ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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
