ABSTRACT
BACKGROUND: Acute and Transient Psychotic Disorder (ATPD) (ICD-10) is characterized by the sudden onset of psychotic symptoms and can be triggered by psychological stress. In the ICD-10 definition of ATPD, episodes are short-term, lasting from days to three months, followed by complete remission. OBJECTIVE: This paper reports the case of a 37-year-old woman with stress-induced new-onset psychosis instigated by fear of coronavirus infection. METHOD: Physical examinations, paraclinical testing, and neuroimaging excluded an organic cause of symptoms. A thorough anamnestic investigation excluded the presence of other concomitant stress factors as the trigger of the patient's psychotic symptoms. RESULTS: In response to the COVID-19 lockdown, the patient developed excessive concern about coronavirus infection and, consequently, sleeping difficulties. Symptoms intensified, and she was admitted to the psychiatric ward, presenting with hallucinations, delusions, disorganized speech, and disorientation. The clinical picture fulfilled the diagnostic criteria of an Acute and Transient Psychotic Disorder. After one week of antipsychotic treatment, her symptoms had remitted, and the patient was discharged. Albeit, four months after treatment discontinuation, her psychotic symptoms re-emerged, and she was readmitted. The patient recovered from symptoms within 48 hours of treatment initiation with antipsychotics. She later reported to have been stressed and anxious while awaiting her coronavirus test result and, following, had doubted the negative result. CONCLUSION: The present case supports previous reports describing the COVID-19 pandemic's effect on population mental health; the psychological stress caused by the fear of infection can lead to the debut of psychotic manifestations and ATPD.
Objetivo: El Trastorno Psicótico Agudo y Transitorio (ATPD en sus siglas en inglés) (CIE-10) se caracteriza por el inicio súbito de síntomas psicóticos y puede ser gatillado por estrés psicológico. Según la definición de la CIE-10 del ATPD, los episodios son breves, durando desde algunos días hasta tres meses, seguido de remisión completa. Este artículo reporta el caso de una mujer de 37 años con una psicosis de nueva aparición inducida por estrés instigada por el temor a la infección por coronavirus.Método: El examen físico, exámenes de laboratorio, y neuroimagenes excluyeron una causa orgánica de los síntomas. Una investigación anamnéstica exhaustiva excluyó la presencia de otros factores estresantes concomitantes como desencadenantes de los síntomas psicóticos de la paciente.Resultados: En respuesta al confinamiento por COVID 19, la paciente desarrollo una excesiva preocupación por la infección por coronavirus y consecuentemente, dificultades para dormir. Los síntomas se intensificaron y fue hospitalizada en el servicio de psiquiatría, presentando alucinaciones, delirios, discurso desorganizado y desorientación. El cuadro clínico cumplía con los criterios diagnósticos para un Trastorno Psicótico Agudo y Transitorio. Después de una semana de tratamiento con antipsicóticos, sus síntomas habían remitido, y la paciente fue dada de alta. No obstante, cuatro meses después de la discontinuación del tratamiento, reaparecieron sus síntomas psicóticos y fue re- hospitalizada. La paciente se recuperó de los síntomas a las 48 horas del inicio del tratamiento con antipsicóticos. Más tarde informó haber estado estresada y ansiosa mientras esperaba los resultados del test de coronavirus y a continuación había dudado de su resultado negativo.Conclusión: El presente caso apoya reportes previos que describen el efecto de la pandemia por COVID-19 en la salud mental de la población: el estrés psicológico causado por el miedo a la infección puede conducir al debut de manifestaciones psicóticas y de ATPD.
ABSTRACT
BACKGROUND: In the EFFORT (Effects of Exercise and Diet in Nonobese Asthma Patients - A Randomized Controlled Trial) study, maximum exercise capacity (V'O2 max) increased significantly within a 2-month high-intensity spinning period. Furthermore, the study concluded that only the combined exercise and diet intervention improved asthma control, significantly. This study examined whether original improvements in V'O2 max and asthma control were present 1 year after intervention completion. METHOD: In the original trial, 149 patients were randomised into four study groups. Participants were assessed with an incremental cycle ergometer test and the Asthma Control Questionnaire (ACQ). Of the 149 patients, 66 accepted the follow-up invitation. Participants were distributed in their original groups: exercise group (n=18), diet group (n=117), combined diet and exercise group (n=115) and the control group (n=110). Patients were assessed with original procedures. Though, upon measuring V'O2 max, the original four study groups were merged into one spinning group (n=127) and one nonspinning group (n=133). RESULTS: Comparing the spinning and nonspinning group, there was no significant between-group difference in V'O2 max, at 1-year follow-up (p=0.3). In addition, there was no significant between-group difference in ACQ score (p=0.6). Hence, in the combined group, the initial improvement in the ACQ score had regressed to pre-intervention values within 1 year from study completion. CONCLUSION: There were no measurable long-lasting effects on V'O2 max 1 year after the intervention was completed. Furthermore, there was no long-lasting effect of the combined intervention on asthma control.
