Terapia cognitivo conductual para pacientes con riesgo clínico de psicosis / Cognitive behavior therapy for young patients at clinical risk for psychosis

INTRODUCCIÓN. Los estudios de tratamiento indican que el riesgo de transición a un trastorno psicótico puede al menos retrasarse en la población clínica de alto riesgo de psicosis (CHR), además de mejorar variables relacionadas con la calidad de vida de los pacientes, existiendo evidencia a favor de la terapia cognitivo conductual (TCC). MÉTODOS. Se realizó una síntesis narrativa, basada en la búsqueda de artículos originales, que abordasen la efectividad de la TCC en pacientes CHR, publicados en los últimos cinco años, incluidos en esta síntesis. RESULTADOS. Se incluyeron un total de 10 artículos que evalúan la TCC en CHR, siendo un tratamiento efectivo y ampliamente utilizado, lo que se asocia a una disminución en las consecuencias psicosociales que conlleva el retraso en la presentación del cuadro clínico y/o la disminución de síntomas comórbidos. CONCLUSIÓN. Actualmente, la TCC se ha convertido en el tratamiento de primera elección para CHR, existiendo una gran variedad de estrategias psicoterapéuticas específicas dentro de este grupo de intervención.

INTRODUCTION. Treatment studies indicate that the risk of transition to a psychotic disorder can at least be delayed in the clinical population at high risk for psychosis (CHR), in addition to improving variables related to the quality of life of patients, with evidence in favor of cognitive behavioral therapy (CBT). METHODS. A narrative synthesis was carried out, based on the search for original articles, which addressed the effectiveness of CBT in CHR patients, published in the last five years, included in this synthesis. RESULTS. A total of 10 articles that evaluate CBT in CHR were included, being an effective and widely used treatment, which is associated with a decrease in the psychosocial consequences that the delay in the presentation of the clinical picture and/or the decrease in symptoms entails. comorbid. CONCLUSION. Currently, CBT has become the treatment of first choice for CHR, with a wide variety of specific psychotherapeutic strategies within this intervention group.

Applying intervention mapping approach to a program for early intervention in first-episode mental crisis of a psychotic type

Abstract The holotropic mind perspective, an integral part of the framework of transpersonal psychology, has been considered a revolutionary approach to a certain spectrum of experiences in Non-ordinary states of consciousness (NOSC) which conventional approaches tend to treat indiscriminately as pathological processes, because PHM recognizes in these experiences their healing and evolutionary potential. This article describes the needs assessment, implementation, and evaluation of an experiential and educational program on the holotropic mind perspective and its praxis, Holotropic Breathwork® (HB), with students and professionals from the Group for Early Intervention in First-Episode Mental Crisis of a Psychotic Type of the University of Brasilia. The intervention aimed to establish change goals and objectives that would promote the adoption of the holotropic mind perspective's elements, such as a framework to broaden and strengthen mental health programs that assist people experiencing NOSC. The stages developed, inspired by the Intervention Mapping protocol, included a needs assessment; elaboration of change objective matrices; selection and description of methods based on theory and their applications; conception, planning, and implementation of the intervention; and results evaluation. Participants reported that the intervention allowed the expansion of their theoretical-conceptual and technical frameworks, giving them a less pathologizing understanding of and approach to NOSC and allowing them to perceive and manage such states, not as indiscriminately pathological expressions, but as phenomena inherent to the human condition that can be accepted and cared for without the exclusionary and exhaustive bias of mental disorders. Limitations and practical implications are discussed.

Intervenciones terapéuticas en psicosis esquizofrénica de niños y adolescentes / Therapeutic interventions in schizophrenic psychosis in children and adolescents

La prevalencia de Esquizofrenia es muy baja en la infancia y adolescencia temprana, aumentando en la adolescencia y adultez a un 1%. Se ha estimado que la prevalencia de psicosis de 0,9 en 10.000 a los 13 años y 17,6 en 10.000 a los 18 años. Los cuadros esquizofrénicos de inicio temprano y muy temprano son una variante severa del trastorno y se asocian a un mayor deterioro funcional, curso clínico más grave y peor evolución. Todo esto determina la necesidad de implementar tratamientos multimodales tempranos y eficaces, así como estrategias preventivas en los grupos de mayor riesgo. El tratamiento farmacológico cuenta con mayores evidencias de efectividad en este cuadro y otorga notables beneficios a los pacientes, sin embargo se requiere mayor investigación a largo plazo respecto a los efectos adversos secundarios, su impacto en individuos en desarrollo y la eficacia de estos agentes. Estos avances permitirán al clínico establecer un justo balance costo/beneficio de su uso en población infantojuvenil.

The prevalence of schizophrenia is very low during childhood and early adolescence, increasing later in adolescence and adulthood to 1%. It has been established that the prevalence of psychosis is 0.9/10000 at 13 years of age and 17.6/10000 at 18 years of age. Early and very early onset schizophrenia are a severe form of this disorder, and are associated to a larger disability, more severe form of the disease and worse prognosis. These factors determine the need of implementing treatments that are multimodal, early and effective, as well as preventive strategies in high risk groups. The pharmacological treatment of schizophrenia has evidence of effectiveness and gives patients important benefits, however, more long term research is needed regarding its side effects, its impact on the developing brain and its effectiveness. These facts would help the psychiatrist to establish the value, risks and benefits of the use of drugs in children and adolescents.

Prediction of conversion to psychosis: review and future directions / Previsão de conversão para psicose: revisão e perspectivas futuras

This article reviews recent findings on predictors of conversion to psychosis among youth deemed at ultra high risk (UHR) based on the presence of subpsychotic-intensity symptoms or genetic risk for psychosis and a recent decline in functioning. Although transition rates differ between studies, the most well powered studies have observed rates of conversion to full psychosis in the 30-40 percent range over 2-3 years of follow-up. Across studies, severity of subthreshold positive symptoms, poorer social functioning, and genetic risk for schizophrenia appear to be consistent predictors of conversion to psychosis, with algorithms combining these indicators achieving positive predictive power > 80 percent. Nevertheless, a substantial fraction of UHR cases do not convert to psychosis. Recent work indicates that UHR cases who present with lower levels of negative symptoms and higher levels of social functioning are more likely to recover symptomatically and no longer meet criteria for an at-risk mental state. In general, it appears that about 1/3 of UHR cases convert to psychosis, about 1/3 do not convert but remain symptomatic and functionally impaired, and about 1/3 recover symptomatically and functionally. Continued efforts to detect early risk for psychosis are critical for informing early intervention and provide increasing promise of delaying or even preventing the onset of psychosis.

O presente artigo revisa os achados recentes sobre os preditores de conversão para psicose entre jovens considerados de ultra alto risco (UAR) com base na presença de sintomas de intensidade sub-psicótica e risco genético para psicose e declínio recente no funcionamento mental. Apesar das taxas de transição serem diferentes entre os estudos, os estudos de mais peso encontraram taxas de conversão para psicose entre 30 por cento e 40 por cento em pacientes acompanhados por dois a três anos. Entre os estudos, gravidade de sintomas positivos sub-clínicos, pior relacionamento social e risco genético para esquizofrenia parecem ser preditores consistentes de conversão para psicose, com algoritmos combinando esses indicadores alcançando poder preditivo positivo > 80 por cento. Ainda assim, uma fração substancial de casos em UAR não converte para psicose. Trabalhos recentes indicam que casos em UAR que apresentam níveis mais baixos de sintomas negativos e níveis mais altos de bom relacionamento social apresentam maior probabilidade de recuperação dos sintomas e de não mais preencher os critérios para estado mental de risco. Em geral, parece que 1/3 dos casos de UAR convertem para psicose, cerca de 1/3 não convertem, mas se mantém sintomáticos e com comprometimento funcional, e cerca de 1/3 apresentam recuperação sintomática e funcional. Esforços contínuos para detectar risco precoce para psicose são críticos para a intervenção precoce e para fornecer uma promessa cada vez maior de retardar ou até prevenir o início da psicose.

Early intervention in psychosis: a map of clinical and research initiatives in Latin America / Intervenção precoce em psicose: um mapa das iniciativas clínicas e de pesquisa na América Latina

OBJECTIVE: This article aims to review Latin America's early intervention services in psychosis and to shed light into their challenges and particularities. METHOD: An internet-based search comprising medical societies' websites, published articles, and major universities' websites was conducted and the results were critically discussed. RESULTS: Latin American countries are profoundly deficient in specialized early intervention services. Our search found seven target services, four of which are based in urban areas of Brazil, inside tertiary hospitals or universities. Among the initiatives advanced by these centers, there are partnerships with the public educational system and other community-based efforts toward knowledge transfer. On the other hand, several challenges remain to be overcome, especially in relation to their expansion, which is necessary to match the existing demand.

OBJETIVO: Este artigo tem o objetivo de revisar os serviços de intervenção precoce em psicose na América Latina e lançar luz sobre seus desafios e particularidades. MÉTODO: Foi realizada uma busca na internet compreendendo os websites de sociedades médicas e das principais universidades e artigos publicados por autores latino-americanos e os resultados foram discutidos criticamente. RESULTADOS: Os países latino-americanos são profundamente deficientes no que diz respeito a serviços especializados de intervenção precoce em psicose. Nossa busca encontrou sete serviços principais, quatro dos quais baseados em áreas urbanas do Brasil, dentro de hospitais terciários ou universidades. Dentre as iniciativas promovidas por esses centros, há parcerias com o sistema público de educação e outros esforços baseados na comunidade para transferência de conhecimento. Não obstante, vários desafios ainda devem ser superados, relacionados sobretudo à expansão de tais serviços, necessária para abarcar a demanda existente.

First-episode psychosis: an update

Interest in the subject of first-episode psychosis has increased considerably in the last two decades. At present; a number of centres around the world focus on early identification and intervention in people with psychotic disorders. Researchers have focused particularly on people who are possibly experiencing the prodromal phase of the illness in the hope that; by instituting appropriate early intervention; the outcome of schizophrenia will be improved. Patients with first-episode psychosis present with different symptom domains that should be taken into account when planning treatment. Most patients initially respond to treatment; however; there is a high rate of relapse within a few years. It is therefore important that we continue to seek improved relapse prevention strategies. There has also been a resurgence of interest in psychosocial risk factors for the development of schizophrenia in the recent literature. We review the literature on first-episode psychosis and highlight the significant findings

Primeiro episódio psicótico: uma janela de oportunidade para tratamento? / First episode psychosis: a window of treatment opportunity?

CONTEXTO: Programas específicos para a pesquisa e assistência ao primeiro episódio psicótico foram desenvolvidos ao redor do mundo cujos pressupostos básicos são: identificação precoce do episódio psicótico, tratamento intensivo da crise e prevenção de recaídas. OBJETIVO: Este artigo pretende dar uma visão sobre a abordagem atual do paciente no primeiro episódio psicótico. MÉTODO: Revisão de pesquisas sobre primeiro episódio psicótico em centros internacionais e nacionais. RESULTADOS: Programas para identificação precoce do episódio psicótico podem diminuir o tempo de psicose não tratada e intervenções intensivas no primeiro episódio psicótico devem incluir tratamento intensivo do paciente e de seus familiares. CONCLUSÃO: Em alguns países os serviços já foram incorporados à rede de saúde pública. Existem poucas pesquisas e serviços especializados para primeiro episódio em nosso meio mostrando a necessidade de desenvolvimento de novas pesquisas nessa área.

BACKGROUND: Specific first episode programs were developed around the world aiming to: early detection, intensive crises care and relapse prevention. OBJECTIVE: This article intends to outline this new first episode psychosis approach. METHOD: To review study findings from international and national centers. RESULTS: Early education programs can lower the duration of untreated psychosis and interventions in first episode psychosis should include patient and family intensive care. CONCLUSION: In some countries these services have already been incorporated in the health system. There are few research and services in our country, showing the need to develop research in this area.

Prophylactic and therapeutic efficacy of carbamazepine in psychosis

The objective of this study is to assess the effect of carbamazepine [CBZ] in psychotic disorders, and to find the predictors for its use. Forty-three patients with psychotic disorders were selected randomly from private clinic. The duration of their illness varied from two years to twenty years. CBZ started [after two weeks wash out from other antipsychotic medications] in increasing doses from 100- 600mg daily. The outcome of this study depends on the diagnosis and the duration of the psychotic illness, the shorter the duration the better the results. Affective psychoses shows better results than.schizophrenic psychoses, and in depressed schizophrenic patients, CBZ acts as an adjuvant antidepressant to their antipsychiatric medications. Follow up of these patients is still. going on