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1.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130587

RESUMO

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.


Assuntos
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
3.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012721

RESUMO

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Assuntos
Antipsicóticos/efeitos adversos , Betacoronavirus , Clozapina/efeitos adversos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Psicóticos/tratamento farmacológico , Estado Epiléptico/etiologia , Clozapina/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Estado Epiléptico/fisiopatologia
7.
PLoS One ; 15(9): e0238774, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915832

RESUMO

Brain reward processing mechanisms that underlie complex decision-making are compromised in psychosis. The goal of this research was to advance our understanding of the underlying (1) neural mechanisms and (2) discrete neuro-economic/motivational processes that may be altered in complex decision-making in euthymic patients on the psychosis spectrum (PPS). Utilizing a functional magnetic resonance neuroimaging (fmri) paradigm of a well-validated laboratory measure of complex decision-making (Iowa Gambling Task-IGT), the brain activation patterns of a target group of PPS were compared to a demographically matched healthy comparison group (HMC). These two groups were also evaluated on real-life decision outcomes on day of scan. PPS primarily activate the Dorsal Attentional Network (DAN) in real-life decision outcomes and in achieving similar levels of performance on the IGT as the HMC, in-spite of dysregulated dopamine-based brain-reward circuit and salience network fmri activation patterns. However, PPS report more significant negative outcomes of their decision-making in real-life, compared to HMC. The differential engagement of brain networks by PPS on the IGT appear to be moderated by antipsychotic, dopamine antagonist, medication lifetime/daily dose levels. These findings may also be mediated by extent of dysregulation in brain reward circuitry and salience network associated with psychosis severity in the target PPS group. This is also evident in case studies of unmedicated PPS. We conclude by suggesting that the brain may adapt to this dysregulation by co-opting the DAN network, which is implicated in the related function of problem-solving, towards complex decision-making. The extent of utilization of the DAN network in complex decision-making may be moderated by psychosis severity.


Assuntos
Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Rede Nervosa/fisiopatologia , Transtornos Psicóticos/psicologia , Adulto , Encéfalo/efeitos dos fármacos , Tomada de Decisões/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Recompensa
8.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784244

RESUMO

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/psicologia , Adulto , Antipsicóticos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pandemias , Transtornos Psicóticos/tratamento farmacológico
10.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32695312

RESUMO

Behavioral and psychological symptoms of dementia are symptoms of disturbed perception, mood, behavior, and thought content that occurred frequently. These symptoms, which include apathy, depression, anxiety, psychosis, agitation, and aggression, can serve as predictors of and early clinical diagnostic markers for Alzheimer's disease (AD) and are common precipitants of institutional care. Agitation and psychosis are associated with accelerated disease progression and increased tau phosphorylation in patients with AD. Current guidelines recommend the use of second-generation antipsychotics for the treatment of agitation and psychosis in AD, but only after first-line non-pharmacological interventions and for no longer than 12 weeks because long-term use of these drugs is associated with an increased risk of mortality and an increased frequency of cerebrovascular events. Therefore, new antipsychotic drugs with improved efficacy and safety are needed as an alternative to current antipsychotic drugs. In this report, we discuss some of the most relevant advances in the field of agitation and psychosis in AD and focus on the recent positive clinical evidence observed with two new antipsychotics drugs: brexpiprazole and pimavanserin. Brexpiprazole is a receptor partial agonist (D2, D3, 5-HT1A), receptor antagonist (5-HT2A/B, α1B/α2C) according to the neuroscience-based nomenclature. Two recent phase III clinical trials have shown that brexpiprazole 2 mg/day is effective for the treatment of agitation in patients with AD and has an improved tolerability and safety profile compared with currently available second-generation antipsychotics. Pimavanserin is a receptor antagonist (5-HT2A, 5-HT2C) that has been given market authorization for psychosis occurring in Parkinson's disease. Recent phase II studies suggest that this drug is effective in AD patients with more severe psychosis, although further long-term studies are needed to better define the efficacy and long-term safety profile of pimavanserin for the treatment of psychosis in AD.


Assuntos
Doença de Alzheimer , Antipsicóticos/uso terapêutico , Transtornos Psicóticos , Doença de Alzheimer/complicações , Doença de Alzheimer/tratamento farmacológico , Ansiedade , Humanos , Piperidinas , Transtornos Psicóticos/tratamento farmacológico , Quinolonas , Tiofenos , Ureia/análogos & derivados
12.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 13(2): 73-79, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193405

RESUMO

INTRODUCCIÓN: Las diferencias étnicas han sido estudiadas tanto en esquizofrenia como en los primeros episodios psicóticos (PEP).??En estudios realizados en los Países Bajos se ha descrito que en los varones de origen marroquí es más frecuente un episodio psicótico y presentar mayor severidad en la sintomatología. Sin embargo, no existen estudios en España en PEP en población marroquí comparada con autóctona. OBJETIVOS: Explorar las diferencias clínicas entre la población inmigrante de origen marroquí y la población autóctona, en una muestra de PEP recogida en una unidad de hospitalización de agudos. MATERIAL Y MÉTODOS: Se evaluó la sintomatología y el funcionamiento al ingreso y al alta, así como el consumo de cannabis y la dosis de tratamiento antipsicótico y el perfil de efectos adversos en una muestra de 83 pacientes con PEP. Se compararon los pacientes de origen marroquí con los de la población autóctona mediante análisis univariantes y la independencia de las asociaciones fue evaluada mediante análisis de regresión logística. RESULTADOS: El 28,9% de la muestra era de origen marroquí. No se encontraron diferencias en cuanto a la sintomatología al ingreso y al alta. Comparados con los autóctonos, los de origen marroquí eran mayoritariamente hombres, tenían menos años de educación, presentaban peor funcionamiento, menor uso de cannabis, mejor perfil de efectos secundarios y una tendencia al mayor uso de LAI. Tras el análisis multivariante, solo un peor funcionamiento (OR 0,93; IC 95%: 0,88-0,99; p = 0,02) y menos años de educación (OR 0,75; IC 95%: 0,56-1,01; p = 0,05) permanecieron significativamente asociados a ser de origen marroquí. CONCLUSIONES: Existen diferencias sociodemográficas y clínicas entre personas con PEP de origen marroquí y población autóctona. Nuestros resultados señalan que debería contemplarse la trascendencia de la competencia cultural en la evaluación y tratamiento de los PEP


INTRODUCTION: Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES: This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS: Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS: The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS: Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Transtornos Psicóticos/etnologia , Transtornos Psicóticos/tratamento farmacológico , Abuso de Maconha/complicações , Abuso de Maconha/etnologia , Emigrantes e Imigrantes , Marrocos , Espanha
14.
Encephale ; 46(3S): S126-S127, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32475694
19.
Eur J Endocrinol ; 183(2): 221-231, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32583656

RESUMO

Context: In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective: Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design: This was a multicenter (France and Belgium) retrospective study. Patients: Eighteen patients treated with antipsychotics were included. Results: Under DA, median PRL levels decreased from 1247 (117-81 132) to 42 (4-573) ng/mL (P = 0.008), from 3850 (449-38 000) to 141 (60-6000) ng/mL (P = 0.037) and from 1664 (94-9400) to 1215 (48-5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0-57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusions: Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.


Assuntos
Antipsicóticos/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Bélgica , Interações Medicamentosas , Feminino , França , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/psicologia , Prolactina/sangue , Prolactinoma/patologia , Prolactinoma/psicologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Recidiva , Estudos Retrospectivos
20.
Lancet Psychiatry ; 7(7): 602-610, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32563307

RESUMO

BACKGROUND: Delayed treatment for first episodes of psychosis predicts worse outcomes. We hypothesised that delaying treatment makes all symptoms more refractory, with harm worsening first quickly, then more slowly. We also hypothesised that although delay impairs treatment response, worse symptoms hasten treatment, which at presentation mitigates the detrimental effect of treatment delay on symptoms. METHODS: In this longitudinal analysis and modelling study, we included two longitudinal cohorts of patients with first-episode psychosis presenting to English early intervention services from defined catchments: NEDEN (recruiting 1003 patients aged 14-35 years from 14 services between Aug 1, 2005, and April 1, 2009) and Outlook (recruiting 399 patients aged 16-35 years from 11 services between April 1, 2006, and Feb 28, 2009). Patients were assessed at baseline, 6 months, and 12 months with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale for Schizophrenia, Mania Rating Scale, Insight Scale, and Social and Occupational Functioning Assessment Scale. Regression was used to compare different models of the relationship between duration of untreated psychosis (DUP) and total symptoms at 6 months. Growth curve models of symptom subscales tested predictions arising from our hypotheses. FINDINGS: We included 948 patients from the NEDEN study and 332 patients from the Outlook study who completed baseline assessments and were prescribed dopamine antagonist antipsychotics. For both cohorts, the best-fitting models were logarithmic, describing a curvilinear relationship of DUP to symptom severity: longer DUP predicted reduced treatment response, but response worsened more slowly as DUP lengthened. Increasing DUP by ten times predicted reduced improvement in total symptoms (ie, PANSS total) by 7·339 (95% CI 5·762 to 8·916; p<0·0001) in NEDEN data and 3·846 (1·689 to 6·003; p=0·0005) in Outlook data. This was true of treatment response for all symptom types. Nevertheless, longer DUP was not associated with worse presentation for any symptoms except depression in NEDEN (coefficients 0·099 [95% CI 0·033 to 0·164]; p=0·0028 in NEDEN and 0·007 [-0·081 to 0·095]; p=0·88 in Outlook). INTERPRETATION: Long DUP was associated with reduced treatment response across subscales, consistent with a harmful process upstream of individual symptoms' mechanisms; response appeared to worsen quickly at first, then more slowly. These associations underscore the importance of rapid access to a comprehensive range of treatments, especially in the first weeks after psychosis onset. FUNDING: UK Department of Health, National Institute of Health Research, and Medical Research Council.


Assuntos
Antipsicóticos/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Modelos Psicológicos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Fatores de Tempo , Adulto Jovem
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