Prevalence of clozapine-induced sialorrhea and its effect on quality of life.

RATIONALE: Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. OBJECTIVES: To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. METHODS: We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. RESULTS: Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (B = 0.417; p = 2.1e - 6, R2 = 0.156) and nocturnal CIS (B = 0.411; p = 7.7e - 6, R2 = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. CONCLUSIONS: The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. TRIAL REGISTRATION: Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.

Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double-blind randomized controlled exploratory and pragmatic trial.

BACKGROUND: Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS. METHODS: Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing. DISCUSSION: This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.

Trauma psíquico y psicosis. Implicaciones en la etiopatogenia, clínica, pronóstico y tratamiento / No disponible

El trauma infantil se ha asociado con enfermedadesmentales en la edad adulta, como trastornos de ansiedad,depresión, trastornos de personalidad, trastorno porestrés postraumático (TEPT), trastornos alimentarios ydependencia a drogas.Hay un interés creciente en el estudio de los factoresambientales en el desarrollo de esquizofrenia y trastornobipolar. Sin embargo no es hasta el 2004 cuandocomiezan a aparecer estudios con alta rigidez metodológicaen los cuales se analiza la relación entre trauma ypsicosis.Estudios previos ya habían detectado que los pacientescon comorbilidad entre trastorno mental grave(TMG) y TEPT, tienen un curso clinico y una peor evolución,más trastornos por abuso de alcohol y otras sustancias,más hospitalizaciones psiquiátricas, más tentativassuicidas y una peor reinseción laboral.Respecto al tratamiento los pacientes con comorbilidadTMG y TEPT existen pocos estudios. Se proponeincluir de forma rutinaria en la anamnesis los antecedentesde sucesos traumáticos(AU)

In many reports, childhood trauma (physic, psychologicaland sexual abuse), has been associated withadulthood’s mental diseases like anxiety disorders,depression, personality disorders, alcohol and otherdrugs abuse, stress posttraumatic disorder (SPTD) andeating disorders.Increassing interest in environmental factors in thedevelopment of bipolar dosorder and schizophreniahave been notes in recent reports. Otherwise untill 2004there are no accurate studies in which the relationshipbetween psychological trauma and severe mental illness(SMI) is analyzed.Previous studies just detected that SMI and SPTDcomorbidity had a worse clinical outcome , a higher frequencyof achohol and drug abuse, more hospital admisions,more suicide temptations and a poorer laboralreinsertion.Very few studies about SMI and SPTD comorbititytreatment have been reported and a prospect in the clinicalreview about a traumatic events is propossed(AU)