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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 35-41, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-31950787

RESUMO

Objective: We analyzed the brain structure of schizophrenia patients from multiple perspectives to explore the relationship between the duration of untreated psychosis (DUP) and clinical outcomes. Methods: For 85 patients and 86 controls, clinical symptoms and cognitive function were evaluated, magnetic resonance imaging (MRI) and free surfer analysis were used to extract the cortical indicator, such as brain cortex thickness, surface area, volume, and so on. The patients were divided into four subgroups according to the boundary of March, June and two year due to the distribution and median of DUP. Finally multi-group comparison and correlation analysis for above indicators were analysed. Results: DUP was associated with the surface area of the left insula, parsorbitalis, right hippocampus, superior frontal gyrus, frontal pole, and temporal pole; DUP mainly influenced the cortical thickness of left posterior cingulate gyrus, postcentral gyrus, right lateral occipital cortex, parsopercularis, medial orbitofrontal cortex, and the bilateral precentral gyrus. For cortical volume, DUP significantly affected left postcentral gyrus, right precuneus, lateral occipital cortex, parsopercularis, lingual gyrus, superior temporal gyrus, bilateral cuneus, pericalcarine cortex, precentral gyrus,superior parietal lobule, and insula.The first three months after onset is a critical period for the deterioration of cortical morphology and clinical function. Conclusion: DUP in first-episode schizophrenia is associated with cortical morphological changes of temporal lobe, precentral, orbitofrontal cortex and the majority of medial regions of occipital lobe, it is very important to conduct early intervention for patients.


Assuntos
Córtex Cerebral , Imagem por Ressonância Magnética , Transtornos Psicóticos , Esquizofrenia , Córtex Cerebral/diagnóstico por imagem , Humanos , Transtornos Psicóticos/diagnóstico por imagem , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/patologia , Lobo Temporal/diagnóstico por imagem , Fatores de Tempo
2.
Lancet Psychiatry ; 7(1): 93-108, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31669058

RESUMO

There is increasing recognition in the neurological and psychiatric literature of patients with so-called isolated psychotic presentations (ie, with no, or minimal, neurological features) who have tested positive for neuronal autoantibodies (principally N-methyl-D-aspartate receptor antibodies) and who have responded to immunotherapies. Although these individuals are sometimes described as having atypical, mild, or attenuated forms of autoimmune encephalitis, some authors feel that that these cases are sufficiently different from typical autoimmune encephalitis to establish a new category of so-called autoimmune psychosis. We briefly review the background, discuss the existing evidence for a form of autoimmune psychosis, and propose a novel, conservative approach to the recognition of possible, probable, and definite autoimmune psychoses for use in psychiatric practice. We also outline the investigations required and the appropriate therapeutic approaches, both psychiatric and immunological, for probable and definite cases of autoimmune psychoses, and discuss the ethical issues posed by this challenging diagnostic category.


Assuntos
Autoanticorpos/sangue , Consenso , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Receptores de N-Metil-D-Aspartato , Adulto , Encefalite , Feminino , Doença de Hashimoto , Humanos , Neurônios/imunologia
3.
Nervenarzt ; 91(1): 43-49, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31828353

RESUMO

The current treatment guidelines recommend several effective psychotherapeutic approaches for different indications or aims in the therapy of patients with psychotic disorders. In particular, cognitive behavior therapy (CBTp) is recommended for the treatment of positive and general symptoms in all phases of the disorder without any restriction. Although CBTp could be easily implemented in routine care, very few of the affected patients have access to this evidence-based procedure in inpatient or outpatient settings. The interventions in CBTp directly address the psychotic symptoms themselves as well as the factors involved in the development and maintenance of symptoms. The core features of CBTp are a normalizing attitude of the therapist towards symptoms, an individualized approach and cognitive interventions. Recent developments include symptom-specific, metacognitive as well as mindfulness and acceptance-based approaches. Moreover, the reduction of comorbid symptoms can add to the benefit of the treatment. This article provides an overview of the basic CBTp techniques and of some of the latest developments in this field. It is hoped that this will contribute to the training of therapists and to the better implementation of evidence-based and guideline-based psychotherapy in the care of patients with psychotic disorders.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Psicóticos , Comorbidade , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Transtornos Psicóticos/terapia , Resultado do Tratamento
4.
Nervenarzt ; 91(1): 10-17, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31858162

RESUMO

The last two decades of clinical research have clearly demonstrated the comprehensive benefits of the early recognition and treatment of psychotic disorders. The attenuated and transient positive symptoms according to the ultrahigh risk criteria and the basic symptom criterion "Cognitive disturbances" are the main approaches for an indicated prevention. They have recently been recommended as criteria for a clinical high-risk (CHR) state of psychosis by the European Psychiatric Association (EPA) and, following these, in the German S3 guidelines for the treatment of schizophrenia by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN); however, the efficacy of early treatment of patients with a CHR for psychoses critically depends on the development of prognostic instruments, which enable healthcare professionals to reliably identify these patients based on the individual objective risk profiles. An important goal is the treatment of functional deficits, which can be identified by an individual risk profile. The treatment of existing comorbid mental disorders, psychosocial problems and the prevention of potential future disorders also characterizes the recommendations of the EPA and DGPPN for early treatment, which favor psychotherapeutic, especially cognitive behavioral interventions over pharmacological treatment. The close interdisciplinary cross-sectoral cooperation between the disciplines of child and adolescent psychiatry, and adult psychiatry is of outstanding importance in this context.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Adolescente , Adulto , Criança , Terapia Cognitivo-Comportamental , Humanos , Psicoterapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/prevenção & controle , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/prevenção & controle , Esquizofrenia/terapia
5.
J Ment Health Policy Econ ; 22(3): 95-108, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811753

RESUMO

BACKGROUND: Psychosis onset commonly occurs at ages 16-30 when individuals are typically developing their education, employment and career trajectories. Coordinated specialty care (CSC) programs provide access to team-based early invention services for psychosis, including supported education and employment (SEE) services. AIMS OF STUDY: We examine factors associated with the use of SEE services and whether use of SEE services (for supported education, supported employment, or both) is associated with education and employment participation within New York's CSC program, OnTrackNY. METHODS: Participants (n=779) enrolled in OnTrackNY from October 2013-September 2017. Assessments were collected by clinical staff at admission, quarterly, and at discharge. Logistic regression models were specified to identify factors associated with the probability of use of SEE specialist services during the first year of program participation, using generalized estimating equations with an autoregressive covariance structure to account for within-subject correlations over time. Logistic models were also used to predict whether use of SEE services in the prior quarter predict the probability of work and school participation in the subsequent quarter, respectively; these were analyzed cross-sectionally for each time period. Models controlled for other factors associated with work/school outcomes for young people with early psychosis. RESULTS: Participants who were younger, and who had lower rates of work/school participation had greater odds of SEE service use. Use of SEE services for education support in the first quarter among clients under age 23 is significantly associated with school enrollment in the second quarter and this continued through the first year. Use of SEE services for employment support in the first quarter is significantly associated with employment in the second quarter, but significant associations for employment were not found at later periods of participation. Use of SEE services for both education and employment support was inconsistently associated with subsequent school enrollment or employment in the subsequent quarter. Results were upheld when limiting the sample to those not receiving other SEE services. DISCUSSION: Rates of school and work participation increased over the duration of OnTrackNY participation. Clients with lower work/school participation were more likely to use SEE services. Supported education services are associated with greater school participation during the first year for clients under age 23. However, this association is only significant in the first quarter for supported employment services, and is inconsistent when examining those who used both simultaneously. It is possible that we may find significant associations for employment as the program continues. It is also possible that clients may end supported employment services after obtaining employment, while those in school may require ongoing services (e.g. to renew educational accommodations). Additionally, it is possible that OnTrackNY's supported education model, designed to adhere to Individual Placenment and Support (IPS) principles, may be helping clients stay in school. However, as this is an observational study with no control condition, we cannot say that OnTrackNY, or SEE services participation, caused the observed outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Future research should continue to develop the evidence base for supported education services.


Assuntos
Pessoas com Deficiência/psicologia , Intervenção Médica Precoce/métodos , Educação Especial/métodos , Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Adolescente , Adulto , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego/estatística & dados numéricos , Hospitalização , Humanos , New York , Desenvolvimento de Programas , Transtornos Psicóticos/complicações , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Adulto Jovem
6.
Med J Aust ; 211 Suppl 9: S3-S46, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31679171

RESUMO

Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, includingreal-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.


Assuntos
Bem-Estar da Criança/estatística & dados numéricos , Transtornos Mentais/terapia , Saúde Mental , Planejamento de Assistência ao Paciente/organização & administração , Adolescente , Transtornos de Ansiedade/terapia , Austrália , Transtorno Bipolar/terapia , Gerenciamento Clínico , Diretrizes para o Planejamento em Saúde , Humanos , Masculino , Relações Profissional-Paciente , Transtornos Psicóticos/terapia , Adulto Jovem
7.
Fortschr Neurol Psychiatr ; 87(11): 629-633, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31756745

RESUMO

Adolescence is a particularly vulnerable age for the first manifestation of psychoses due to the brain maturation process and especially with additional stress factors and these have negative psychosocial consequences for the affected persons and their relatives. The disadvantages of an early onset of the disease can be partially compensated for by high-quality early diagnosis and early treatment, taking into account transitional medical approaches. In order to promote a successful transition of adolescent patients with psychoses, there are practical recommendations for the establishment of community-based, flexible and follow-up early diagnosis and treatment networks in which employees work together across diagnosis, age, discipline, and setting, enabling a structured, comprehensive, patient-oriented and flexible successful transition.


Assuntos
Diagnóstico Precoce , Transferência de Pacientes , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Adolescente , Adulto , Criança , Humanos
8.
Soins Psychiatr ; 40(324): 33-36, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31623805

RESUMO

Transcultural consultations receive unaccompanied minors experiencing psychological distress as a result of their personal history in their country of origin, their harrowing journey until their arrival in France and their vulnerable situation. Presentation of the mental health pathway and identity issues of one of these young unaccompanied foreigners, and asylum seeker.


Assuntos
Criança Abandonada/psicologia , Menores de Idade/psicologia , Transtornos Psicóticos/terapia , Refugiados/psicologia , Estresse Psicológico/psicologia , Adolescente , Criança , Características Culturais , França , Humanos , Psicoterapia
10.
BMC Med ; 17(1): 161, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412884

RESUMO

BACKGROUND: Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. METHODS: CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at least one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. RESULTS: Five hundred fifty-one participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99, 382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group; however, the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. CONCLUSIONS: Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered.


Assuntos
Terapia Comportamental/métodos , Cannabis , Transtornos Psicóticos/terapia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Terapia Comportamental/economia , Cannabis/efeitos adversos , Condicionamento Operante , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Masculino , Motivação , Adulto Jovem
11.
Acta Medica (Hradec Kralove) ; 62(2): 45-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31362812

RESUMO

OBJECTIVE: The aim of this article is to review the interface between psychiatry and ophthalmology at several levels, such as the influence of psychopharmacology on eye disorders, the occurrence of psychiatric symptoms in eye diseases, and the neuroophthalmological examination methods supporting the validity of psychiatric diagnoses. MATERIALS AND METHODS: We searched the PubMed computer database for the key words "Psychiatry" and "Ophthalmology" on the 28th of August, 2018 to obtain relevant articles which were consequently summarized. RESULTS: The results showed that most patients with ocular disease simultaneously have one or more psychiatric symptoms. We also found a prevalence of eye-related side effects in patients who use psychiatric drugs. At the same time, we observed that some ophthalmology methods of diagnostics can be used as diagnostic tools in psychiatry. CONCLUSIONS: Most studies showed a significant relation between psychiatry and ophthalmology, such as eye symptoms and diseases following long-term use of psychotropics as well as psychiatric symptoms and syndromes in patients with eye disorders. Our review may be beneficial to psychiatrists, ophthalmologists, and, last but not least, the patients themselves.


Assuntos
Oftalmopatias/diagnóstico , Oftalmologia , Psiquiatria , Transtornos Psicóticos/diagnóstico , Oftalmopatias/terapia , Humanos , Exame Neurológico , Testes Neuropsicológicos , Psicofarmacologia , Transtornos Psicóticos/terapia
12.
Rev Med Suisse ; 15(658): 1402-1406, 2019 Aug 14.
Artigo em Francês | MEDLINE | ID: mdl-31411831

RESUMO

In psychiatry, alternatives to hospitalisation have been developed further to deinstitutionalisation. With the decrease in the number of psychiatric beds and the emergence of new representations regarding the possibility of recovery for people with mental disorder, hospitalisations have been limited to crisis periods. Sheltered housing has been created for vulnerable people. New models of care such «â€…assertive ¼ community treatment ¼ allow to following people with severe mental disorders in the community, whilst avoiding precariousness and isolation. This article aims to present alternatives to psychiatric hospitalisation in a vision of care that answers patients' needs in a proportional and efficient way, that offers a good collaboration with other care providers and that is well-balanced between community care and hospitalisations.


Assuntos
Assistência Ambulatorial , Serviços Comunitários de Saúde Mental , Transtornos Mentais , Psiquiatria , Transtornos Psicóticos , Hospitalização , Humanos , Transtornos Mentais/terapia , Transtornos Psicóticos/terapia
13.
Psiquiatr. biol. (Internet) ; 26(2): 66-72, mayo-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185033

RESUMO

Introducción: La esquizofrenia es uno de los trastornos mentales que mayor discapacidad humana genera en todo el mundo. Hasta el momento, el tratamiento de síntomas negativos en esquizofrenia dista de estar resuelto de un modo satisfactorio. La singular capacidad del cine para activar la atención, la imaginación y la memoria, así como de activar procesos mentales complejos en los espectadores, permite pensar que puede ser una herramienta terapéutica eficaz para el tratamiento de determinados trastornos mentales. Objetivos: Evaluar el eficacia de una nueva técnica psicoterapéutica (diseñada ad hoc) basada en el análisis fílmico por secuencias y el doble visionado utilizando cine de ficción en pacientes con diagnóstico de trastornos del espectro de la esquizofrenia y otros trastornos psicóticos. Metodología: Se realizó un ensayo clínico multicéntrico, aleatorizado y en grupos paralelos en el que participaron 48 pacientes con diagnóstico de trastornos psicóticos del espectro de la esquizofrenia. Se compararon los efectos de la aplicación de una técnica psicoterapéutica grupal, basada en el uso de cine de ficción como soporte y cuya técnica estaba inspirada en el análisis fílmico, frente a un grupo control que también trabajaba con una técnica más inespecífica sobre el mismo soporte. Para el desarrollo de la nueva técnica psicoterapéutica grupal -objeto de este estudio- se seleccionaron 3 técnicas del análisis fílmico en las que los investigadores en su práctica clínica observaron un potencial terapéutico: 1) la segmentación del material fílmico en secuencias; 2) el análisis por secuencias de los contenidos de la película, y 3) el doble visionado del material cinematográfico. La intervención constaba de 26 sesiones, que implicaban la doble visión de los 13 episodios de la primera temporada de la serie de televisión Los Soprano. Las medidas primarias de resultado fueron los cambios obtenidos en las subescalas de la Escala de Síndromes Positivo y Negativo de la Esquizofrenia, según el modelo pentafactorial de Wallwork, entre la situación basal y final tras el tratamiento. Como medidas de resultado cognitivas se utilizaron los cambios en las escalas de cognición incluidas en la MATRICS Consensus Cognitive Battery y en escalas de cognición social (MSCEIT, FEIT, FBS) antes y después del tratamiento. Resultados: Los resultados mostraron una mejoría estadísticamente significativa en el grupo experimental frente al grupo control en los síntomas, positivos (p=0,01; d=0,82 [IC del 95%, 0,2-1,43]), negativos (p=0,005; d=0,89 [IC del 95%, 0,26-1,51]) y desorganizados (p=0,013; d=0,49 [IC del 95%, 0,11-1,09]). En el análisis post-hoc del factor negativo se encontró mejorías estadísticamente significativas en las variables: embotamiento afectivo (p=0,041; d=0,64 [IC del 95%, 0,03-1,24]), retraimiento emocional (p=0,012; d=0,80 [IC del 95%, 0,18-1,41]), contacto pobre (p=0,000; d=1,18 [IC del 95%, 0,52-1,82]) y enlentecimiento motor (p=0,003; d=0,96 [IC del 95%, 0,33-1,58]). En el análisis post-hoc del factor positivo se encontró mejoría significativa en el subdominio delirios (p=0,01; d=0,82 [IC del 95%, 0,2-1,4]). No se encontraron diferencias significativas entre ambos grupos en síntomas afectivos ni en ninguno de los dominios cognitivos estudiados. Conclusiones: La nueva técnica psicoterapéutica propuesta es aplicable y bien aceptada por los pacientes con esquizofrenia y otros trastornos psicóticos. El uso de esta nueva técnica psicoterapéutica inspirada en el uso del análisis fílmico puede servir para mejorar los síntomas positivos, negativos y desorganizados en pacientes con esquizofrenia


Introduction: Schizophrenia is one of the mental disorders that generate the greatest human disability in the world. The treatment of negative symptoms in schizophrenia is still far from being resolved satisfactorily. The unique ability of cinema to activate attention, imagination and memory, as well as to activate complex mental processes in viewers leads one to think that it can be an effective therapeutic tool for the treatment of certain mental disorders. Objective: To evaluate the efficacy of a new psychotherapeutic technique (designed ad hoc) based on the analysis of film sequences and double viewed using fiction films in patients diagnosed with spectrum disorders of schizophrenia and other psychotic disorders. Methods: A multicentre, randomised and parallel group clinical trial was conducted on 48 patients with a diagnosis of psychotic disorders of the schizophrenia spectrum. The effects of the application of a psychotherapeutic group therapy technique, based on the use of fiction films, were compared to a control group that also worked with fiction films, but using a non-specific technique. Three film analysis techniques with potential therapeutic properties were selected for the development of the new group psychotherapy technique: 1) the segmentation of the cinematic material into sequences, 2) the analysis by sequences of the contents of the film, 3) the double viewing of the cinematographic material. The intervention consisted of 26 sessions, which involved the double viewing of the 13 episodes of the first season of the television series Los Soprano. The primary outcome measures were the changes obtained in the Positive and Negative Syndrome Scale (PANSS) subscales, according to Wallwork's five-factor model, between the baseline and final situation after treatment. Cognitive outcome measurements included changes in the cognition scales included in the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) and in social cognition scales, like MSCEIT, FEIT, and FBS (Mayer-Salovey-Caruso Emotional Intelligence Test, Facial Emotion Identification Test, and Frankfurt self-assessment scale for persons with schizophrenia, respectively), before and after treatment. Results: The results showed a statistically significant improvement in the experimental group versus the control group in the positive [P=.01; d=0.82 (95% CI; 0.2-1.43)], negative [P=.005; d=0.89 (95% CI; 0.26-1.51)] and disorganised symptoms [P=.013; d=0.49 (95% CI; 0.11-1.09)]. In the "post-hoc" analysis of the negative factor, statistically significant improvements were found in the following variables: blunted effect (P=.041, d=0.64 (95% CI; 0.03-1.24)], emotional withdrawal (P=.012, d=0.80 (95% CI; 0.18-1.41)], poor contact (P=.000, d=1.18 (95% CI; 0.52-1.82)], and motor retardation (P=.003, d=0.96 (95% CI; 0.33-1.58).] In the "post-hoc" analysis of the positive factor there was a significant improvement in the delusions subdomain [P=.01; d=0.82 (95% CI; 0.2-1.4).] No significant differences were found between groups in affective symptoms or in any of the cognitive domains. Conclusions: The proposed new psychotherapy technique is applicable and well accepted by patients with schizophrenia and other psychotic disorders. The use of this new psychotherapy technique inspired in film analysis is effective in leading to improvements in the positive, negative, and disorganised symptoms in patients with schizophrenia


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Esquizofrenia/terapia , Psicoterapia de Grupo/métodos , Filmes Cinematográficos , Transtornos Psicóticos/terapia , Resultado do Tratamento , Terapias Sensoriais através das Artes/métodos
15.
Trials ; 20(1): 395, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272477

RESUMO

BACKGROUND: Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP. METHODS/DESIGN: The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14-18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants' usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions. DISCUSSION: This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences. TRIAL REGISTRATION: Current controlled trial with ISRCTN, ISRCTN80567433 . Registered on 27 February 2017.


Assuntos
Comportamento do Adolescente/efeitos dos fármacos , Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapia Familiar , Transtornos Psicóticos/terapia , Adolescente , Fatores Etários , Antipsicóticos/efeitos adversos , Inglaterra , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
16.
Mult Scler Relat Disord ; 34: 158-161, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31302591

RESUMO

Psychiatric symptoms resulting from Multiple Sclerosis (MS) itself or its treatment are well known. However, the relationship between psychotic episodes and Multiple Sclerosis remains debated. In this paper, we present the case of a woman who developed a chronic psychotic disorder a few months after the onset of MS. We describe the process which led us to make the diagnosis of Psychotic Disorder due to Medical Condition (Multiple Sclerosis). Because her criminal charges brought significant attention to her case, we also address the difficulty in treating a neurological condition with psychiatric features within the forensic context. Moreover, one of the main concerns of the patient was that Lyme Disease was the correct diagnosis as opposed to MS. We also report the difficulty of treating and initiating successful follow-up for a patient whose paranoia is enabled by the opinions of certain health advocacy groups.


Assuntos
Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Adulto , Comportamento Criminoso , Feminino , Humanos , Defesa por Insanidade , Doença de Lyme/psicologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/psicologia , Transtornos Psicóticos/diagnóstico
17.
Autoimmun Rev ; 18(9): 102348, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323365

RESUMO

Psychotic disorders are debilitating mental illnesses associated with abnormalities in various neurotransmitter systems. The development of disease-modifing therapies has been hampered by the mostly unknown etiologies and pathophysiologies. Autoantibodies against several neuronal antigens are responsible for autoimmune encephalitis. These autoantibodies disrupt neurotransmission within the brain, resulting in a wide range of psychiatric and neurologic manifestations, including psychosis. The overlap of symptoms of autoimmune encephalitis with psychotic disorders raised the question as to whether autoantibodies against a number of receptors, ion channel and associated proteins could ultimately be responsible for some forms of psychosis. Here we review our current knowledge, on antibody mediated autoimmunity in psychotic disorders, the different diagnostic methods and their limitations, as well as on varying therapeutic approaches targeting the immune system.


Assuntos
Autoimunidade/fisiologia , Testes Imunológicos/tendências , Imunoterapia/tendências , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/imunologia , Transtornos Psicóticos/terapia , Autoanticorpos/análise , Autoanticorpos/sangue , Autoanticorpos/imunologia , Encéfalo/fisiologia , Encefalite/diagnóstico , Encefalite/imunologia , Encefalite/terapia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/imunologia , Doença de Hashimoto/terapia , Humanos , Sistema Imunitário/fisiologia , Testes Imunológicos/métodos , Imunoterapia/métodos , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendências , Neurônios/imunologia , Neurônios/patologia
18.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352381

RESUMO

Temporal lobe epilepsy (TLE), a common form of localisation-related epilepsy, is characterised by focal seizures and accompanied by variety of neuropsychiatric symptoms. This form of epilepsy proves difficult to manage as many anticonvulsant and psychotropic medications have little to no effect on controlling the seizure and neuropsychiatric symptoms respectively. The authors, report a patient with TLE and recurrent seizures that were refractory to multiple classes of antiepileptic therapy. Additionally, she exhibited psychosis, depression and irritability that required antipsychotic medication. After several years of poorly controlled seizure disorder, the patient underwent anterior temporal lobectomy and amygdalohippocampectomy, which proved beneficial for seizure control, as well as her neuropsychiatric symptoms. While it is common to treat refractory temporal lobe epilepsy with surgical interventions, there is little literature about it also treating the neuropsychiatric symptoms. This case underscores both the neurological and psychiatric benefits following surgical intervention for patients with TLE.


Assuntos
Lobectomia Temporal Anterior , Anticonvulsivantes/uso terapêutico , Epilepsia do Lobo Temporal/terapia , Transtornos Psicóticos/terapia , Convulsões/prevenção & controle , Adulto , Tonsila do Cerebelo/cirurgia , Emigrantes e Imigrantes , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/psicologia , Feminino , Acesso aos Serviços de Saúde , Hipocampo/cirurgia , Humanos , Transtornos Psicóticos/fisiopatologia , Convulsões/fisiopatologia , Resultado do Tratamento
19.
Soc Psychiatry Psychiatr Epidemiol ; 54(10): 1295-1298, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31183503

RESUMO

PURPOSE: Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis. RESULTS: Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups. CONCLUSIONS: These findings highlight the importance of in-depth research on disaggregated ethnic groups to inform targeted early intervention strategies for minority populations.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Transtornos Psicóticos/etnologia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupos de Populações Continentais/psicologia , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Grupos Minoritários/psicologia , Transtornos Psicóticos/terapia , Fatores de Tempo
20.
J Consult Clin Psychol ; 87(8): 734-744, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31219276

RESUMO

OBJECTIVE: The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). METHOD: The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. RESULTS: Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. CONCLUSIONS: A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Psicóticos/terapia , Qualidade de Vida/psicologia , Resiliência Psicológica , Aliança Terapêutica , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos Psicóticos/psicologia , Resultado do Tratamento , Adulto Jovem
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