Experiencia académica sobre la presentación de trabajos científicos en la IV Conferencia Internacional: Desafíos clínicos y terapéuticos en psicosis / Academic experience on the presentation of scientific papers at the IV International Conference: Clinical and therapeutic challenges in psychosis

Dentro de los desafíos de la investigación en psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los trabajos científicos presentados en la IV conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en octubre del 2022. Métodos: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. Resultados: Se seleccionaron 5 trabajos. El 100% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, la mayoría de los trabajos presentados provienen de la región metropolitana. El 80% de los trabajos realizan un diseño experimental con reclutamiento de pacientes y el 20% usaron una metodología cualitativa. Conclusión: Así como años anteriores, los trabajos seleccionados dan cuenta de la importancia por el mejoramiento en la prevención, diagnóstico e intervención temprana en Psicosis. Se debe potenciar en Chile y latinoamerica el desarrollo académico y clínico en el campo de los EMARS.

Among the challenges of research in psychosis in Chile and the world, is the development of academic hubs for research in at-risk mental states (ARMS). This article presents a descriptive analysis of the summaries of the scientific works presented at the IV international conference: Clinical and Therapeutic Challenges in Psychosis held in October 2022. Methods: A selection and award were made for the best work according to a scoring system developed by an ad-hoc scientific committee. Then the information was systematized in a summary table for its subsequent qualitative descriptive analysis. Results: 5 works were selected. 100% of the selected works address the issue of early detection and early intervention in psychosis, particularly in the ARMS. Most of the papers presented come from the metropolitan region. 80% of the works carried out an experimental design with patient recruitment and 20% used a qualitative methodology. Conclusion: As in previous years, the selected works show the importance of improving prevention, diagnosis, and early intervention in psychosis. Research and clinical work in Chile and Latinoamerica should be strengthened in the field of ARMS.

Análisis de alteraciones del discurso en estados mentales de alto riesgo de psicosis (EMAR): una revisión sistemática / Speech disturbances analysis in ultra-high risk of psychosis (UHR): a systematic review

INTRODUCCIÓN: La necesidad de intervenir precozmente en la psicosis ha llevado a la búsqueda de biomarcadores útiles en su predicción, donde el análisis del lenguaje hablado destaca por su fácil obtención y bajo coste económico. En esta revisión sistemática se analizan las principales alteraciones del lenguaje en pacientes con riesgo ultra alto de psicosis (UHR), evaluando su prevalencia y su relación con la transición a la psicosis. MÉTODOS: Se realizó una búsqueda en las bases de datos PubMed y Embase de estudios en inglés o español, así como en las listas de referencias de los artículos encontrados. RESULTADOS: De 140 artículos identificados, se incluyeron 15. Las variables del lenguaje analizadas fueron Cohesión Lingüística, Coherencia Semántica, Complejidad Sintáctica, Producción Metafórica, Prosodia Emocional y Trastorno del Pensamiento Formal (TFP). La prevalencia encontrada osciló entre el 21% y el 85% para las alteraciones incluidas en el TFP, sin que se hayan encontrado medidas de prevalencia para el resto de las variables. La precisión global para la transición de RH a psicosis osciló entre el 70% y el 100% en todos los estudios. CONCLUSIONES: Existe un amplio abanico de alteraciones del habla en los pacientes con RHU, donde la PTF es la más estudiada. La prevalencia de estas alteraciones parece ser alta, especialmente en lo que respecta a la PTF. El análisis de esas alteraciones del habla en pacientes con RHU aparece como una excelente herramienta para predecir la transición a la psicosis, particularmente a través de la transcripción de entrevistas y el uso de la Inteligencia Artificial.

INTRODUCTION: The need for early intervention in psychosis has led to the search for useful biomarkers in its prediction, where the analysis of spoken language stands out for its easy obtaining and low economic cost. In this systematic review, we analyze the main speech disturbances in patients at ultra-high risk for psychosis (UHR), evaluating their prevalence and their relationship with transition to psychosis. METHODS: A search was carried out in PubMed and Embase databases for studies in English or Spanish, as well as the reference lists of the articles found. RESULTS: Of 140 articles identified, 15 were included. The variables of the language analyzed were Linguistic Cohesion, Semantic Coherence, Syntactic Complexity, Metaphorical Production, Emotional Prosody and Formal Thought Disorder (TFP). The prevalence found ranged between 21% and 85% for disturbances included within the TFP, with no prevalence measures for the rest of the variables. The global accuracy for UHR transition to psychosis ranged from 70% to 100% across studies. CONCLUSION: There is a wide range of speech disorders in UHR patients, where the TFP is the most studied one. The prevalence of these alterations seems to be high, especially with regard to TFP. The analysis of those speech alterations in UHR patients appears as an excellent tool to predict transition to psychosis, particularly through interview transcription and the use of Artificial Intelligence.

Influence of migration on the thought process of individuals at ultra-high risk for psychosis

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student's t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.

Plasma prevalence of anti-N-methyl-d-aspartate receptor IgG antibodies in early stages of psychosis / Prevalência plasmática de anticorpos IgG antirreceptor N-metil-d-aspartato nos estágios iniciais de psicose

Abstract We investigated the feasibility of including plasma anti-NMDAR antibody screening in the assessment of first-episode psychosis patients in an early intervention programme in the Southern hemisphere. Anti-NMDAR IgG antibodies were assessed by ELISA in 166 patients (64.0% men), 166 matched population-based controls and 76 patients' siblings (30.3% men). Fisher's exact test and ANOVA were performed. Positive anti-NMDAR antibody patients were more often observed in bipolar disorder (10.0%) than schizophrenia (2.4%) or psychotic depression (3.1%), although no significant differences were observed. Our results are not conclusive regarding the inclusion of plasma anti-NMDAR IgG antibodies in differential diagnostic protocols for psychosis.

Resumo Nós investigamos a viabilidade de incluir a pesquisa de anticorpos anti-NMDAR na avaliação de pacientes em primeiro episódio psicótico em um programa de intervenção precoce no Hemisfério Sul. Anticorpos IgG anti-NMDAR foram avaliados por ELISA em 166 pacientes (64,0% homens), 166 controles de base populacional pareados e 76 irmãos (30,3% homens). Foram realizados teste exato de Fisher e ANOVA. Os anticorpos anti-NMDAR positivos foram mais observados no transtorno afetivo bipolar (10,0%) do que na esquizofrenia (2,4%) ou depressão psicótica (3,1%), embora não tenham sido observadas diferenças significativas. Nossos resultados não são conclusivos quanto à inclusão de anticorpos IgG anti-NMDAR no plasma em protocolos de diagnósticos diferenciais para psicose.

Uso de cannabis en jóvenes hospitalizados por un primer episodio de psicosis: un estudio caso-control

Background: Cannabis use among young people in Chile has increased significantly in the last years. There is a consistent link between cannabis and psychosis. Aim: To compare cannabis use in patients with a first episode of psychosis and healthy controls. Material and Methods: We included 74 patients aged 20 ± 3 years (78% males) admitted to hospital with a first episode of psychosis and a group of 60 healthy controls aged 23 ± 4 years (63% males). Cannabis consumption was assessed, including age of first time use and length of regular use. Results: Patients with psychosis reported a non-significantly higher frequency of life-time cannabis use. Patients had longer periods of regular cannabis use compared with healthy subjects (Odds ratio [OR] 2.4; 95% confi-dence intervals [CI] 1.14-5.05). Patients also used cannabis for the first time at an earlier age (16 compared with 17 years, p < 0.0). The population attributable fraction for regular cannabis use associated with hospital admissions due to psychosis was 17.7% (95% CI 1.2-45.5%). Conclusions: Cannabis use is related to psychosis in this Chilean group of patients. This relationship is stronger in patients with early exposure to the drug and longer the regular use. One of every five admissions due to psychosis is associated with cannabis consumption. These data should influence cannabis legisla-tion and the public policies currently being discussed in Chile.

Comorbid addictive behaviors in disordered gamblers with psychosis

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors - specifically food bingeing - in this population may be warranted.

Morbilidad psiquiátrica en pacientes mayores de 18 años / Psychiatric morbidity in older than 18 years

Introducción: las enfermedades psiquiátricas constituyen un problema de salud que afecta todas las esferas de la vida humana. Objetivo: describir la morbilidad psiquiátrica de pacientes mayores de 18 años de edad. Métodos: estudio descriptivo transversal. La muestra estuvo constituida por 260 pacientes. Los entrevistados fueron pacientes mayores de 18 años de edad atendidos en el Departamento de Salud Mental del Policlínico Héroes de Girón, durante el año 2015. Se revisaron las historias clínicas de los pacientes y se les aplicó el método clínico, entrevista semiestructurada. Resultados: las entidades psiquiátricas de mayor prevalencia fueron las Psicosis (38,84 por ciento) y los Trastornos neuróticos (36,92 por ciento); seguidas de un predominio de las Adicciones (13,07 por ciento) y las Demencias (11,15 por ciento). Conclusiones: la morbilidad psiquiátrica que predomina está constituida por las Psicosis y los Trastornos neuróticos(AU)

Introduction: psychiatrics diseases constitute a problem of health that affects all the spheres of the human life. Objective: describing the psychiatric morbidity in older than 18 years of age. Material and method: It was carried out a descriptive transversal study. The sample was constituted by 260 patients. The interviewed were older than 18 years of age attended patients of the Mental Health Department at the Héroes de Girón Policlinic, during the year 2015. To the patients applied them the clinical method, semi -structural interview. Clinical reports of the examined patients were reviewed. Results: It was obtained that the most common psychiatrics diseases were Psychosis (38.84 percent%), Neurotics disorders (36.92 percent); it prevailed the diagnosis of Drug adiction isorder (13.07 percent) and Dementia (11.15 percent). Conclusion: the psychiatric morbidity that prevails is Psychosis and Neurotics disorders(AU)

Descripción de la población asistida en la sala de salud mental del Hospital Maciel en un año / Description of assisted population in the mental health ward Maciel Hospital in a year

Los trastornos psiquiátricos son una de las principales causas de morbilidad mundial, y la respuesta insuficiente de los servicios de salud mental viene siendo objeto de estudios científicos.Surge así la necesidad de actualizar la información epidemiológica de nuestros servicios y compararla con estudios previos.La impresión clínica lleva a plantearnos la hipótesis de un aumento en la frecuencia delos trastornos por consumo de sustancias psicoactivas y violencia, lo cual requiere objetivar estos datos.Es un estudio descriptivo observacional transversal de la población asistida en la sala de salud mental del Hospital Maciel durante un año. La internación en sala cumple actualmente con una asistencia de corta estadía, multidisciplinaria,con criterios geográficos y clínicos, de amplio espectro nosológico, predominando los trastornos por consumo de sustancias.Algunos puntos objetivados son: patología dual 40,82 %, no compensación 15 % (egresos sin alta médica y derivaciones) y el 12,24 % de reinternaciones en el período analizado.

Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico / Age of onset symptoms and gender in schizophrenic spectrum disorders

Introducción. Existe controversia sobre la posibilidad de que la edad de inicio de la esquizofrenia y de algunas características clínicas del trastorno, sean diferentes entre hombres y mujeres. Objetivo. Evaluar la relación entre sexo, edad de inicio y síntomas negativos en pacientes con trastornos del espectro esquizofrénico. Materiales y métodos. Se evaluaron 225 pacientes para medir la edad de inicio de los síntomas y el puntaje en la escala SANS (Scale for the Assessment of Negative Symptoms). Se usaron estimadores de densidad kernel para evaluar las características de la edad de inicio. Se estimaron los parámetros de distribuciones mezcladas usando algoritmos de máxima verosimilitud. La relación síntomas negativos-edad de inicio se evaluó usando regresión múltiple. Resultados. Hubo diferencia significativa en la edad de inicio según el sexo (24,5 años en hombres Vs. 27,5 años en mujeres). Se encontró asociación entre sexo y comienzo temprano de síntomas, siendo este último más frecuente en hombres. Los estimadores de densidad para la edad de inicio sugieren un modelo mezclado con tres componentes, con los siguientes parámetros: m1=21,55, sd1=5,25; m2=29,54, sd2=7,22; y m3=40,01, sd3=3,98. Al tener en cuenta el sexo, se aíslan dos estructuras bimodales: la de hombres tiene la menor media de edad de inicio (18,02 años) mientras que la de media más alta corresponde a las mujeres (41,03 años). Los coeficientes de regresión sugieren incremento en los síntomas negativos a medida que aumenta el tiempo con enfermedad. Conclusión. Nuestros resultados apoyan la hipótesis de que existe relación entre la edad de inicio de los síntomas, el sexo y las características clínicas, en pacientes con trastornos del espectro esquizofrénico, lo que demuestra que los hombres tienen un inicio más temprano y un curso de la enfermedad con mayor deterioro.

Introduction. Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. Objective. The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. Materials and methods. A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. Results. A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. Conclusion. The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Knowledge, experience & attitudes concerning electroconvulsive therapy among patients & their relatives.

Background & objectives: Electroconvulsive therapy (ECT) is used frequently in developing countries, but investigations of patients’ awareness and perception of ECT are rare. The present study thus attempted a comprehensive examination of knowledge, experience and attitudes concerning ECT among patients treated with brief-pulse, bilateral, modified ECT, and their relatives. Methods: Of the 153 recipients of ECT, 77 patients and relatives were eventually assessed using questionnaires designed to evaluate their awareness and views about ECT. Results: Patients were middle-aged, poorly-educated, often unemployed, with chronic, severe, and predominantly psychotic illnesses. Relatives were mainly parents, older, better-educated and usually employed. Apart from the very rudimentary aspects, patients were largely unaware of the procedure. Though most did not find the experience of ECT upsetting, sizeable proportions expressed dissatisfaction with aspects such as informed consent, fear of treatment and memory impairment. Although patients were mostly positive about ECT, ambivalent attitudes were also common, but clearly negative views were rare. Relatives were significantly likely to be more aware, more satisfied with the experience and have more favourable attitudes towards ECT, than patients. Interpretation & conclusions: The results endorse the notion that recipients of ECT are generally well-disposed towards the treatment, but also indicate areas where practice of ECT needs to be improved to enhance satisfaction among patients and relatives.

Diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis en Chile / Design and evaluation of a community intervention for early detection of the first episode of schizophrenia

Introducción: La esquizofrenia es una enfermedad mental que genera discapacidad, afectando la calidad de vida de la persona y de sus cuidadores. Las investigaciones demuestran que un menor tiempo de psicosis no tratada durante el primer episodio se asocia con un mejor pronóstico. Objetivo: En este trabajo se describe el diseño y evaluación de proceso de una intervención comunitaria para la detección precoz del primer episodio de psicosis, que fue aplicada en tres sectores del país (comunas de Iquique, La Granja y El Bosque) ligados a un servicio de salud mental. Material y método: Para la evaluación se utilizó una metodología cualitativa de tipo etnográfica, basada en entrevistas semi-estructuradas y entrevistas grupales con los diferentes tipos de participantes (profesores, coordinadores, profesionales médicos y no médicos). Resultados: La evaluación de proceso de esta intervención permitió concluir que contribuyó al cumplimiento de los objetivos de la intervención de manera heterogénea; se obtuvo una buena participación de médicos y profesores; la capacitación fue bien evaluada. Conclusiones: Las recomendaciones principales fueron: 1) obtener respaldo político (autoridades sanitarias locales), 2) crear y mantener vínculos cercanos con el equipo investigador, y 3) adecuar la intervención a los valores y/o necesidades de la comunidad.

Introduction: Schizophrenia is a disabling mental illness that affects the quality of life of both the sufferer and their caretakers. Research has shown that quick diagnosis and treatment of the first episode is associated with better prognosis. Objective: In this paper, the design and evaluation of a community intervention for early detection of the first episode of psychosis in three sectors of the country (municipalities of Iquique, La Granja and El Bosque) is described. Materials and Methods: For the evaluation, a qualitative, ethnographic methodology was used, based in semi-structured and group interviews with different categories of participants (teachers, coordinators, medical professionals and non-medical professionals). Results: Evaluation of this intervention shows that the objectives were fulfilled unequally. A high level of participation was obtained from doctors and teachers, and the training was positively evaluated. Conclusions: The main recommendations were, 1) obtain political support (local health authorities), 2) create and manage close relationships within the research team, and 3) modify the intervention to serve the needs and values of each community.

Diagnóstico diferencial entre experiências espirituais e psicóticas não patológicas e transtornos mentais: uma contribuição de estudos latino-americanos para o CID-11 / Differential diagnosis between non-pathological psychotic and spiritual experiences and mental disorders: a contribution from Latin American studies to the ICD-11

OBJETIVO: Contribuir para a validade da Classificação Internacional de Doenças-11ª edição no diagnóstico diferencial entre experiências espirituais/anômalas e transtornos mentais revisando artigos de pesquisa sobre o tema em psiquiatria e psicologia envolvendo populações latino-americanas e/ou produzidos por pesquisadores latino-americanos. MÉTODO: Pesquisa em bases de dados (PubMed, PsycINFO, Scopus, and SciELO) por meio de palavras-chave (possessão, transe, experiência religiosa, experiência espiritual, Latin, Brazil) em busca de artigos com dados psicológicos e psiquiátricos originais em experiências espirituais. Também foram analisadas as referências dos artigos selecionados e autores na área foram contactados em busca de dados e referências adicionais. RESULTADOS: Há evidências consistentes que experiências psicóticas e anômalas são frequentes na população geral e que em sua maioria não estão relacionadas a transtornos psicóticos. Frequentemente, experiências espirituais envolvem experiências dissociativas e psicóticas de caráter não patológico. Embora as experiências espirituais não estejam habitualmente relacionadas a transtornos mentais, elas podem causar sofrimento transitório e são frequentemente relatadas por pacientes psicóticos. CONCLUSÃO: Propomos algumas características que sugerem a natureza não patológica de uma dada experiência espiritual: ausência de sofrimento, de prejuízo funcional ou ocupacional, compatibilidade com o contexto cultural do paciente, aceitação da experiência por outros, ausência de comorbidades psiquiátricas, controle sobre a experiência e crescimento pessoal ao longo do tempo.

OBJECTIVE: To review research articles in psychiatry and psychology involving Latin American populations and/or produced by Latin American scholars to investigate the differential diagnosis between spiritual/anomalous experiences and mental disorders in order to contribute to the validity of the International Classification of Diseases towards its 11th edition in this area. METHOD: We searched electronic databases (PubMed, PsycINFO, Scopus, and SciELO) using relevant keywords (possession, trance, religious experience, spiritual experience, latin, Brazil) for articles with original psychiatric and psychological data on spiritual experiences. We also analyzed the references of the articles found and contacted authors for additional references and data. RESULTS: There is strong evidence that psychotic and anomalous experiences are frequent in the general population and that most of them are not related to psychotic disorders. Often, spiritual experiences involve non-pathological dissociative and psychotic experiences. Although spiritual experiences are not usually related to mental disorders, they may cause transient distress and are commonly reported by psychotic patients. CONCLUSION: We propose some features that suggest the non-pathological nature of a spiritual experience: lack of suffering, lack of social or functional impairment, compatibility with the patient's cultural background and recognition by others, absence of psychiatric comorbidities, control over the experience, and personal growth over time.

Avaliação neurocognitiva dos estados de risco ultra-alto de psicose usando a bateria MATRICS (Medição e Pesquisa de Tratamento para Melhorar Cognição na Esquizofrenia) / Neurocognitive assessment of ultra high risk of psychosis states using the MATRICS battery (Measurement and Treatment Research to Improve Cognition in Schizophrenia)

CONTEXTO: Diversos déficits neuropsicológicos têm sido detectados em indivíduos com risco ultra-alto de desenvolver psicose, mas o melhor instrumento neuropsicológico para detectar esses déficits está ainda para ser determinado. OBJETIVOS: Avaliar o perfil neuropsicológico de indivíduos em risco ultra-alto de psicose (UHRP) usando a bateria MATRICS, em comparação com controles combinados por idade, gênero e quociente de inteligência. MÉTODO: O funcionamento neuropsicológico foi medido em 27 pacientes em UHRP e 38 controles usando a bateria MATRICS. UHRP foi diagnosticado usando a escala para Avaliação Cognitiva de Estados Mentais em Risco (CAARMS), e tanto o funcionamento social como o global também foram avaliados. As comparações entre grupos foram estabelecidas usando ANOVA, ANCOVA e correlação de Pearson. RESULTADOS: Os sujeitos em UHRP marcaram 0,5 a 1,7 desvios-padrão abaixo dos controles na memória de trabalho, aprendizagem verbal e visual e cognição social. CONCLUSÃO: Indivíduos em UHRP apresentam déficits seletivos no funcionamento neurocognitivo quando comparados com controles, que podem ser detectados com MATRICS. Esse instrumento parece ser útil para a detecção temporã de estados de UHRP.

BACKGROUND: Several neuropsychological deficits have been detected in subjects at ultra high risk of developing psychosis, but the best neuropsychological instruments to detect these deficits are yet to be determined. OBJECTIVES: Assess neuropsychological profile of subjects at ultra high risk of psychosis (UHRP) using MATRICS battery (Measurement and Treatment Research to Improve Cognition in Schizophrenia) compared with age, gender and Intelligence Quotient matched controls. METHOD: Neuropsychological functioning was measured in 27 UHRP patients and 38 controls using MATRICS battery. UHRP was diagnosed using the Cognitive Assessment of at Risk Mental States (CAARMS) scale, and both social and global functioning was assessed as well. Comparisons between groups were established using ANOVA, ANCOVA and Pearson correlation. RESULTS: UHRP subjects scored 0.5 to 1.7 SD below controls in working memory, verbal and visual learning and social cognition. DISCUSSION: UHRP subjects exhibit selective deficits in neuro-cognitive functioning when compared with controls, which can be detected with MATRICS. This instrument seems to be helpful for early detection of UHRP states.

Consumo de fumonisinas y daños a la salud humana / Fumonisin intake and human health

Las fumonisinas son una familia de micotoxinas que contaminan al maíz, alteran el metabolismo de los esfingolípidos y del folato, se asocian con defectos del tubo neural y están catalogadas por la Agencia Internacional de Investigación en Cáncer (IARC por sus siglas en inglés) como posibles carcinógenos humanos. Debido a que en México los derivados de maíz constituyen una parte importante de la dieta y existe alta prevalencia de población genéticamente susceptible a la deficiencia de folato, en este ensayo se presentan las evidencias mundiales y nacionales de la exposición a fumonisinas y la relevancia que para México representa la evaluación de esta exposición.

Fumonisins are mycotoxins that contaminate maize, disrupt the folate and sphingolipid metabolism, are associated with neural tube defects, and are considered by the International Agency for Research on Cancer (IARC) as possible human carcinogens. Since maize-based foods are significant components of the Mexican diet and there is a high prevalence of genetic susceptibility for folate deficiency among Mexicans, this essay presents international and national evidence of fumonisin exposure and the relevance that such exposure represents for Mexico.

Consumo de sustancias psicoactivas en pacientes con trastornos psicóticos ingresados en sala de emergencia psiquiátrica: Hospital Vilardebó: Montevideo: Uruguay / Psychoactive substance use in patients with psychotic disorders admitted to psychiatric emergency room: Hospital Vilardebó: Montevideo: Uruguay

Se realizó un estudio descriptivo desde Octubre a Diciembre de 2008 en la Emergencia del Hospital Vilardebó estableciéndose la prevalencia del consumo de sustancias psicoactivas en los pacientes que ingresaban por Trastornos Psicóticos. La presencia de consumo reciente se estableció por autorreporte y test en orina para marihuana y cocaína/ pasta base de cocaína. La prevalencia del consumo reciente en los pacientes con Trastornos Psicóticos fue de 17,9 por ciento. Los pacientes con testeado positivo mostraron una tasa total de ingresos mayor que aquella del grupo de los no consumidores, y los ingresos en el último año fueron claramente mayores para el grupo que consume cocaína y sus derivados.

A descriptive study was conducted from October to December 2008 in the emergency room of Hospital Vilardebó (State Mental Facility) to establish the prevalence of psychoactive substance use in patients admitted for Psychotic Disorders. The presence of recent use of substance was established by self-report and urine test for marijuana and cocaine / cocaine base. The prevalence of recent use in patients with psychotic disorders was 17.9 percent. Patients who tested positive showed a total hospitalization rate greater than that of the group of nonusers, and hospitalization in the last year were clearly higher for the group who uses cocaine and its derivatives.

Análise da prevalência dos transtornos psíquicos na região metropolitana do Recife / Analysis of the prevalence of psychic disorders in the metropolitan region of Recife

A saúde mental é um estado de bem-estar em que o indivíduo tem consciência das suas capacidades, é capaz de lidar com o estresse normal da vida, trabalhar produtivamente e contribuir para a sua comunidade. O presente trabalho tem como objetivo analisar quantitativamente a prevalência dos transtornos psíquicos, usando parâmetros referenciais como sexo, idade, tipos de distúrbios e assistência prestada aos portadores. Foi realizada uma abordagem quantitativa através de uma adaptação do questionário Self Reporting Questionnaire (SRQ - 20), em que foram entrevistadas assistentes sociais de três hospitais psiquiátricos da Região Metropolitana do Recife (RMR) - Hospital Psiquiátrico Ulysses Pernambucano, Núcleo de Atenção Psicossocial de Pernambuco (NAPPE) e Hospital Colônia Aucides Codiceira. O resultado mostrou uma maior incidência dos transtornos nas mulheres, entre a faixa etária de 41 - 60 anos, destacando-se a esquizofrenia como o principal tipo de patologia dentre as encontradas. Entre os diversos tratamentos oferecidos, prevalecem as terapias medicamentosas, em grupo e individual, estas apresentando melhor resultado.

Mental health is a state of well-being, in which the individual is aware of its capacities, capable of coping with the ordinary stress of everyday life, of working productively and of functioning in society. The purpose of the present work is a quantitative analysis of the prevalence of psychic disorders, using references such as sex, age, kind of disorder and care delivered to the carriers. Social assistants of three psychiatric hospitals of the Metropolitan Region of Recife - the Psychiatric Hospital Ulysses Pernambucano, the Nucleus for Psychosocial Care of Pernambuco (NAPPE) and the Hospital Colony Alcides Codeceira - answered an adapted version of the Self Reporting Questionnaire (SRQ-20). The results showed a higher incidence of disorders in women in the age group between 41 and 60 years. Schizophrenia was the most frequently observed kind of mental disorder. Among the different treatments offered were drug therapy and individual and group therapy, the latter showing better results.

Padrão de distúrbios psíquicos menores em mulheres vítimas de violência atendidas em uma unidade de urgência e emergência / Patterns of minor psychiatric disorders among battered women treated at an emergency care unit

Este estudo de corte transversal teve como objetivo descrever o padrão de ocorrência de distúrbios psíquicos menores entre mulheres de 15 a 49 anos, atendidas em um hospital de emergência de Salvador, Bahia, Brasil, e que sofreram diferentes tipos de violência. As mulheres foram identificadas a partir de entrevistas face a face, utilizando-se o Abuse Assessment Screen. Para avaliar o estado mental, utilizou-se uma versão do Self-Reporting Questionnaire (SRQ-20). Do total de 273 mulheres, 77,3 por cento (IC95 por cento: 78,2-82,2) apresentaram escore igual ou acima de sete no SRQ-20, sugerindo provável morbidade psiquiátrica. Mulheres que sofreram mais de um tipo de violência (RP = 1,31; IC95 por cento: 1,11-1,56) e foram agredidas nos últimos 12 meses (RP= 1,30; IC95 por cento: 1,08-1,58) apresentaram maior prevalência de distúrbios psíquicos menores. Os resultados sugerem uma associação positiva entre violência e doença mental, o que requer medidas mais eficazes de atenção às vítimas, como a criação de redes institucionais que garantam a integralidade da assistência às mulheres.

The aim of this cross-sectional study was to describe the patterns in minor psychiatric disorders among women who suffered different types of violence. Using a version of the Abuse Assessment Screen, face-to-face interviews were conducted in a cluster sample of women ages 15 to 49 years using an emergency care hospital. Women's mental status was assessed with a version of the Self-Reporting Questionnaire (SRQ-20). From a total of 273 women, 77.3 percent (95 percentCI: 78.2-82.2) scored 7 or more on the SRQ-20, indicating the presence of psychiatric illness. The findings suggest that women who had experienced more than one type of violence (PR = 1.31; 95 percentCI: 1.11-1.56) and who had been battered in the previous 12 months (PR = 1.30; 95 percentCI: 1.08-1.58) were more likely to suffer minor mental disorders. The results show a positive association between violence and mental illness, suggesting the need for more effective measures in the care of victims, such as the creation of institutional nets to guarantee comprehensive care for women.

Factores Pronósticos de Esquizofrenia en Primer Episodio Psicótico / Prognostic factors for schizophrenia during first psychotic episode

Objetivo: Revisar la literatura disponible sobre el pronóstico del primer episodio psicótico para el desarrollo de esquizofrenia. Método: Una revisión sistemática de los estudios que han evaluado los determinantes pronósticos para el primer episodio psicótico y su relación con esquizofrenia. Resultados: Se revisaron 161 artículos que cumplían con los criterios de búsqueda y que se ajustaban con el propósito del estudio. Conclusiones: El tiempo de psicosis no tratada (DUP), el nivel del funcionamiento premórbido, la presencia o predominio de síntomas negativos, el consumo comórbido de sustancias psicoactivas y el estado psicosocial fueron las características mas influyentes para el desarrollo de la esquizofrenia, en los pacientes que presentaban un primer episodio psicótico.

Objective: Reviewing the available literature regarding prognosis for first psychotic episode for developing schizophrenia. Method: A systematic review of studies which have evaluated prognostic determinants for the first psychotic episode and its relationship to schizophrenia was made. Results: 161 articles were reviewed which fulfilled the search criteria and which were adjusted to the purpose of the study. Conclusions: Duration of untreated psychosis (DUP), pre-morbid functioning level, the presence or predominance of negative symptoms, co-morbid consumption of psychoactive substances and psychosocial state were the most influential characteristics for developing schizophrenia in patients presenting a first psychotic episode.

Prevalence of psychiatric ailments among patients with sexually transmitted disease.

A cross-sectional descriptive study conducted on 250 sexually transmitted disease patients was carried out in two teaching institutes and their tertiary hospitals. These subjects constitute a special group of population for psychiatric diagnosis by using Structured Clinical Interview for Diagnostic and Statistical Manual IIIR. The study was done in the dermatology and venereology outpatient department of two tertiary hospitals of Dhaka, between January 1998 and January 1999. The findings show that 34% of total sexually transmitted disease patients had psychiatric disorders. Anxiety disorders (11.2%) were found to be the most common disorder among these psychiatric patients; this was followed by depressive disorder (8.4%), psychoactive substance use disorder (6.8%), sexual dysfunction (6.8%), bipolar mood disorder (0.4%), and schizophrenia (0.4%). Four percent of anxiety disorder was associated with psychoactive substance use disorder and sexual dysfunction. Similarly 3.6% of depressive disorder was found with psychoactive substance use disorder and sexual dysfunction while 1.6% of sexual dysfunction was associated with substance use disorder. Most of the patients in the sexually transmitted disease population recruited in the present study had both anxiety disorder and depressive disorder though majority of them were undetected and untreated. These findings underscore that special attention needs to be given to the mental health component of our health care delivery system.