Factors Affecting Admission Type in Patients with Schizophrenia Spectrum / 신경정신의학

OBJECTIVES: This study examined the admission type and its related factors among patients with psychotic disorders defined based on the revised mental health welfare law. METHODS: This study was conducted on a total of 100 patients diagnosed on the schizophrenia spectrum and other psychotic disorders. The admission type and sociodemographic characteristics were examined. Social support, psychopathology, excitement, insight, and social functioning were evaluated using the Social Support Scale, Positive and Negative Syndrome Scale (PANSS), PANSS excitement component, Brief Psychiatric Rating Scale, Global Assessment Functioning Scale, Strauss-Carpenter scale, Korean version of the Scale to Assess Unawareness of Mental Disorder, and Korean version of Beck Cognitive Insight Scale. RESULTS: The severity of psychotic symptoms, excitement, social functioning, and insight were significantly different between involuntary and voluntary admissions (p<0.05). Excitement and insight were found to be factors affecting the admission type (p<0.05). CONCLUSION: Excitement and insight were factors mainly accounting for the admission type in patients with psychotic disorder. This study could be helpful in improving clinical decision-making and community mental health care.

Change in Cognitive Function after Antipsychotics Treatment : A Pilot Study of Long-Acting Injectable versus Oral Form / 대한정신분열병학회지

OBJECTIVES: This study investigated whether long-acting injectable (LAI) paliperidone is different from its oral form in terms of the effect on cognitive function in schizophrenia spectrum and other psychotic disorders. METHODS: We reviewed the medical records of patients in Seoul National University Bundang Hospital who were diagnosed as having schizophrenia and/or other psychotic disorders based on DSM-5 from 2016 to 2017. Seven patients were treated with oral paliperidone and 11 were treated with paliperidone palmitate. All patients underwent clinical and neuropsychological assessment, including the Korean version of the MATRICS Consensus Cognitive Battery (MCCB) at their first visit or within one month of their initial treatment. MCCB was repeated within three to 12 months after the initial assessment. RESULTS: There was no significant difference between the two groups in most cognitive domains including speed of processing, attention and vigilance, working memory, verbal learning, visual learning and reasoning and problem solving domain. However, patients treated with paliperidone palmitate showed better improvement in social cognition domain than those taking oral paliperidone. The standardized values of social cognition domain scores had significantly improved over time in patients under paliperidone palmitate, demonstrating a significant time-by-group interaction. CONCLUSION: Our results show that long-acting injectable paliperidone could be helpful in some aspects of improving cognitive function in schizophrenia spectrum and other psychotic disorders. Further studies with other antipsychotics are necessary to generalize the results.

Análisis económico del costo de los medicamentos usados en patologías psiquiátricas: el tercio de los ingresos de un paciente se consumen en fármacos / Economic analysis of the cost of medicines used in psychiatric pathologies: one third of a patient's income is consumed in drugs

Contexto: los pacientes con enfermedades crónicas gastan entre el 5% a 18% del presupuesto individual o familiar destinado a salud en países europeos. Estas cifras pueden ser mayores en Ecuador. Objetivo: realizar un análisis del costo económico de los medicamentos usados para patologías psiquiátricas. Metodología: estudio descriptivo en 439 pacientes con diagnóstico de esquizofrenia, trastorno bipolar, depresión y adicciones para determinar el costo del tratamiento según la patología diagnosticada y el número de fármacos requeridos en su tratamiento. Resultados: el 95% de sujetos provienen de la región sierra, el 2,2% provienen de la costa y el 1,8% del oriente. Predominan pacientes del sexo femenino (53%), con una edad promedio de 36,7±15,8 años. El 68% es desempleado y apenas el 20% tiene un empleo inadecuado. Respecto al diagnóstico, el 28,6% corresponde a ansiedad, 27,2% a depresión, 21% consumen sustancias, 16,3% es esquizofrénico y el 6,7% tiene trastorno bipolar. El 80% de individuos tiene adherencia al tratamiento de un mes. La mayoría de patologías ameritan un tratamiento con dos fármacos, lo que implica un costo mensual promedio 30,67±24,94 dólares. La esquizofrenia es la patología que tiene un mayor costo de tratamiento con un valor mensual de 51,28±85,04 dólares Conclusión: el 80% de los pacientes estudiados requiere tratamiento farmacológico superior a 30 días; la mayoría de pacientes encuestados, el 28,6%, sufre síndrome de ansiedad generalizada, el 40% del total de pacientes necesita al menos dos medicamentos de forma simultánea, el trastorno bipolar es la patología que demanda mayor costo mensual, con más de US$ 112 con tres medicamentos de uso simultáneo, lo que representa el 29% de sus ingresos si ganase un remuneración mínima unificada en Ecuador, al 2017.(AU)

Context: patients with chronic diseases spend between 5% and 18% of the individual or family budget for health in European countries. These expenditures could be higher in Ecuador. Objective: to carry out an analysis of the economic cost of medicines used for psychiatric pathologies Methodology: descriptive study in 439 patients diagnosed with schizophrenia, bipolar disorder, depression and addictions, to determine the cost of treatment according to the pathology diagnosed, and the number of drugs required in their treatment. Results: 95% of subjects come from the sierra region, 2,2% come from the coast and 1,8% from the east. Female patients predominate (53%), with an average age of 36,7 ± 15,8 years. 68% are unemployed and only 20% have inadequate employment. Regarding the diagnosis, 28,6% corresponds to anxiety, 27,2% to depression, 21% consume substances, 16,3% are schizophrenic and 6.7% have bipolar disorder. 80% of individuals have adherence to the treatment of one month. Most pathologies merit a treatment with two drugs, which implies an average monthly cost of 30,67 ± 24,94 dollars. Schizophrenia is the pathology that has a higher cost of treatment with a monthly value of 51,28 ± 85,04 dollars Conclusion: 80% of the patients studied require pharmacological treatment of more than 30 days; the majority of patients surveyed, 28,6%, suffer from generalized anxiety syndrome, 40% of all patients need at least two medications simultaneously, bipolar disorder is the pathology that demands the highest monthly cost, with more than US $ 112 with three medications for simultaneous use, which represents 29% of their income if you earn a unified minimum remuneration in Ecuador, to 2017. (AU)

Design and Methodology of the Korean Early Psychosis Cohort Study

The present study details the rationale and methodology of the Korean Early Psychosis Cohort Study (KEPS), which is a clinical cohort investigation of first episode psychosis patients from a Korean population. The KEPS is a prospective naturalistic observational cohort study that follows the participants for at least 2 years. This study includes patients between 18 and 45 years of age who fulfill the criteria for one of schizophrenia spectrum and other psychotic disorders according to the diagnostic criteria of DSM-5. Early psychosis is defined as first episode patients who received antipsychotic treatment for fewer than 4 consecutive weeks after the onset of illness or stabilized patients in the early stages of the disorder whose duration of illness was less than 2 years from the initiation of antipsychotic treatment. The primary outcome measures are treatment response, remission, recovery, and relapse. Additionally, several laboratory tests are conducted and a variety of objective and subjective psychiatric measures assessing early life trauma, lifestyle pattern, and social and cognitive functioning are administered. This long-term prospective cohort study may contribute to the development of early intervention strategies and the improvement of long-term outcomes in patients with schizophrenia.

Um palácio abandonado: um estudo sobre a psicose na infância / An abandoned palace: a study on childhood psychosis

No domínio da produção teórica em psicanálise, há um vasto campo de formulações acerca das manifestações das psicoses na infância e de suas consequências para as suas práticas clínicas. O presente trabalho tem por objetivo a discussão de um caso clínico de psicose na infância, tomando como balizadores as questões relativas à transferência. As concepções psicanalíticas de constituição de sujeito e suas relações com o trabalho na transferência foram brevemente discutidas, sobretudo, a partir do interesse em destacar as particularidades do caso, para então aproximá-las ou distanciá-las das concepções teóricas existentes sobre a psicose na infância. A escrita do presente estudo de caso tem como pano de fundo a experiência no Núcleo de Atenção a Crianças e Adolescentes (NAIA) do Hospital de Saúde Mental Professor Frota Pinto em Fortaleza, Ceará, no qual se realizou o atendimento de orientação psicanalítica de uma criança com diagnóstico psiquiátrico de esquizofrenia paranoide.

In the domain of the theoretical production in Psychoanalysis, there is a wide field of ruminations about childhood psychosis' manifestations and its consequences to the clinical practice. The following work aims to discuss a clinical case of childhood psychosis, taking as landmarks the questions related to the transference. The psychoanalytical concepts of subject's constitution and its relations to the clinical practice were briefly discussed for the purpose of highlighting the particularities of the case, in order to approximate or to distinguish them from the existing theoretical concepts on childhood psychosis. According to the case studied, one concludes that the structural delineation allowed a treatment's handling, which made possible to insert the subject into the transference and thus made possible the treatment itself. The background of this case study's writting is the experience at Núcleo de Atenção a Crianças e Adolescentes (NAIA) from Professor Frota Pinto Mental Hospital in Fortaleza, Ceará, where the author has been responsible for the psychoanalytical oriented treatment of a child, who has received a psychiatrical diagnosis of paranoid schizophrenia.

Caracterização dos usuários de um Centro de Atenção Psicossocial Infantojuvenil do município de Salvador (BA) / Characterization of users in a Psychosocial Care Center for Children and Youth of the municipality of Salvador (BA): contributions for construction of a medical device

Neste estudo objetivou-se caracterizar o perfil dos pacientes diagnosticados com Transtorno Global do Desenvolvimento, atendidos em um Capsi que visa ofertar cuidados em saúde mental para crianças e adolescentes com transtornos mentais severos e persistentes no Município de Salvador (BA). Realizou-se um estudo exploratório descritivo a partir de dados secundários de um Centro de Atenção Psicossocial Infantojuvenil localizado no Município supracitado. A análise foi realizada considerando dois conjuntos de variáveis, a saber: a) variável relativa à clientela: idade, sexo, diagnóstico, b) variável relativa ao cuidado oferecido: refere-se à modalidade de atendimento em que o paciente foi engajado. Verificou-se que o serviço em questão possui em seu quadro um total de 480 usuários, sendo 72% pertencente ao sexo masculino, com maior expressividade dos diagnósticos de: Transtorno Global do Desenvolvimento (31,25%); Transtornos do Comportamento e Transtornos Emocionais que Aparecem Habitualmente na Infância (8,5%); retardo mental (8,5%); Esquizofrenia, Transtornos Esquizotípicos e Transtornos delirantes (6,3%). No que diz respeito aos TGD, encontrou-se um quantitativo de 150 usuários, sendo 84% do sexo masculino. Os diagnósticos mais recorrentes foram os de Autismo Infantil (46%) e Autismo Infantil em comorbidade com Retardo Mental (24,7%). Dentre estes, um quantitativo considerável frequenta ou já frequentou simultaneamente outra instituição além do Capsi.

This study aimed to characterize the profile of patients diagnosed with Pervasive Developmental Disorder, attended in a Capsi which aims to offer mental health care for children and adolescents with severe and persistent mental disorders in Salvador (BA). It was made a descriptive exploratory study from a secondary data center Psychosocial Care of Children and Youth located in the city above. The analysis was performed considering two sets of variables, namely: a) variable on the customer: age, sex, diagnosis, b) variable related to the care offered: refers to the type of care in which the patient was engaged. It was found that the service in question has on its staff a total of 480 users, 72% were male, with greater expressiveness of diagnoses: Pervasive Developmental Disorder (31.25%); Behavior Disorders and Emotional Disorders that usually appear in Childhood (8.5%), mental retardation (8.5%); Schizophrenia, schizotypal and delusional disorders (6.3%). With regard to the TGD, it was found a quantity of 150 users, 84% were male. The most frequent diagnoses were those of Infantile Autism (46%) and Autism Children with comorbid mental retardation (24.7%). Among these, an considerably amount where already attended or have attended another institution beyond Capsi.

An Open Label Study on Amisulpride in Augmentation with Atypical Antipsychotics in Treatment Resistant Patients of Schizophrenia and Schizoaffective Disorders.

The authors report an open label study in treatment resistant patients of schizophrenia and schizoaffective disorders. The patients who were earlier being treated with atypical antipsychotics were put on combination of amisulpride and atypical antipsychotics and efficacy as well as safety of the combination was assessed. Method: A study of 6 weeks duration was conducted on 30 patients (9 women, 21 men).The mean dose of amisulpride used was from 250.00 mg/day + 91.65. SAPS, SANS, CGI-S scales were applied. 4 patients dropped out of study. 26 patients completed 6 weeks duration. Results: There was significant improvement in negative symptoms, positive symptoms, cognition especially in old chronic schizophrenics.Only two patients developed extrapyramidal symptoms.Improvement in all symptoms was remarkable. Conclusion: The combination of amisulpride with atypical antipsychotics is a promising option in patients who are resistant to treatment.

Grupo de terapia ocupacional: um espaco de construcao de fatos, vivencias e historia / Groupwork in occupational therapy: constructing facts, experiences and history

Este trabalho descreve o processo de constituicao de um grupo de terapia ocupacional, destinado a pacientes psicoticos do Programa de Esquizofrenia (PROESQ) do Ambulatorio de Psiquiatria da Escola Paulista de Medicina da Universidade Federal de Sao Paulo EPM/UNIFESP. O grupo foi criado em abril de 1994, atendendo a demanda de pacientes mais jovens, com menor tempo de doenca e internacoes, e e coordenado por terapeutas ocupacionais, alunas do Curso de Especializacao em Terapia Ocupacional em Saude Mental, do Departamento de Psiquiatria da EPM/UNIFESP. O artigo aborda a composicao da historia do grupo, evidenciando os principais aspectos da experiencia do processo terapeutico: 1) A promocao, a integracao e a troca de experiencias e vivencias entre os integrantes do grupo; 2) A possibilidade de experimentacao com diversos materiais e atividades, promovendo a ampliacao do repertorio sociocultural de cada integrante; 3) O trabalho a partir das questoes referentes as necessidades e dificuldades de cada um, e a tentativa de elaboracao grupal...