Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records.

BACKGROUND: There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS: This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD: A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS: The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS: The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.

Clinical Diagnosis of an Autoimmune Encephalitis Presented as a Manic Episode with Psychotic Symptoms: A Case Report.

INTRODUCTION: Autoimmune encephalitis is caused by antineuronal immune mechanisms. Its clinical presentation is heterogeneous and in many cases onset with psychiatric symptoms. Paraclinical criteria guide the approach; however, the challenge occurs when there are no detectable autoantibodies in serum or cerebrospinal fluid (CSF). Methodology. We report one case that highlights the variability of clinical manifestations, which in the absence of antibodies was treated with immunotherapy with good response. CONCLUSION: In places where there is no antibody measurement, or when its measurement is negative, the clinical suspicion supported by CSF studies, magnetic resonance imaging, and electroencephalographic recording, should guide us to start immunotherapeutic treatment early. The early initiation of treatment ensures the reversibility of the neurological disorder in the vast majority of patients.

Dolor y manía / Pain and mania

La relación entre dolor y depresión queda bien documentada en la literatura científica, sin embargo, resulta escasa la bibliografía que asocia manía y percepción dolorosa.En el presente artículo se realiza una revisión de la relación mencionada a propósito de 2 casos. Se trata de 2 pacientes diagnosticados de trastorno bipolar que fueron hospitalizados por episodios maníacos y, donde concurría, una lesión traumática grave. Se observó ausencia de dolor mientras persistía la alteración psicopatológica, a su vez, a medida que se estabilizaba el ánimo la sensación dolorosa aumentaba.Por ello, se plantea la utilidad que podría tener la valoración de la ausencia de dolor o la hipoalgesia como parte de la sintomatología maníaca. (AU)

The relation among pain and depression is well documented in the scientific literature, however, the bibliography that associates mania and perception of pain is scarce.In this article, a review of the aforementioned relationship is made regarding two cases. Is this about two patients diagnosed with bipolar disorder who were hospitalized for manic episodes, at the same time they were suffering a serious traumatic injury. The absence of pain was observed while the psychopathological alteration persisted, in turn, as the mood stabilized, the painful sensation increased.For this reason, it is proposed the utility of the absence of pain or hypoalgesia as an assessment of part of the manic symptoms. (AU)

Estudio observacional sobre los efectos del palmitato de paliperidona inyectable mensual sobre la hospitalización y asistencia urgente / An observational study of the effects of the monthly injections of paliperidone palmitate on hospital admissions and emergency care

Se trata de un estudio donde se ha seleccionado una muestra de 84 pacientes en seguimiento en unidades de salud mental comunitaria con diagnóstico de trastorno mental y en tratamiento con palmitato de paliperidona (PPM). El objetivo ha sido investigar si, tras la administración de PPM, se experimentan reducciones en los ingresos hospitalarios, media de estancia y necesidad de atención urgente durante el periodo de un año. El método utilizado para analizar los diferentes grupos (muestra general, muestra con esquizofrenia, muestra con esquizofrenia o trastorno esquizoafectivo) ha sido de imagen en espejo. Se ha realizado un análisis bivariante comprobando la existencia de diferencias estadísticamente significativas (Prob > chi2) entre los resultados anteriores y posteriores al tratamiento con PPM, observándose una disminución de los ingresos hospitalarios, reduciendo los días de hospitalización y la asistencia a urgencias generales

This observational study included a sample of 84 patients selected for follow-up in community mental health units, with a diagnosis of mental disorder and on treatment with paliperidone palmitate (PPM). The objective was to determine whether there were any reductions in hospital admissions, days of hospital stay, and emergency care after administering PPM, during a one year follow-up. A mirror-image method was used to analyse the different groups (general sample, sample with schizophrenia, sample with schizophrenia, or schizoaffective disorder). A bivariate analysis was carried out, with statistically significant differences (Prob > chi2) being found between the results before and after the treatment with PPM, with a reduction in hospital admissions, days of hospital stay, and urgent care

La encefalopatía espongiforme: ¿un trastorno conversivo? / Spongiform encephalopathy: a conversive disorder?

Las prionpatías, constituyen un grupo de enfermedades neurodegenerativas con presentación familiar, esporádica o adquirida, con clínica heterogenea y resultado fatal. Los síntomas psiquiátricos pueden estar presentes al inicio y/o durante la evolución del cuadro, con la presencia o no de focalidad neurológica. Esta condición conlleva a que estos pacientes sean derivados a unidades de Psiquiatría tanto a nivel hospitalario como ambulatorio, para estudio de trastornos psiquiátricos. El caso clínico que nos ocupa el paciente fue atendido en varias ocasiones en las Urgencias Hospitalarias, evaluado por neurólogos y psiquiatras con diversos diagnósticos psiquiátricos. Sin embargo, la encefalopatía espongiforme sólo fue diagnosticada en el último mes de enfermedad (AU)

Prionpathies represent a group of neurodegenerative diseases of familiar, sporadic or acquired origin, heterogeneous symptoms and fatal outcome. The psychiatric symptoms can be present at the beginning and/or during the clinical evolution, with the presence or not of neurological disorders. Patients with these sympthoms are referred to psychiatric units, both at hospital level and as outpatients, to study a psychiatric disorder. In the described clinical case, the patient was admitted several times at emergency units, rated by neurologists and psychiatrists leading to different psychiatric disorders diagnoses. However spongiform encephalopathy was diagnosed only during the last month of the disease (AU)