Covid-19, hypercoagulability and risk of mortality in schizophrenia.

Covid-19 disease has been linked to a high risk of hyper- coagulability that can severely condition the evolution of this respiratory syndrome in the acute phase; and also due to the possible sequelae of a chronic thrombosis, as is the case of chronic pulmonary thromboembolism; or due to complications associated with anticoagulant treatment such as bleeding.

Prevalencia del delirium en pacientes con enfermedad oncológica avanzada ingresados en una unidad de cuidados paliativos / Prevalence of delirium in patients with advanced cancer admitted to a palliative care unit

OBJETIVO: Conocer la prevalencia de delirium en los pacientes diagnosticados de enfermedad oncológica avanzada y terminal ingresados en una unidad de cuidados paliativos (UCP). Analizar la prevalencia relacionada con factores sociodemográficos y clínicos. MÉTODO: Estudio observacional descriptivo durante 6 años (2007-2012) de los pacientes diagnosticados de enfermedad oncológica en fase avanzada y terminal ingresados consecutivamente en una UCP. Se recogieron las siguientes variables: diagnóstico de delirium, edad, género, índice de Karnofsky, localización tumoral primaria, extensión de la enfermedad, síntomas (dolor, disnea) y mortalidad. RESULTADOS: De los 1.995 pacientes ingresados en la UCP durante los 6 años, 1.826 (91,5%) fueron incluidos en el estudio por presentar enfermedad oncológica. De los 1.826 pacientes, 497 (27,2%) presentaron delirium. La edad media fue de 72,3±11,7 años, el 77,3% presentaron enfermedad metastásica y el 79,9% fallecieron durante el ingreso. La frecuencia del género masculino (66% vs.61%) y la presencia de dolor (58% vs.45,9%) fueron significativamente superiores en los pacientes con delirium que en los pacientes sin él. No se hallaron diferencias significativas respecto a la edad media y a la frecuencia de disnea. No hubo diferencias significativas entre los pacientes≤75 años y los>75 años respecto a la prevalencia de delirium (27,6% vs.26,8%). Las localizaciones tumorales primarias que presentaron frecuencias más altas de delirium fueron: cerebral (39,3%), hepática (36%), y riñón y vías urinarias (34,5%). CONCLUSIONES: La prevalencia de delirium en los pacientes con cáncer avanzado y terminal ingresados en una UCP fue del 27,2%. La prevalencia no fue mayor en edades avanzadas. El delirium fue significativamente más frecuente en hombres y en pacientes con dolor. Los pacientes con tumor cerebral primario presentaron una mayor frecuencia de delirium

OBJECTIVE: To determine the prevalence of delirium in patients admitted to a palliative care unit (PCU) diagnosed with advanced cancer disease, and its associated sociodemographic and clinical factors. METHOD: An observational study was conducted during a 6-year period (2007-2012) of patients suffering from an advanced cancer disease admitted to a PCU. Variables: delirium diagnosis, age, gender, Karnofsky performance status, primary tumour location, tumour stage, symptoms (pain, dyspnoea), and mortality. RESULTS: Of the 1,995 patients admitted to PCU in the study period 1,826 patients diagnosed with advanced cancer were included. Of these 1,826 patients, 497 (27.2%) suffered from delirium. The mean age was 72.3±11.7 years, and 77.3% had metastatic disease, and 79.9% died during admission. The frequency of male gender (66% vs.61%) and the presence of pain (58% vs.45.9%) were significantly higher in patients with delirium than in patients without delirium. No significant statistically differences in the mean age and the presence of dyspnoea were found. There were no significant differences between patients≤75 years and>75 years (27.6% vs.26.8%) for the prevalence of delirium. Within primary tumour locations, the major prevalence of delirium was in brain (39.3%), liver (36%), and kidney-urinary tract (34.5%) tumours. CONCLUSIONS: The prevalence of delirium in advanced cancer patients admitted to a PCU was 27.2%. Prevalence of delirium was not associated with advanced age. Delirium was significantly more prevalent in men, and in patients who suffered from pain. Patients with primary brain tumour had the highest incidence of delirium

Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors.

THE AIMS OF THIS STUDY WERE: 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. METHODS: Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses. RESULTS: 61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered "yes" to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering "yes" to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering "yes" to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance status (OR 14.3 [1.62-125.43]; p = 0.017), and moderate to severe insomnia with nocturnal rumination (OR 5.6 [1.1-29.1]; p = 0.041), and inversely associated with daytime sleepiness (OR 0.25 [0.07-0.9]; p = 0.043). CONCLUSIONS: Insomnia was highly frequent. Several physical, psychological and environmental factors seemed to influence insomnia. Within the multimodal management of insomnia, the assessment of nocturnal rumination may be of particular interest, irrespective of emotional distress. Further studies with larger sample sizes could confirm this result.

Galactorrea asociada a paroxetina / Galactorrhea induced by paroxetine

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Olanzapine-induced agranulocytosis: a case report and review of the literature.

The novel antipsychotic olanzapine has structural and pharmacological properties similar to clozapine. Until recently, no haematological toxicity has been reported with olanzapine use and it was expected to be a safer alternative. The authors report a case of agranulocytosis induced by olanzapine and reviewed the 11 cases reported in the literature.