be based on an early diagnosis. In the current environment, Primary Care services are the gateway to the healthcare environment and Primary Care should be able to detect psychotic disorders as early as possible, but the reality is that there is still an insufficient level of detection. From the PAE-TPI of Sagrat Cor, strategies have been implemented to increase the capacity for early detection of psychosis from Primary Care based on a double informative and formative intervention

Humanos , Adolescente , Adulto Jovem , Atenção Primária à Saúde/organização & administração , Transtornos Psicóticos/diagnóstico , Intervenção Médica Precoce/métodos , Diagnóstico Precoce , Medição de Risco , Prevenção Secundária , Serviços de Saúde Mental/organização & administração , Sistemas de Apoio Psicossocial , Tempo para o Tratamento
Psiquiatr. biol. (Internet) ; 27(2): 68-70, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193249


OBJETIVO: El interés del caso es la documentación de las vicisitudes asistenciales de personas con TMG que se presentan con creencias religiosas inusuales (nuestra paciente era devota de Hare Krishna) y que además estén en una insólita situación de desaparición y necesidad de identificación policial. CASO CLÍNICO: Se trata de una mujer con diagnóstico de trastorno psicótico crónico, que fue ingresada en una Unidad de Hospitalización de Adultos de Psiquiatría por orden judicial. Transcurridas varias semanas de su ingreso, finalmente, fue identificada por la policía científica, donde constaba que se encontraba desaparecida desde hacía dos años en otra Comunidad Autónoma. RESULTADOS: Entre las personas sin hogar destaca una elevada prevalencia de trastorno mental, patología dual o ambos. En recientes estudios se encontraron las siguientes características sociodemográficas: mayor proporción de hombres, edad media, más sintomatología médica, bajo nivel de educación, mayor gravedad de síntomas psiquiátricos, con un deterioro funcional grave, periodos de más de 36 meses de estar sin hogar, y casi la mitad presentaban abuso de sustancias. Se encontró que el 78% de los pacientes tenían trastorno mental con psicosis. Además, en otro estudio, se objetivó que la mortalidad en mujeres indigentes de más de 45 años era más del doble de lo esperado. CONCLUSIONES: Sería conveniente mejorar las estructuras y procesos del trabajo comunitario, como se realiza en otros países de Europa, para poder atender a las personas sin hogar de una forma más adecuada, asegurando que reciben los servicios de salud que requieran

OBJECTIVE: The interest of this case is the documentation of the healthcare vicissitudes of people with Severe Mental Illness (SMI) who have unusual religious beliefs (our patient was a devotee of Hare Krishna), and who are also in an unusual situation of disappearance, and need of police identification. CLINICAL CASE: This is a woman diagnosed with chronic psychotic disorder, who was admitted to an Adult Psychiatric Ward by court order. After several weeks of admission, she was finally identified by the forensic police, stating that she had been missing for two years in another city. RESULTS: There is a high prevalence of mental disorder and/or dual disorder among the homeless. In recent studies the following sociodemographic characteristics were found: higher proportion of men, middle aged, more medical symptoms, low level of education, greater severity of psychiatric symptoms, with severe functional impairment, periods of more than 36 months of being homeless, and almost half had substance abuse. More than three-quarters (78%) of patients were found to have mental disorder with psychosis. Furthermore, in another study, it was found that mortality was more than double that expected in homeless women over 45 years old. CONCLUSIONS: It would be worthwhile to improve the structures and processes of community work, as has happened in other European countries, in order to be able to attend to the homeless in a more adequate way, ensuring that they receive the health services they deserve

Humanos , Feminino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Religião , Pessoas em Situação de Rua , Índice de Gravidade de Doença , Doença Crônica
Psychopathology ; 53(2): 103-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32610320


BACKGROUND: The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of first-rank symptoms for schizophrenia. Yet, it seems that Schneider's original concept of first-rank symptoms was overly simplified when it was introduced in DSM-III. Specifically, it was overlooked that first-rank symptoms, in Schneider's understanding, fundamentally involve a disorder of the self. The aim here is to empirically test Schneider's claim that first-rank symptoms involve self-disorders. METHODS: In a modified, cross-sectional study of 98 first-admission patients, the relation between lifetime presence of first-rank symptoms and self-disorders was examined. Self-disorders were examined with the EASE (Examination of Anomalous Self-Experiences). RESULTS: We found an odds ratio of 1.56 (95% CI 1.10-2.21) for having first-rank symptoms for each 5-point increase in the EASE (measuring self-disorder) using a generalized linear mixed model regression. We did not find first-rank symptoms in the absence of self-disorders. CONCLUSION: The close relation between first-rank symptoms and self-disorders seems to support Schneider's original concept of first-rank symptoms. We suggest that first-rank symptoms occurring without the pervasively altered self-experiences might not be different from other psychotic phenomena in terms of their diagnostic significance. Awareness of self-disorders can help clinicians in assessing and detecting first-rank symptoms.

Transtornos Psicóticos/diagnóstico , Adulto , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino
BMC Psychiatry ; 20(1): 289, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513209


BACKGROUND: This study aimed to identify predictors and perceived facilitators of positive change and posttraumatic growth in persons with a first episode of psychosis using a mixed methods convergent design. METHODS: In the quantitative component, 94 participants completed measures of posttraumatic growth and predictors of posttraumatic growth. The qualitative component involved in-depth interviews with 12 participants. RESULTS: Quantitative results revealed that being hospitalized for psychosis, spiritual coping, positive reframing and subjective recovery were significant predictors of posttraumatic growth. Qualitative findings revealed that positive change was perceived to be facilitated by the psychosis itself; receiving mental health services; drawing on personal and social resources and strategies; healing and recovering; a meaning-making and knowledge gaining process; and normative developmental processes. CONCLUSIONS: Posttraumatic growth following a first episode of psychosis may therefore be facilitated by complex person-environment interactions.

Adaptação Psicológica , Serviços de Saúde Mental/organização & administração , Crescimento Psicológico Pós-Traumático , Transtornos Psicóticos/diagnóstico , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos Psicóticos/psicologia , Pesquisa Qualitativa
J Vis Exp ; (159)2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32478737


Recent studies have shown that an automated, lifespan-inclusive, transdiagnostic, and clinically based, individualized risk calculator provides a powerful system for supporting the early detection of individuals at-risk of psychosis at a large scale, by leveraging electronic health records (EHRs). This risk calculator has been externally validated twice and is undergoing feasibility testing for clinical implementation. Integration of this risk calculator in clinical routine should be facilitated by prospective feasibility studies, which are required to address pragmatic challenges, such as missing data, and the usability of this risk calculator in a real-world and routine clinical setting. Here, we present an approach for a prospective implementation of a real-time psychosis risk detection and alerting service in a real-world EHR system. This method leverages the CogStack platform, which is an open-source, lightweight, and distributed information retrieval and text extraction system. The CogStack platform incorporates a set of services that allow for full-text search of clinical data, lifespan-inclusive, real-time calculation of psychosis risk, early risk-alerting to clinicians, and the visual monitoring of patients over time. Our method includes: 1) ingestion and synchronization of data from multiple sources into the CogStack platform, 2) implementation of a risk calculator, whose algorithm was previously developed and validated, for timely computation of a patient's risk of psychosis, 3) creation of interactive visualizations and dashboards to monitor patients' health status over time, and 4) building automated alerting systems to ensure that clinicians are notified of patients at-risk, so that appropriate actions can be pursued. This is the first ever study that has developed and implemented a similar detection and alerting system in clinical routine for early detection of psychosis.

Registros Eletrônicos de Saúde/normas , Armazenamento e Recuperação da Informação/normas , Transtornos Psicóticos/diagnóstico , Algoritmos , Humanos , Estudos Prospectivos , Medição de Risco
BMJ Case Rep ; 13(6)2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-32540882


A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient's mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.

Sintomas Afetivos , Betacoronavirus/isolamento & purificação , Clonazepam/administração & dosagem , Infecções por Coronavirus , Olanzapina/administração & dosagem , Pandemias , Pneumonia Viral , Agitação Psicomotora , Transtornos Psicóticos/diagnóstico , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/tratamento farmacológico , Sintomas Afetivos/etiologia , Betacoronavirus/patogenicidade , Líquido Cefalorraquidiano/virologia , Infecções por Coronavirus/líquido cefalorraquidiano , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Serviços Médicos de Emergência/métodos , Cefaleia/etiologia , Cefaleia/virologia , Humanos , Masculino , Neuroimagem/métodos , Pneumonia Viral/líquido cefalorraquidiano , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia , Psicotrópicos/administração & dosagem , Resultado do Tratamento