Desenvolvimento de um programa digital de exercícios físicos para pacientes na fase inicial da psicose e seus familiares / Development of a digital physical exercise program for patients in the early stage of psychosis and their families

Programas de intervenção, voltados aos transtornos psicóticos, têm investido em melhorar a qualidade do cuidado ofertado aos jovens na fase inicial da psicose, na tentativa de garantir um melhor prognóstico. Assim, a prática de exercícios físicos tem sido incentivada e elencada como estratégia essencial para o processo de recovery. Porém, alguns desafios têm sido identificados para a prática de exercício físico por esses indivíduos como, principalmente, a falta de motivação e o engajamento. Desse modo, faz-se fundamental a elaboração de programas de exercícios físicos que incorporem estratégias para o enfrentamento destes desafios. O presente estudo teve como objetivo desenvolver um programa de exercícios físicos digital para indivíduos na fase inicial da psicose e seus familiares. Assim, o estudo metodológico qualitativo realizado considerou as recomendações para o primeiro estágio, desenvolvimento, da versão revisada do Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI2) e, para auxiliar na descrição de todos os componentes da intervenção, foi adotado os 16 itens aprovados pelo Consensus on Exercise Reporting Template (CERT). O programa foi desenvolvido por um profissional de educação física em parceria com docentes e profissionais da saúde, especialistas em saúde mental. Os resultados descreveram o desenvolvimento do Mental Move - vinculado ao Centro de Ciência, Cuidado e Apoio na Psicose (CiCAP) que propõe uma intervenção combinada com sessões de treino disponíveis no formato digital para indivíduos na fase inicial da psicose e seus familiares. Para auxiliar nas orientações e na motivação para realização do programa foram elaborados um manual em formato de ebook e outros materiais de apoio. Todo o conteúdo do programa foi inserido em uma Plataforma digital que confere acesso livre aos participantes. O programa incorporou estratégias para motivar o público-alvo para iniciar a prática de exercício físico em sua rotina semanal; ser de fácil execução; podendo ser realizado de forma individual, ou com a presença de um familiar ou grupo; ser gerenciado pelos participantes e/ou ao mesmo tempo por profissionais de saúde de forma indireta ou direta; ser de fácil acesso; ser viável para ser oferecido em diferentes cenários, como o domicílio, serviços de saúde, entre outros; e com baixo custo financeiro. Outros estudos serão necessários para que sejam percorridas as etapas de validação e avaliação previstas para a sua disponibilização. Espera-se que programas desta natureza possam ser incorporados às ações de cuidado em saúde mental pelos profissionais de saúde e contribuir para a promoção de saúde mental e melhora da qualidade de vida dos indivíduos na fase inicial da psicose e seus familiares

Intervention programs focused on psychotic disorders have invested in improving the quality of care offered to young people in the early stages of psychosis in an attempt to ensure a better prognosis. Thus, the practice of physical exercises has been encouraged and listed as an essential strategy for the recovery process. However, some challenges have been identified for the practice of physical exercise by these individuals, mainly the lack of motivation and engagement. Therefore, it is essential to develop exercise programs that incorporate strategies to face these challenges. The present study aimed to develop a digital physical exercise program for individuals in the initial phase of psychosis and their families. Thus, the qualitative methodological study conducted considered the recommendations for the first stage, development, of the revised version of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI2) and, to assist in the description of all components of the intervention, the 16 items approved by the Consensus on Exercise Reporting Template (CERT) were adopted. The program was developed by a physical education professional in partnership with faculty and health professionals who specialize in mental health. The results described the development of Mental Move - linked to the Center for Science, Care and Support in Psychosis (CiCAP) which proposes a combined intervention with training sessions available in digital format for individuals in the early stages of psychosis and their families. To assist in the orientation and motivation for carrying out the program, a manual in ebook format and other support materials were prepared. All the content of the program was inserted in a digital platform that gives free access to the participants. The program incorporated strategies to motivate the target audience to start practicing physical exercise in their weekly routine; to be easy to implement; to be carried out individually, or with the presence of a family member or group; to be managed by the participants and/or at the same time by health professionals indirectly or directly; to be easily accessible; to be feasible to be offered in different settings, such as home, health services, among others; and with low financial cost. Further studies will be necessary to go through the validation and evaluation stages foreseen for its availability. It is hoped that programs of this nature can be incorporated into mental health care actions by health professionals and contribute to the promotion of mental health and improvement in the quality of life of individuals in the initial phase of psychosis and their families

Características de pacientes con diagnóstico de primer episodio psicótico internados en un hospital universitario

RESUMEN Introducción: la esquizofrenia y otros trastornos psicóticos constituyen la mayor parte de los diagnósticos realizados en el Departamento de Emergencias y Admisión del Servicio de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción, seguidos por los trastornos depresivos y los trastornos de ansiedad. Objetivo: determinar las características de los pacientes con diagnóstico de primer episodio psicótico, siendo esta información relevante en el contexto de la atención que pueda brindarse a los mismos y a la información epidemiológica que proporciona. Metodología: estudio observacional, descriptivo, con muestreo no probabilístico, temporalmente retrospectivo. Se incluyó las historias clínicas de pacientes del Servicio de Psiquiatría del Hospital de Clínicas, de ambos sexos, que hayan sido hospitalizados con síntomas de un primer episodio psicótico entre 2014 y 2019. Resultados: se analizaron las historias clínicas de 143 pacientes. El 62,8% era del sexo femenino. La edad media fue 31 ± 13 años. El 48,9% tenía historial de diagnósticos psiquiátricos en su familia. El 66,43% era de nivel económico medio, el 32,17% nivel bajo y el 1,4% nivel alto. El pensamiento desorganizado fue el síntoma más frecuente (86%) encontrado en el examen del estado mental. Conclusiones: la mayoría de los pacientes con diagnóstico de primer episodio psicótico provenía del Departamento Central de Paraguay, residía en zonas urbanas, era del sexo femenino, era de nivel económico medio, aproximadamente la mitad con antecedentes de trastornos mentales en la familia y presentaba casi dos meses de evolución de la enfermedad. El pensamiento (ideas delirantes), el afecto, la introspección, el humor, el lenguaje y la sensopercepción (alucinaciones) fueron los indicadores más frecuentemente alterados del examen mental.

ABSTRACT Introduction: Schizophrenia and other psychotic disorders make up the majority of diagnoses made in the Emergency and Admission Department of the Psychiatry Service of the "Hospital de Clínicas" of the National University of Asunción, followed by depressive disorders and anxiety disorders. Objective: The objective of the present study was to determine the characteristics of the patients diagnosed with a first psychotic episode. This information is relevant in the context of the care that can be provided to patients and the epidemiological information provided. Methodology: This was an observational, descriptive study, with non-probabilistic sampling, temporarily retrospective. The medical records of male and female patients of the Psychiatry Service of the "Hospital de Clínicas" who have been hospitalized with symptoms of a first psychotic episode were included. Results: The medical records of 143 patients were analyzed, 62.8% of them was female. The mean age was 31.5 ± 13.6 years, 48.9% had a history of psychiatric diagnoses in their family, 66.43% had medium economic level, 32.17% low level and 1.4% high level. distortion in thinking was the most frequent symptom (86%) found in the mental state exam. Conclusions: The majority of patients diagnosed with the first psychotic episode came from the Central Department of Paraguay, resided in urban areas, were female, had medium economic status, approximately half had a history of mental disorders in the family and had almost two months of disease evolution. Thought (delusions), affection, introspection, humor, language, and perception (hallucinations) were the most frequently altered indicators of the mental examination.

Electroconvulsoterapia en el primer episodio de esquizofrenia: impacto en la evolución / Electroconvulsoterapia in the first episode of schizophrenia: impact on evolution

La esquizofrenia es una patología que evolucionade forma crónica, proclive al deterioro, siendo este último variable de acuerdo con comorbilidades presentes y adherencia al tratamiento integral. Genera alteraciones cognitivas e influye negativamente en el desempeño de quienes la padecen, causando detrimento global de los pragmatismos. La electroconvulsoterapia es una opción terapéutica ampliamente utilizada en nuestro país para tratar sintomatología del humor y episodios psicóticos agudos, entre otros. En la actualidad se sabe que la detección e intervención precoz de un episodio psicótico agudo —el cual puede corresponder al primer episodio psicótico de esquizofrenia —mejora el pronóstico a largo plazo. El objetivo es demostrar si existe un vínculo entre la indicación de electroconvulsoterapia durante el primer episodio psicótico de esquizofrenia y la duración del intervalo libre de internación. Este es un estudio de tipo analítico, observacional, retrospectivo (cohorte histórica) que busca aumentar las evidencias en este amplio campo de investigación. Observamos que el tiempo libre de internación luego de la primera hospitalización no tuvo relación con el hecho de si recibieron electroconvulsoterapia o no; sin embargo, al realizar el análisis de potencia estadístico surge que los resultados no son concluyentes. Se destaca el importante porcentaje de patología dual en este grupo de usuarios: un 39%.

Schizophrenia is a chronic disease, prone todeterioration, the latter being variable accordingto comorbidities and treatment adherence. It generates cognitive impairment and adverselyaffects overall performance, causing deterioration of pragmatisms. Electroconvulsive therapy is awidely used therapeutic option in our countryfor acute affective and psychotic episodes. It iswell known that early detection and interventionof an acute psychotic episode —which maycorrespond to the first psychotic episode of schizophrenia— improves long-term prognosis.This study intended to show whether there is alink between early indication of electroconvulsive therapy during the first episode and timeto relapse and hospital readmission. This is ananalytical, observational, retrospective (historical cohort) study, which aims to increase theevidence in this broad research field. As a resultthere was no link between time to relapse and electro convulsive therapy in the first episode; nevertheless after a post hoc analysis resultsare not conclusive. Dual diagnosis stands outin this group and corresponds to 39%.

Revisión actualizada de la relación BDNF, cognición y esquizofrenia/psicosis / BDNF, cognition and schizophrenia/psychosis: an updated review

El Factor Neurotrófico Derivado del Cerebro (BDNF) se ha relacionado con los síntomas cognitivos de la esquizofrenia, lo que se ha documentado en revisiones previas. Sin embargo, recientemente el foco de la investigación neurobiológica ha pasado de estudiar la esquizofrenia como enfermedad a estudiar las psicosis como grupo. El objetivo de esta investigación fue realizar una revisión actualizada de las publicaciones de los últimos cinco años (2013 a 2018) respecto a BDNF y síntomas cognitivos, tanto en esquizofrenia como en psicosis en general. Para esto se revisaron en PubMed los artículos con las palabras clave BDNF, cognitive y schizophrenia, y luego se repitió este proceso con la palabra psychosis. Como resultado, en el desarrollo del artículo se describe la manera en que distintos estudios, tanto en seres humanos como en modelos animales, dan cuenta de la relación entre BDNF y cognición, y de cómo influyen en ella elementos importantes como por ejemplo el género o el ejercicio. Sin embargo, se constata que aún la mayor parte de la investigación respecto a BDNF y síntomas cognitivos en psicosis se realiza en torno a la esquizofrenia como enfermedad. Por lo tanto, es necesario ampliar el estudio de la relación entre BDNF y síntomas cognitivos a cuadros psicóticos de distintos estadios y orígenes

Brain Derived Neurotrophic Factor (BDNF) has been linked to cognitive symptoms of schizophrenia, which has been documented in previous reviews. However, recently the focus of neurobiological research has moved from studying schizophrenia as a disease to studying psychosis as a group. The main aim of this research was to carry out an updated review of all relevant publications in the last 5 years (2013 to 2018) regarding BDNF and cognitive symptoms, both in schizophrenia and in psychosis. In order to achieve this, the keywords BDNF, cognitive and schizophrenia were reviewed in PubMed, and then this process was repeated with the word psychosis. As a result, in this article we describe the way in which different studies, both in human beings and in animal models, account for the relation between BDNF and cognition, and for the way in which important elements such as gender or exercise influence it. However, we found that still most of the research regarding BDNF and cognitive symptoms in psychosis is done around schizophrenia as a disease. Therefore, it is necessary to expand the study of the relationship between BDNF and cognitive symptoms to psychotic illnesses of different stages and origins