Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol.

Background: More than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children's knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma. Materials and methods: A quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups. Discussion: This will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers' with psychosis and adolescents' functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457].

Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice.

AIM: Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. METHODS: Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. RESULTS: An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. CONCLUSIONS: Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

The Impact of COVID-19 Lockdown on Adults with Major Depressive Disorder from Catalonia: A Decentralized Longitudinal Study.

The present study analyzes the effects of each containment phase of the first COVID-19 wave on depression levels in a cohort of 121 adults with a history of major depressive disorder (MDD) from Catalonia recruited from 1 November 2019, to 16 October 2020. This analysis is part of the Remote Assessment of Disease and Relapse-MDD (RADAR-MDD) study. Depression was evaluated with the Patient Health Questionnaire-8 (PHQ-8), and anxiety was evaluated with the Generalized Anxiety Disorder-7 (GAD-7). Depression's levels were explored across the phases (pre-lockdown, lockdown, and four post-lockdown phases) according to the restrictions of Spanish/Catalan governments. Then, a mixed model was fitted to estimate how depression varied over the phases. A significant rise in depression severity was found during the lockdown and phase 0 (early post-lockdown), compared with the pre-lockdown. Those with low pre-lockdown depression experienced an increase in depression severity during the "new normality", while those with high pre-lockdown depression decreased compared with the pre-lockdown. These findings suggest that COVID-19 restrictions affected the depression level depending on their pre-lockdown depression severity. Individuals with low levels of depression are more reactive to external stimuli than those with more severe depression, so the lockdown may have worse detrimental effects on them.

Effect of raloxifene (a Selective Estrogen Receptor Modulator (SERM)) as coadjuvant to antidepressant treatment: a case report.

We report a case of a woman with a depressive disorder with partial response to antidepressant treatment. Raloxifene, a Selective Estrogen Receptor Modulator (SERM) was added to the treatment, the patient achieving complete remission of her depressive symptoms. The interest of our case lies in the fact that it exemplifies the relationship between depressive disorders and hormonal changes during menopause. Furthermore, raloxifene may become a novel therapeutic option in some postmenopausal women who do not respond or only partially respond to SSRIs, especially in those with a history of depressive disorders related to menopause.

Cognitive functioning in first episode psychosis. Gender differences and relation with clinical variables.

AIMS: to study the differences in cognitive functioning in patients and controls. In addition, study the influence of symptoms, cannabis consumption, chlorpromazine doses, DUP and IQ in cognitive performance in patients, both in the total sample and divided by gender. METHODS: 70 first episode psychosis patients and 63 healthy controls (HC) participated in the study and were assessed with the MATRICS battery and the Vocabulary subtest of WAIS-IV. Symptoms in FEP patients were evaluated with the Emsley factors of the PANSS scale. RESULTS: patients showed lower scores than controls in all cognitive domains studied. There were no significant differences between FEP men and FEP women, but we found gender differences in favour of women in processing speed, working memory and composite total scored domains in the HC group. Finally, symptoms and Chlorpromazine doses showed an influence on cognitive performance in the total FEP sample. When splitting the sample by gender, positive symptoms may be more detrimental to women's cognitive functioning, while disorganized symptoms may play the most important role in cognitive performance in men. CONCLUSIONS: patients showed worse cognitive performance in all cognitive domains compared to healthy controls. In our FEP sample, gender does not seem to influence cognitive performance measured with the MATRICS. Severity of symptoms influences positively in cognitive performance. The dose of Chlorpromazine and symptoms are influential variables to be taken into account in cognition rehabilitation programs.

Estrategias de afrontamiento durante el confinamiento por COVID-19 en pacientes con primer episodio psicótico: el impacto en su vida diaria / Coping strategies during covid-19 lockdown in patients with first-episode psychosis: the impact on their daily life

Introducción: El confinamiento por la enfermedad del coronavirus 2019 (COVID-19) interrumpió la vida de todo el mundo en marzo de 2020. El confinamiento obligatorio duró dos meses, lo que tuvo un impacto en la salud mental de las personas. Sin embargo, se desconoce en gran medida cómo afectó a quienes ya luchaban con problemas de salud mental. Métodos: Se recopiló información de 18 pacientes con primer episodio psicótico (PEP) mediante una encuesta en línea. La encuesta tenía preguntas sobre COVID-19, el impacto del confinamiento en la vida diaria y las estrategias de afrontamiento utilizadas durante el confinamiento entre marzo y abril de 2020 en España. Resultados: Algunas estrategias de afrontamiento se asociaron con diferentes actividades de la vida diaria: normalizar la situación, buscar ayuda de amigos o familiares y buscar ayuda de profesionales en situaciones estresantes, leer fuentes de información y autoayuda para enfrentar el estrés, enfocarse en las emociones que generan estrés, intentar centrarse en problemas concretos y buscar soluciones, y aceptar la situación con resignación. Conclusiones: Como conclusión, los resultados sugieren que no todas las estrategias de afrontamiento impactaron de la misma manera en la vida diaria de los/las pacientes con PEP durante el confinamiento por COVID-19.(AU)

Introduction: Lockdown for 2019 coronavirus disease (COVID-19) disrupted life worldwide from March 2020. Mandatory lockdown lasted two months, which had an impact on people’s mental health. However, how it affected those who already struggled with mental health problems is largely unknown. Methods: We collected information from 18 patients with first-episode psychosis (FEP) through an online survey. The survey contained questions regarding COVID-19, impact of confinement on daily life, and coping strategies during lockdown between March and April 2020 in Spain. Results: Some coping strategies were associated with different daily life activities: normalizing the situation, seeking help from friends or family, and seeking help from professionals in stressful situations, reading information sources and self-help to cope with stress, focusing on the emotions that generate stress, trying to focus on specific problems and seek solutions, and accepting the situation with resignation. Discussion: As a conclusion, results suggest that not all coping strategies impacted in the same way in daily life of patients with FEP during COVID-19 lockdown.(AU)

Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection.

BACKGROUND: Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. CASE REPORT: We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. CONCLUSION: This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.

Cognitive profiles of three clusters of patients with a first-episode psychosis.

OBJECTIVE: The primary objective was to identify specific groups of patients with a first-episode psychosis based on family history, obstetric complications, neurological soft signs, and premorbid functioning. The secondary objective was to relate these groups with cognitive variables. METHOD: A total of 62 first-episode psychoses were recruited from adult and child and adolescent mental health services. The inclusion criteria were patients between 7 and 65 years old (real range of the samples was 13-35 years old), two or more psychotic symptoms and less than one year from the onset of the symptoms. Premorbid functioning (PAS), soft signs (NES), obstetric complications and a neuropsychological battery (CPT, TMTA/TMTB, TAVEC/TAVECI, Stroop, specific subtest of WAIS-III/WISC-IV) were administered. RESULTS: We found three clusters: 1) higher neurodevelopment contribution (N=14), 2) higher genetic contribution (N=30), and 3) lower neurodevelopment contribution (N=18). Statistical differences were found between groups in TMTB, learning curve of the TAVEC, digits of the WAIS and premorbid estimated IQ, the cluster 1 being the most impaired. CONCLUSIONS: A cluster approach could differentiate several groups of patients with different cognitive performance. Neuropsychological interventions, as cognitive remediation, should be addressed specifically to patients with more impaired results.

Efecto del raloxifeno (Modulador Selectivo del Receptor Estrogénico (SERM)) como coadyuvante del tratamiento antidepresivo. A propósito de un caso / Effect of raloxifene (a Selective Estrogen Receptor Modulator [SERM]) as coadjuvant to antidepressant treatment: A case report

Se presenta el caso de una paciente con un trastorno depresivo con respuesta parcial al tratamiento antidepresivo. A la paciente se le añadió raloxifeno, Modulador Selectivo del Receptor Estrogénico (SERM), y se consiguió una remisión completa del episodio depresivo que presentaba. El interés de nuestro caso radica en el hecho que ejemplifica la relación entre los trastornos depresivos y los cambios hormonales durante la menopausia. Además, el raloxifeno puede ser una nueva opción terapéutica en algunas mujeres en la postmenopausia que no responden o lo hacen de forma parcial a los ISRS, especialmente en aquellas con historia de trastornos depresivos relacionados con la menopausia (AU)

We report a case of a woman with a depressive disorder with partial response to antidepressant treatment. Raloxifene, a Selective Estrogen Receptor Modulator (SERM) was added to the treatment, the patient achieving complete remission of her depressive symptoms. The interest of our case lies in the fact that it exemplifies the relationship between depressive disorders and hormonal changes during menopause. Furthermore, raloxifene may become a novel therapeutic option in some postmenopausal women who do not respond or only partially respond to SSRIs, especially in those with a history of depressive disorders related to menopause (AU)