Ejercicio físico como intervención en personas en alto riesgo clínico de psicosis: revisión narrativa / Physical exercise as an intervention in people at clinical high-risk for psychosis: A narrative review

El constructo de alto riesgo clínico de psicosis ha favorecido la investigación en la neurobiología de los estadios previos a la psicosis, así como también en intervenciones preventivas. Se trata de personas jóvenes que presentan síntomas psicóticos de menor intensidad o de menor frecuencia en un tiempo determinado, o bien tienen antecedentes genéticos de trastornos psicóticos sumados a un deterioro significativo del funcionamiento. Las escasas intervenciones existentes para esta población cuentan con un bajo nivel de evidencia. La actividad y el ejercicio físico han demostrado ser parte de la terapia de múltiples trastornos psiquiátricos, mientras que el sedentarismo sería un factor favorecedor de la psicosis. Efectivamente, las personas en alto riesgo clínico de psicosis presentan un peor estado físico asociado a mayor sedentarismo y hábitos de vida poco saludables. Se ha propuesto que el ejercicio genera un efecto biológico positivo sobre el hipocampo y las áreas circundantes, regiones que estarían involucradas en la fisiopatología de la psicosis. Algunos estudios experimentales han mostrado una disminución en la sintomatología psicótica en pacientes en alto riesgo clínico de psicosis que han seguido pautas de ejercicio físico. También dan cuenta de cambios morfofuncionales en estructuras cerebrales. Si bien existen barreras para la implementación de esta intervención, se trata de una intervención segura y factible. Es necesario realizar una mayor cantidad de estudios experimentales de una escala mayor para medir su eficacia, generando evidencia científica que permita eventualmente integrar el ejercicio físico a las guías de práctica clínica como una recomendación sistemática.

The concept of clinical high risk for psychosis has favored research in the neurobiology of the stages prior to psychosis, as well as in preventive interventions. This group is made up of young people with: (1) psychotic symptoms of less intensity or less frequency during a brief time or having genetic history of psychotic disorders associated to a significant deterioration in functioning. The few existing interventions for this population have a low level of evidence. Physical activity and exercise have been shown to be part of the therapy for multiple psychiatric disorders, while a sedentary lifestyle would be a factor that favors psychosis. Indeed, people in clinical high risk for psychosis present a worse physical condition associated with a greater sedentary lifestyle and unhealthy habits. It has been proposed that exercise generates a positive biological effect on the hippocampus and surrounding areas, regions that would be involved in the pathophysiology of psychosis. Some experimental studies have shown a decrease in psychotic symptoms in patients with clinical high risk for psychosis who have followed physical exercise guidelines, as well as morphofunctional changes in brain structures. Although there are barriers to the implementation of this intervention, it is safe and feasible. It is necessary to conduct a greater number of experimental studies on a larger scale to measure its efficacy, generating scientific evidence that will eventually allow physical exercise to be included in clinical practice guidelines as a systematic recommendation for clinical high risk for psychosis.

Análisis psicopatológico y sociodemográfico de pacientes hospitalizados por intento de suicidio en un hospital público chileno: estudio transversal analítico / Psychopathological and sociodemographic analysis of hospitalized patients for suicide attempt in a Chilean public hospital: An analytical cross-sectional study

Resumen Introducción: El suicidio es una problemática de salud pública global. A nivel regional, el análisis de las dimensiones psicopatológicas y sociodemográficas del intento de suicidio (IS) son escasas. Método: estudio transversal que analizó psicopatológica y sociodemográficamente a adultos hospitalizados por IS en un hospital público de Chile. Los participantes se caracterizaron sociodemográficamente y clínicamente, evaluando síndromes neuropsiquiátricos, trastornos de la personalidad y niveles de desesperanza, impulsividad, intencionalidad, letalidad y agresividad del IS. Se aplicó estadística no paramétrica. Resultados: 45 participantes fueron incluidos, con una mediana de 39 años de edad. La mayoría residió en zonas urbanas, pertenecía a un nivel socioeconómico bajo, eran solteros, presentó algún evento vital estresante y antecedente de IS. El método de IS más frecuente fue la ingesta medicamentosa. Los diagnósticos más frecuentes fueron trastorno por consumo de alcohol y personalidad límite. En la mitad de los casos la desesperanza fue leve o inexistente. La letalidad se correlacionó positiva y significativamente con la intencionalidad suicida, así como la impulsividad con la agresividad. El antecedente familiar de IS y el trauma psíquico fueron significativamente mayores en mujeres y el dolor crónico en hombres. Los casos graves mostraron altos niveles de desesperanza, intencionalidad y letalidad, mientras que la impulsividad fue significativamente menor que en los casos no graves. En este grupo, el diagnóstico más frecuente fue episodio depresivo. Conclusiones: La muestra analizada mostró características psicopatológicas y sociodemográficas distintivas. La letalidad y la intencionalidad del IS deben ser sistemáticamente evaluadas. Los casos graves de IS mostraron características psicopatológicas diferenciales.

Introduction: Suicide is a global public health problem. At the regional level, the analysis of the psychopathological and sociodemographic dimensions of suicide attempt (SA) are scarce. Methods: We conducted a cross-sectional study to analyze psychopathological and sociodemographic characteristics of adults hospitalized for SA in a public hospital in Chile. We describe participants according to sociodemographic and clinical characteristics, appraising neuropsychiatric syndromes, personality disorders, and levels of hopelessness, impulsiveness, intentionality, lethality and aggressiveness of the SA. Non-parametric statistics were applied. Results: 45 participants were included, with a median of 39 years of age. The majority lived in urban areas, belonged to low socioeconomic status, were single, had some stressful life event and a history of SA. The most frequent SA method was drug intake. The most frequent diagnoses were alcohol use disorder and borderline personality. In half of the cases the hopelessness was low or inexistent. Lethality was positively and significantly correlated with suicidal intent, as was impulsivity with aggressiveness. Family history of SA and psychological trauma were significantly higher in women and chronic pain in men. Severe cases showed high levels of hopelessness, intentionality, and lethality, while impulsivity was significantly less than in non-severe cases. In this group, the most frequent diagnosis was depressive episode. Conclusions: The analyzed sample showed distinctive psychopathological and sociodemographic characteristics. The lethality and intent of the SA must be systematically appraised. The severe cases of SA showed particular psychopathological characteristics.

Differentiation of oxyntic cells and cell-matrix interactions during avian gastric gland morphogenesis

The relation between the expression of the oxyntic cell phenotype and the modifications of the extracellular matrix during development of the gastric glands, was studied in 10 to 21 day-old chick embryos. Cytodifferentiation of the oxyntic cells was established by ultrastructural methods, while the expression of pepsinogen, mitochondrial enzyme markers and apical secretory membranes was determined by histochemical and biochemical procedures. Results show that the morphogenesis of the glandular lobules occurs between days 8 and 15 of gestation. Later on, the lobules enlarge but maintain their basic morphology. Until day 13, the developing glands consist of primary tubes lined by a stratified columnar epithelium. The apical poles of the cells that contact the lumen show cytoplasmic processes, and Mg-ATPase activity and F-actin are concentrated at the apical cell borders. From day 13 on, the cells of the simple epithelium that lines secondary tubules budding from the primary tube, show all the features that define differentiated oxyntic cells. The synthesis of glycosaminoglycans during glandular morphogenesis was studied measuring the incorporation of radioactive sulfate into developing chick embryo proventriculi. An important increase in isotope incorporation was found between days 13 and 18 of development. Histochemical localization of these macromolecules shows that glycosaminoglycans are closely associated with the developing glandular lobules. Variations in the structure of epithelial cells undergoing morphogenesis and in the composition of the extracellular matrix are synchronous, suggesting that interactions between them may be significant in terms of the establishment and maintenance of the adult gastric gland phenotype