Síntomas maníacos en encefalitis autoinmune por anticuerpos contra mGluR5: a propósito de un caso / Maniac symptoms in autoimmune encephalitis due to mGluR5 antibodies: Presentation of a case

La encefalitis autoinmune es una entidad heterogénea en cuanto a su presentación clínica y pronóstico. Es frecuente que este cuadro presente síntomas psiquiátricos por lo que es habitual la intervención de los servicios de psiquiatría tanto en el proceso diagnóstico como en el manejo sintomático. El curso de la enfermedad suele ser agudo o rápidamente progresivo motivo por el cual es esencial la detección precoz de esta enfermedad con el fin de realizar las exploraciones complementarias y el tratamiento etiológico. Describimos el caso de un varón de 49 años, sin antecedentes psiquiátricos que presenta sintomatología maniforme en urgencias pero que a las pocas horas de ingresar en la unidad de agudos presenta disminución del nivel de consciencia y fiebre. Las exploraciones complementarias permiten orientarlo como encefalitis autoinmune por anticuerpos contra el receptor metabotrópico de glutamato 5. La psiquiatría de interconsulta participa en el manejo sintomático del paciente

Autoimmune encephalitis is a heterogeneous entity in terms of its symptoms and prognosis. As the clinical presentation frequently includes psychiatric symptoms, the intervention of psychiatric services is usual in the diagnostic process, as well as in the management of the symptoms. The course of the disease is usually acute or rapidly progressive, making the early detection of this disease essential in patients in order to perform the complementary tests and to treat the origin. The case is presented of a 49 year-old man, with no psychiatric history, who presents with maniac symptoms in the emergency room. A few hours after being admitted to the inpatient unit he presents with decrease in consciousness level and fever. Complementary tests led to the diagnosis of autoimmune encephalitis with antibodies against the metabotropic receptor of glutamate 5. The psychiatric approach for symptomatic treatment was made by joint consultation

Risk of underdiagnosis of hypertension in schizophrenia patients.

AIM: Arterial hypertension requires proper screening and management, and its underdiagnosis in patients with schizophrenia (SZ) and/or antipsychotic treatment has been postulated. The objective of the study is to assess whether there are differences in the proportion of screened patients with a blood pressure >140/90 mmHg that are undiagnosed or not confirmed later (risk of underdiagnosis). METHODS: Cross-sectional study of clinical records from SIDIAPQ (Spain) during the 2006-2011 period. Three groups were studied: SZ, no SZ but under antipsychotic treatment, and control groups. Patients with established hypertension, cardiovascular disease, dementia, or diagnosis of SZ or starting with antipsychotic treatment during this period were excluded. RESULTS: The SZ group had a lower risk of underdiagnosis than the control group (OR 0.91; 95% CI: 0.83-0.99; p < 0.05), at the expense of men (OR 0.8; 95% CI: 0.71-0.9; p < 0.001) and patients younger than 50 years of age (OR: 0.84; 95% CI: 0.74-0.93; p < 0.003). In the no SZ but under antipsychotic treatment group there were some differences, but not in the overall results. CONCLUSION: Preventive management of hypertension seemed to be sufficient for SZ and antipsychotic treatment patients. The lower prevalence of hypertension found in these groups may be due to other factors (blood pressure-lowering effect of psychoactive drugs or smoking) but these hypotheses must be evaluated with specific studies.

Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

Many studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population. Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking. A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence. The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required. ABBREVIATIONS: Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose (DDD).

Somatotipo ectomórfico e hiperlaxitud articular como marcadores potenciales para la ansiedad comórbida en la esquizofrenia / Ectomorphic somatotype and joint hypermobility as potential markers for co-morbid anxiety in schizophrenia

Objetivo: Evaluar si la asociación descrita entre los trastornos de ansiedad y el síndrome de hiperlaxitud articular se mantiene en presencia de esquizofrenia y determinar su importancia clínica. Métodos: Se comparan 20 pacientes casos (10 hombres y 10 mujeres) con esquizofrenia y ansiedad comórbida y 20 pacientes de control, emparejados por sexo, con esquizofrenia sin ansiedad y diagnosticados mediante SCID-I. Se valoran las características sociodemográficas, las escalas de sintomatología positiva y negativa de la esquizofrenia (PANSS), Ansiedad Social de Liebowitz (LSAS) y Adaptación Social (SAS), el somatotipo (método Heath-Carter), las anomalías físicas menores (escala de Waldrop) y los criterios del Hospital del Mar para la hiperlaxitud articular. Resultados: No hubo diferencias significativas por sexo entre los casos y controles en cuanto a edad y características sociodemográficas (estado civil, nivel educativo y situación laboral). Los hombres con ansiedad fueron significativamente más ectomórficos (U = 20; p =0.023), más hiperlaxos (U = 21; p = 0.025) y con menos anomalías físicas menores (U = 14.5; p = 0.007) que los hombres del grupo control. Las mujeres con ansiedad fueron significativamente más ectomórficas (U = 17; p = 0.009) y más hiperlaxas (U = 19; p = 0.017). En toda la muestra, tras ajustar por edad y sexo, únicamente la hiperlaxitud articular se asocia de manera independiente con la ansiedad social (odds ratio [OR] = 1.1; intervalo de confianza [IC] del 95%: 1.02-1.2). Discusión: En los pacientes con esquizofrenia, la asociación entre hiperlaxitud articular, somatotipo ectomórfico y ansiedad comórbida parece persistir.Es un probable marcador clínico-biológico de interés.

To evaluate whether the reported link between anxiety disorders and joint hypermobility syndrome still holds in the presence of schizophrenia, and to ascertain its clinical relevance. Methods: Twenty schizophrenic case-patients (10 men and 10 women) with a comorbid anxiety disorder diagnosed by SCID-I were compared to 20 schizophrenic control-patients without anxiety, matched by gender. Socio-demographic characteristics, positive and negative symptoms of schizophrenia (PANSS), Liebowitz Social Anxiety scale (LSAS), Social Adjustment Scale (SAS), somatotype (Heath-Carter method), minor physical anomalies (Waldrop scale), and Hospital del Mar criteria for joint hypermobility were also assessed. Re-sults: There were no significant differences by gender between cases and controls in terms of age and sociodemographic characteristics (educational level, marital status and labor situation). Men displaying anxiety were significantly more ectomorphic (U = 20; p = 0.023), more hypermobile (U = 21; p = 0.025) and had fewer minor physical anomalies (U = 14.5; p = 0.007) than controls. Women with anxiety were significantly more ectomorphic (U = 17; p = 0.009) and more hypermobile (U = 19; p = 0.017) than con-trols. In the entire sample, after adjusting for age and sex, joint hypermobility was independently related to social anxiety (odds ratio [OR] = 1.1; 95%CI: 1.02-1.2). Discussion: In patients with schizophrenia, the association between JHS, ectomorphic somatotype and co-morbid anxiety seems to persist. It is a probable clinical biological marker of interest.

Reasons and subjective effects of cannabis use among people with psychotic disorders: a systematic review.

UNLABELLED: Cannabis use is a frequent problem among people with psychotic disorders that has been related to a worse prognosis. Understanding the reasons of cannabis use may help to develop comprehensive treatments and, as a result, improve the psychosis course. METHODS: A systematic review of studies published in English and Spanish language from 1990 until March 2012 describing reasons for and subjective effects of cannabis use in patients with psychosis were reviewed. However, only those studies in which cannabis use was one of the three main substances studied were included. RESULTS: Initially, 73 studies, of which 12 met the inclusion criteria, were identified. Most of the studies include heterogeneous patients, at different illness stages, and a few studies included a non-psychotic comparison group. The most common reasons for cannabis use were those related with social activities, mood disturbance, relaxation and getting high. CONCLUSIONS: The most common reasons for cannabis use in patients with psychosis were related with social activities, mood disturbances, relaxation and getting high. However, a more homogeneous methodology need to be established, including different illness stages, to facilitate the interventions to reduce cannabis use in all phases of psychotic disorders development.

Revisión sistemática de las razones y efectos subjetivos del consumo de cannabis en pacientes con trastornos psicóticos / Reasons and subjective effects of cannabis use among people with psychotic disorders: a systematic review

El consumo de cannabis es un problema frecuente en los pacientes con trastornos psicóticos y se ha relacionado con un peor pronóstico. Entender las razones de este consumo, puede ayudar a desarrollar planes de tratamiento más integrales y mejorar la evolución de la psicosis. Métodos: Se ha revisado sistemáticamente la literatura publicada en inglés y español desde 1990 a marzo del 2012,que describe las razones de consumo y los efectos subjetivos de las sustancias consumidas en pacientes con psicosis, se han incluido sólo aquellos estudios en los que el cannabis aparece entre las tres principales sustancias estudiadas. Resultados: Se han identificado inicialmente 73 estudios, de los cuales doce cumplen los criterios de inclusión. La mayoría incluyen pacientes heterogéneos, en diferentes fases de la enfermedad y pocos estudios utilizan comparación con sujetos con consumo sin psicosis. Las razones más habituales del consumo observadas son las relacionadas con la actividad social, las alteraciones del ánimo, la relajación y la intoxicación. Conclusiones: Las razones más habituales del consumo en pacientes con psicosis están relacionadas con la actividad social, las alteraciones del ánimo, la relajación y conseguir intoxicarse, pero sería necesario establecer una metodología más homogénea en diferentes fases de la enfermedad para facilitar el desarrollo de intervenciones destinadas a reducir el uso/abuso de esta sustancia en todas las fases de los trastornos psicóticos

Cannabis use is a frequent problem among people with psychotic disorders that has been related to a worse prognosis. Understanding the reasons of cannabis use may help to develop comprehensive treatments and, as a result, improve the psychosis course. Methods: A systematic review of studies published in English and Spanish language from 1990 until March 2012 describing reasons for and subjective effects of cannabis use in patients with psychosis were reviewed. However, only those studies in which cannabis use was one of the three main substances studied were included. Results: Initially, 73 studies, of which 12 met the inclusion criteria, were identified. Most of the studies include heterogeneous patients, at different illness stages, and a few studies included a non-psychotic comparison group. The most common reasons for cannabis use were those related with social activities, mood disturbance, relaxation and getting high. Conclusions: The most common reasons for cannabis use in patients with psychosis were related with social activities, mood disturbances, relaxation and getting high. However, a more homogeneous methodology need to be established, including different illness stages, to facilitate the interventions to reduce cannabis use in all phases of psychotic disorders development

Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino? / Psychosis, cardiovascular risk and associated mortality: Are we on the right track?

Los pacientes con patología psicótica tienen un mayor riesgo de mortalidad precoz. Además de las causas no naturales (accidentes, suicidio), la causa cardiovascular (CV) está de 2 a 4 veces más presente que en población general. Esta revisión no sistemática de MEDLINE pretende esclarecer el papel de todos los condicionantes implicados. La patología psicótica se relaciona con hábitos de vida poco saludables tales como el tabaquismo, la dieta no equilibrada o el sedentarismo. Los fármacos neurolépticos también han sido estudiados como desencadenantes de obesidad y síndrome metabólico. Por tanto, los pacientes psicóticos parecen predispuestos a sufrir muchos de los factores de riesgo CV «clásicos». No es de extrañar que las puntuaciones en las escalas de riesgo cardiovascular (RCV) (Framingham, SCORE) sean superiores a las de la población general. También encontramos publicaciones en las que evidencian mayor dificultad en el manejo de la prevención primaria y secundaria de la enfermedad CV. Además, algunos factores bioquímicos (niveles plasmáticos de cortisol, ACTH, homocisteína, PCR) podrían indicar una vulnerabilidad de la psicosis per se, así como los hallazgos sobre hiperglucemia y resistencia a la insulina en psicóticos no tratados con psicofármacos. Estos factores «no-clásicos» podrían alteran la validez de las escalas de RCV diseñadas para población general. Por otro lado, los fármacos antipsicóticos podrían controlar factores intrínsecos de la psicosis (han demostrado disminuir la mortalidad global), no quedando claro su papel en la mortalidad CV

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic» CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear

[Psychosis, cardiovascular risk and associated mortality: are we on the right track?]. / Psicosis, riesgo cardiovascular y mortalidad asociada: ¿vamos por el buen camino?

Patients with psychotic disorders have a higher risk of early mortality. In addition to unnatural causes (accidents, suicide), death due to cardiovascular (CV) reasons is two to four times more prevalent in these patients than in the general population. This non-systematic review of MEDLINE aims to clarify the role of all the determining factors are involved. Psychotic disorders are related to unhealthy life habits such as smoking, poor diet and physical inactivity. Neuroleptic drugs have also been studied as triggers of obesity and metabolic syndrome. Therefore, psychotic patients seem predisposed to suffer from several of the «classic¼ CV risk factors. It is not surprising that their scores on the CV risk scales (Framingham, SCORE) are higher than the general population. We also found publications that showed poorer management of primary and secondary prevention of CV disease. In addition, some biochemical factors (plasma levels of cortisol, ACTH, homocysteine, PCR) may indicate a vulnerability in psychosis per se, as well as the findings on hyperglycemia and insulin resistance in psychotic "drug naive" patients. These "non-classical" factors could alter the validity of CV risk scales designed for the general population. Furthermore, antipsychotic drugs could control intrinsic factors of psychosis (they have shown to reduce global mortality), and their role in CV mortality is not clear.