Psychometric validation of the 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP).

Introduction: Reliable and valid instruments are needed to measure the impact of mental health services and programs on the journeys of recovery of service users. The aim of this study was to explore the psychometric properties of the cross-culturally adapted 15-item Questionnaire about the Process of Recovery in Spain (QPR-15-SP). Methods: One hundred and ten participants from three locations in Spain (Málaga, Barcelona and Madrid), who were users of primary and specialized mental health services, were interviewed from October 2021 to June 2022. Results: The internal consistency obtained was excellent: ω =.93 and α =.92. Temporal reliability using intraclass correlation coefficients was moderate (ICC=.684, p <.000). Regarding convergent validity, the QPR-15-SP had a moderate correlation with the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (ρ =-.500, p <.000), a Visual Numeric Recovery Scale (VNRS) (ρ =.591, p <.000), and the Stages of Recovery Instrument (STORI) (r =.566, p <.000). Correlations between advanced stages of recovery and higher QPR-15-SP scores were found (Moratorium: ρ =-.579, p <.000; Awareness: ρ =-.130, p =.189; Preparation: r =-.043, P=.665; Rebuilding: r =.460, p <.000; Growth: ρ =.697, p <.000). In terms of divergent validity, the QPR-15-SP had low correlation with the DUKE-UNC Functional Social Support Scale (ρ =.273, p <.005). The confirmatory factor analysis of the 1-factor structure obtained reasonable goodness of fit indexes. Discussion: The QPR-15-SP has acceptable psychometric properties, providing support for measuring recovery in Spain and allowing international comparison research.

Long-term outcomes of deep brain stimulation for treatment-resistant schizophrenia: Exploring potential targets.

BACKGROUND: Schizophrenia is a complex and disabling disorder. Around 30% of patients have treatment-resistant schizophrenia (TRS). OBJECTIVE: This study summarizes the outcomes after three years follow-up of the first series of patients with TRS treated with deep brain stimulation (DBS) and discuss surgical, clinical and imaging analysis. METHODS: Eight patients with TRS treated with DBS in the nucleus accumbens (NAcc) or the subgenual cingulate gyrus (SCG) were included. Symptoms were rated with the PANSS scale and normalized using the illness density index (IDI). A reduction in IDI-PANSS of ≥25% compared to baseline was the criterion of good response. The volume of activated tissue was calculated to perform a connectomic analysis for each patient. An estimation of the tracts and cortical areas modulated was generated. RESULTS: Five women and three men were analyzed. After 3 years' follow-up, positive symptoms improved in 50% of the SCG group and 75% of the NAcc group (p = 0.06), and general symptoms improved in 25% and 50% respectively (p = 0.06). The SCG group showed activation of the cingulate bundle and modulation of orbitofrontal and frontomesial regions; in contrast, the NAcc group showed activation of the ventral tegmental area projections pathway and modulation of regions associated with the "default mode network" (precuneus) and Brodmann areas 19 and 20. CONCLUSIONS: These results showed a trend toward improvement for positive and general symptoms in patients with TRS treated with DBS. The connectomic analysis will help us understand the interaction of this treatment with the disease to pursue future trial designs.

Gray and white matter changes and their relation to illness trajectory in first episode psychosis.

Previous works have studied structural brain characteristics in first-episode psychosis (FEP), but few have focused on the relation between brain differences and illness trajectories. The aim of this study is to analyze gray and white matter changes in FEP patients and their relation with one-year clinical outcomes. A sample of 41 FEP patients and 41 healthy controls (HC), matched by age and educational level was scanned with a 3T MRI during the first month of illness onset. One year later, patients were assigned to two illness trajectories (schizophrenia and non-schizophrenia). Voxel-based morphometry (VBM) was used for gray matter and Tract-based spatial statistics (TBSS) was used for white matter data analysis. VBM revealed significant and widespread bilateral gray matter density differences between FEP and HC groups in areas that included the right insular Cortex, the inferior frontal gyrus and orbito-frontal cortices, and segments of the occipital cortex. TBSS showed a significant lower fractional anisotropy (FA) in 8 clusters that included segments of the anterior thalamic radiation, the left body and forceps minor of corpus callosum, the right anterior segment of the inferior fronto-occipital fasciculus and the anterior segments of the cingulum. The sub-groups comparison revealed significant lower FA in the schizophrenia sub-group in two clusters: the anterior thalamic radiation and the anterior segment of left cingulum. These findings are coherent with previous morphology studies. The results suggest that gray and white matter abnormalities are present at early stages of the disease, and white matter differences may distinguish different illness prognosis.

m-RESIST, a complete m-Health solution for patients with treatmentresistant schizophrenia: a qualitative study of user needs and acceptability in the Barcelona metropolitan area.

BACKGROUND: Despite the theoretical potential of m-health solutions in the treatment of patients with schizophrenia, there remains a lack of technological solutions in daily practice. The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to an integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment Resistant Schizophrenia (m-RESIST). METHODS: A qualitative study of the needs and acceptability of outpatients with treatment-resistant schizophrenia was carried out in Parc Sanitari Sant Joan de Déu (Barcelona). We analyzed the opinions of patients, informal carers, and clinicians concerning the services initially thought to be part of the solution. Five focus groups and eight interviews were carried out, using discourse analysis as the analytical approach. RESULTS: A webpage and a virtual forum were perceived as suitable to get reliable information on both the disease and support. Data transmission service, online visits, and instant messages were evaluated as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and medical appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions for improving the effectiveness of the solution. CONCLUSIONS: Positive acceptance of m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact.

m-RESIST, una solución m-Health integral para personas con Esquizofrenia Resistente: estudio cualitativo de necesidades y aceptabilidad de usuarios en el área de Barcelona / m-RESIST, a complete m-Health solution for patients with treatment-resistant schizophrenia: a qualitative study of user needs and acceptability in the Barcelona metropolitan area

Introducción. A pesar del creciente potencial teórico de las soluciones m-Health en el tratamiento de pacientes con esquizofrenia, siguen faltando soluciones tecnológicas a nivel práctico. El objetivo de este estudio fue medir las necesidades y aceptabilidad de pacientes, familiares y profesionales hacia un modelo m-Health de intervención integral: Salud Móvil para pacientes con esquizofrenia resistente al tratamiento (m-RESIST). Métodos. Se llevó a cabo un estudio cualitativo en el Parc Sanitari Sant Joan de Déu (Barcelona) de las necesidades y aceptabilidad de pacientes con esquizofrenia resistente. Se analizaron sus opiniones, junto con las de familiares y profesionales, relativas a los servicios inicialmente pensados para formar parte del m-RESIST. Se realizaron cinco grupos focales y ocho entrevistas, usando el análisis del discurso como aproximación analítica. Resultados. Se consideró adecuada la creación de una página web y un foro virtual para obtener información fiable sobre la enfermedad y como apoyo entre usuarios. Para mejorar el contacto con los profesionales, se valoró positivamente el servicio de transmisión de datos, visitas "online" y mensajes instantáneos. Las alertas fueron consideradas útiles como recordatorios de tareas diarias y citas médicas. Las principales sugerencias para mejorar la eficacia fueron: evitar el exceso de alertas para no generar estrés, promover un papel activo del paciente en el manejo de la enfermedad y mantener contacto personal con los profesionales. Conclusiones. La buena aceptabilidad hacia el m-RESIST se relaciona con su utilidad para satisfacer las necesidades del usuario, su capacidad para empoderarles y la posibilidad de mantener contacto humano (AU)

Background. Despite the theoretical potential of m-health solutions in the treatment of patients with schizophrenia, there remains a lack of technological solutions in daily practice. The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to an integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment Resistant Schizophrenia (m-RESIST). Methods. A qualitative study of the needs and acceptability of outpatients with treatment-resistant schizophrenia was carried out in Parc Sanitari Sant Joan de Déu (Barcelona). We analyzed the opinions of patients, informal carers, and clinicians concerning the services initially thought to be part of the solution. Five focus groups and eight interviews were carried out, using discourse analysis as the analytical approach. Results. A webpage and a virtual forum were perceived as suitable to get reliable information on both the disease and support. Data transmission service, online visits, and instant messages were evaluated as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and medical appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions for improving the effectiveness of the solution. Conclusions. Positive acceptance of m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact (AU)

[Olanzapine long-acting post-injection syndrome: a case report and brief review]. / Síndrome post-inyección por olanzapina de liberación retardada: Breve revisión a propósito de un caso.

The introduction of long-acting injectable atypical antipsychotics has ensured adherence to treatment in patients with low awareness of the disorder, with an acceptable rate of side effects. In the case of long acting olanzapine injection in particular, has particular relevance the existence of a special side-effect called post-injection syndrome. This rare side effect consisting in the presence of symptoms of olanzapine overdose after intramuscular administration of medication has led to restrictions on the use of the drug and the need for patient observation for three hours after each injection. We report a case of postinjection syndrome, to our knowledge, the first in Spain since the commercialization of Zypadhera. As in most cases described in the literature have symptoms of overdosage of olanzapine (dysarthria, sedation, fatigue, etc.) that are selflimiting without any therapeutic measure and are accompanied by supratherapeutic plasma levels of olanzapine.

Síndrome post-inyección por olanzapina de liberación retardada: Breve revisión a propósito de un caso / Olanzapine long-acting post-injection syndrome: A case report and brief review

La introducción de los antipsicóticos atípicos de liberación retardada ha permitido asegurar la adherencia al tratamiento en aquellos pacientes con baja conciencia de trastorno, con una tasa aceptable de efectos secundarios. En el caso de la olanzapina de liberación retardada en concreto, tiene especial relevancia la existencia del llamado Síndrome post-inyección. Este efecto secundario poco común consistente en la presencia de síntomas de sobredosis de olanzapina tras la administración intramuscular de la medicación ha supuesto restricción del uso del medicamento y la necesidad de observación del paciente durante tres horas después de cada inyección. Se presenta un caso de Síndrome post-inyección, a nuestro conocimiento, el primero en España desde la comercialización de Zypadhera. Al igual que en la mayoría de casos descritos en la bibliografía el paciente presenta síntomas de sobredosificación de olanzapina (disartria, sedación, astenia, etc.) que se auto limitan sin medida terapéutica alguna y se acompañan de niveles plasmáticos supraterapéuticos de olanzapina(AU)

The introduction of long-acting injectable atypical antipsychotics has ensured adherence to treatment in patients with low awareness of the disorder, with an acceptable rate of side effects. In the case of long acting olanzapine injection in particular, has particular relevance the existence of a special side-effect called post-injection syndrome. This rare side effect consisting in the presence of symptoms of olanzapine overdose after intramuscular administration of medication has led to restrictions on the use of the drug and the need for patient observation for three hours after each injection. We report a case of postinjection syndrome, to our knowledge, the first in Spain since the commercialization of Zypadhera. As in most cases described in the literature have symptoms of over dosage of olanzapine (dysarthria, sedation, fatigue, etc.) that are selflimiting without any therapeutic measure and are accompanied by supra therapeutic plasma levels of olanzapine(AU)