Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders.

Background: The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct.Aims: This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression.Methods: From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators.Results: Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations.Conclusions: Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

Coronary vascular disease event risk and metabolic syndrome prevalence in patients enrolled in an assertive treatment community program.

OBJECTIVE: To examine the risk of coronary vascular disease event (CVDE) and the prevalence metabolic syndrome (MS) and its cardiovascular risk factors (CVRF) in patients with severe mental illnesses enrolled in an assertive treatment community program (ATC) in Spain. METHOD: We carried out a cross-sectional descriptive study with all of the patients included in an ATC program in 2016 in a health area with 547,328 inhabitants in Galicia, Spain. We identified the CVRF in all the individuals, and calculated MS and 10-year CVDE. We also compared the prevalence of all traits in our cohort and the general population. RESULTS: The 10-year median of coronary vascular disease event (CVDE10) was 8.4%. The percentage of individuals with high CVDE10 (>5%) was 41.2% The CVDE10 median was higher in men than women (10.5% vs 5.1%, p<0.001). MS was detected in 50% of patients without differences between men and women (51.2% vs 48.2%). A prevalence of 68% was found for smoking, 55% for dyslipidemia, 47% for obesity, 29% for impaired glucose metabolism, and 38% for hypertension. Women showed a higher prevalence of obesity measured by elevated waist circumference (88.9% vs 55.6%, p=0.003). Men showed a higher prevalence of arterial hypertension (46.6% vs 22.2%, p=0.0001). CONCLUSIONS: The SMD Patients enrolled in ATC programs had a 1.5-times higher prevalence of MS and 8 times higher CVDE10 than those reported in the general population. Individual CVRF were also higher in the SMD patients. Prevention, early detection, and comprehensive treatment are important issues for patients with severe mental illnesses.

[Ekbom syndrome in an intravenous methylphenidate abuser]. / Síndrome de Ekbom en consumidor de metilfenidato intravenoso.

Ekbom syndrome is a mental disorder in which the patient has the monothematic delusion of being infected by parasites. It is an uncommon condition that was initially studied by dermatologists. The exactly etiology is unknown to date, though several causes have been proposed, including metabolic diseases (among other physical causes), psychiatric disorders, drugs, etc. Research has now found a relationship between drug abuse and psychotic symptoms, which appear to be due to altered levels of dopamine at the receptor level. In this article we review the clinical features of the condition and present the case report of an intravenous methylphenidate abuser who developed a delusion of parasitosis.

Síndrome de Ekbom en consumidor de metilfenidato intravenoso / Ekbom Syndrome in an intravenous methylphenidate abuser

El Síndrome de Ekbom es un trastorno mental en que el paciente tiene la convicción delirante monotemática de estar infectado por parásitos. Se trata de un cuadro poco frecuente, que inicialmente fue estudiado por dermatólogos. No se conoce exactamente la etiopatiogenia hasta el momento, si bien se han objetivado diversas causas: enfermedades metabólicas (entre otras causas físicas), cuadros psiquiátricos, fármacos, etc. En la actualidad, se ha encontrado relación entre el consumo de tóxicos y cuadros psicóticos, que parecen debidos a la alteración de la Dopamina a nivel de sus receptores. En este artículo realizamos una revisión del cuadro clínico y presentamos el caso clínico de un paciente consumidor de metilfenidato intravenoso que desarrolla un delirio de infestación(AU)

Ekbom syndrome is a mental disorder in which the patient has the monothematic delusion of being infected by parasites. It is an uncommon condition that was initially studied by dermatologists. The exactly etiology is unknown to date, though several causes have been proposed, including metabolic diseases (among other physical causes), psychiatric disorders, drugs, etc. Research has now found a relationship between drug abuse and psychotic symptoms, which appear to be due to altered levels of dopamine at the receptor level. In this article we review the clinical features of the condition and present the case report of an intravenous methylphenidate abuser who developed a delusion of parasitosis(AU)