Las fases iniciales de la psicosis. ¿Se han olvidado de Klaus Conrad? / The early phases of psychosis. Has Klaus Conrad been forgotten?

Las primeras fases de la psicosis han sido objeto de atención psicopatológica, con especial empuje a partir de las aportaciones de Jaspers y su escuela. Tradicionalmente, se sabe que la evaluación de estas fases requiere de una exploración clínica atenta y cuidadosa. Sin embargo, a principios de este siglo una corriente de entusiasmo biomédico llevó al convencimiento de que era posible identificar a las personas en riesgo de psicosis mediante biomarcadores. De esta forma se podrían aplicar medidas preventivas para evitar su progresión. Los programas de fases iniciales o de primeros episodios se extendieron profusamente. Los promotores de estos programas hicieron tabla rasa del saber psicopatológico previo y buscaron en un espacio natural donde no encontraron nada. Las claves para entender la psicosis están en la vivencia, no en los biomarcadores. Klaus Conrad hizo aportaciones indispensables para identificar y describir los fenómenos vivenciales que aparecen en las primeras etapas de la psicosis. A pesar del tiempo transcurrido desde entonces y de los hallazgos neurocientíficos, conservan vigencia y actualidad. (AU)

The first phases of psychosis have been the object of psychopathological attention, with special emphasis from the contributions of Jaspers and his school on. It is traditionally known that the evaluation of these phases requires an attentive and careful clinical examination. However, at the beginning of this century a current of biomedical enthusiasm led to the conviction that it was possible to identify people at risk of psychosis by means of biomarkers. In this way, preventive measures could be applied in order to avoid progression. Early-stage or first-episode programs spread widely. The promoters of these programs made a clean slate of previous psychopathological knowledge and searched in a natural space in which they found nothing. The keys to understanding psychosis are in the experience, not in biomarkers. Klaus Conrad made essential contributions to identify and describe the experiential phenomena that appear in the early stages of psychosis. Despite the time that has passed and neuroscientific contributions, they remain valid and up-to-date. (AU)

Evolución de primeros episodios psicóticos: relación entre neuroimagen funcional, clínica y neuropsicología / Evolution of first psychotic episodes: relationship between functional, clinical neuroimaging and neuropsychology

Una de las principales líneas de investigación en desarrollo sobre los primeros episodios psicóticos se centra en el estudio de biomarcadores con el objetivo de dar respuesta a cuestiones como la gran heterogeneidad clínica o el riesgo de recaídas. Sin embargo, los estudios de neuroimagen muestran resultados contradictorios y los estudios longitudinales son escasos. Por ello se ha realizado un seguimiento de entre 8 y 10 años a una cohorte de 30 pacientes con un primer episodio psicótico y un grupo equivalente de controles sanos, tanto a nivel de neuroimagen estructural como funcional durante la realización de una tarea de memoria de trabajo, la N-Back. En la evaluación inicial los PEP mostraron una reducción del volumen global y un fallo en desactivación en zonas frontales durante la realización de la N-Back, que fue más significativo en pacientes con un posterior diagnóstico de esquizofrenia. En la evaluación de seguimiento los resultados muestran un fallo en desactivación en el grupo de pacientes que se extiende a regiones parietales posteriores. Estas regiones forman la llamada red neuronal por defecto, una serie de regiones que se activan en reposo, pero que se desactivan durante la realización de tareas con una alta demanda cognitiva. Estos resultados apuntan a una disfunción progresiva de la red neural por defecto en primeros episodios, subyacentes a la progresión del trastorno, y proporcionan una mejor comprensión de la evolución de los factores fisiopatológicos que afectan a los PEP (AU)

A major developing area on first psychotic episodes (FEP) research focuses on the study of biomarkers with the aim of answering questions such as the great clinical heterogeneity or the risk of relapse. However, neuroimaging studies show contradictory results and longitudinal studies are scarce. Therefore, a cohort of 30 patients with a first psychotic episode and an equivalent group of healthy controls were followed up for 8 to 10 years, both at the structural and functional neuroimaging level during the performance of a working memory task, the N-Back. At baseline, the FEP group showed a reduced global volume and a failure to deactivate frontal areas during the N-Back task. This failure was more pronounced in patients with a later diagnosis of schizophrenia. At the follow-up assessment the results show a failure of deactivation in the patient group that extends to posterior parietal regions. These regions form the so-called default mode network, a series of regions that are activated at rest, but deactivated during the performance of cognitively demanding tasks. These results point to a progressive dysfunction of the default mode network in first episodes psychosis underlying the progression of the disorder and provide a better understanding of the evolution of pathophysiological factors affecting FEP (AU)

Comparison between a morocco and a native-born population, in a sample of first episode psychosis. / Diferencias en la presentación clínica de primeros episodios psicóticos entre población de origen marroquí y población autóctona.

INTRODUCTION: Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES: This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS: Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS: The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS: Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects.

Substance abuse and gender differences in first episode psychosis: Impact on hospital readmissions. / Consumo de sustancias y diferencias de género en personas afectas de un primer episodio psicótico: impacto en los porcentajes de reingreso.

INTRODUCTION: There have been controversial results in the study of gender differences in first episode psychosis (FEP). Substance abuse is the main existing comorbidity in FEP, and has been associated with worse prognosis and greater symptom severity. OBJECTIVES: To explore gender differences in FEP in relation to drug abuse, and their relationship with hospital readmissions. METHODOLOGY: Descriptive and prospective study (18 months). RESULTS: We included 141 patients (31.2% women), aged 26.1 years on average, mostly diagnosed with schizophreniform disorder (32.6%). A percentage of 58.9 had problematic use of drugs. Gender significant differences were found in age of onset, age at entry to the programme, marital status and cohabitation, and percentage differences were revealed in current drug abuse and frequency of consumption. Gender, duration of untreated psychosis, psychiatric history, age of onset and previous drug use were not predictors of re-entry. Hospital readmission rate was 24.8%, with no gender differences. The most common reasons for admission were abandonment of treatment (66.7%) and drug abuse (44.4%). Drug abuse was higher in the men than in the women as a reason for re-admission. CONCLUSIONS: There are gender differences in FEP. Men have an earlier onset of symptoms and have worse functional outcomes. Drug abuse in men is higher and represents a major cause of hospital readmission. Therapeutic interventions to prevent the effects of drug abuse are necessary from the early stages of the illness.

[Lipid profile in patients admitted with acute coronary syndrome in Spain: data from Toledo health care area between 2005 and 2008]. / Perfil lipídico en pacientes ingresados por síndrome coronario agudo en España: datos del área sanitaria de Toledo entre los años 2005 y 2008.

INTRODUCTION AND OBJECTIVES: To evaluate the lipid profile of patients admitted with acute coronary syndrome in Toledo (Spain) between 2005 and 2008. METHODS: Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were evaluated. Descriptive analyses and means comparison were performed. RESULTS: 1,381 patients of 3,986 admitted with acute coronary syndrome had a complete lipid profile. The mean age was 67.8±12.9 years (72.4% men). A first event was present in 76.3%. The mean total cholesterol (±SD) was 180.0±43.4, LDL-cholesterol 115±38.0, HDL-cholesterol 44.1±12.3, and triglyceride 145.3±92.4mg/dL, with statistically significant differences between men and women in LDL-cholesterol (116.3±37.8 vs 111.6±38.5mg/dL; p=0.04) and HDL-cholesterol (42.3±11.6 vs 48.4±13.2mg/dL; p=0.0001). In first or recurrent events were found, respectively, total cholesterol 179.1±43.1 and 174.5±44.1 (p<0.05), LDL-cholesterol 116.5±38.4 and 110±36.5 (p=0.007), HDL-cholesterol 44.1±12.2 and 44.2±12.9 (p<0.05), and triglyceride 141.2±81.7 and 158.5±119.7 (p=0.03). Optimal levels of LDL-cholesterol and HDL-cholesterol were found in 14.1 and 11.6% of patients with recurrent episodes, respectively. CONCLUSIONS: While most patients admitted with first episode of acute coronary syndrome to the Toledo Health Area have a lipid profile according to current guidelines, only 10% of those with recurrent acute coronary syndrome presented optimal LDL-cholesterol and HDL-cholesterol levels, which suggest the need to be more aggressive in the lipids control.

Evaluación del efecto de talleres orientados a padres cuyos hijos presentan primeros episodios psicóticos / Evaluation of the effect of workshops oriented to parents whose children present first psychotic episodes

The effectiveness of a Psycho-Educational Workshop oriented to parents with children undergoing first psychotic episodes is evaluated. The Workshop is aimed at promoting strategies for confronting the pathology, reducing stress, anxiety, and depression in the parents, to produce an effect on the treatment of the youngsters. This research was done in the framework of the "Treatment of People from the First Episode of Schizophrenia" Program of Chilean Public health. It is an explicative study based on a pre-experimental design, with pre- and post- intervention measurements with a non-probabilistic and intentional sample of 55 parents distributed randomly in five workshops of 12 sessions each. The results show the use of planned active confrontation strategies, controlling emotion and using preferentially cognitive activity, also achieving decreased anxiety, stress, and depression indicators in the parents. It is concluded that it is important to incorporate the theme of confrontation strategies by the parents in the psychoeducational workshops, particularly in the initial stage of the disorder.

Se evalúa la efectividad de un Taller Psico-Educativo orientado a padres con hijos víctimas de primeros episodios psicóticos. El Taller persigue promocionar estrategias de afrontamiento frente a la patología, reducir estrés, ansiedad y depresión en los padres para incidir en el tratamiento del joven. Investigación realizada en el marco del Programa "Tratamiento de Personas desde el Primer Episodio de Esquizofrenia", de la Salud Pública chilena. Estudio explicativo, en base a un diseño pre-experimental, con medidas pre y post intervención en un grupo. Muestra no probabilística e intencionada de 55 padres, distribuidos aleatoriamente en 5 talleres de 12 sesiones cada uno. Los resultados señalan la utilización de estrategias de afrontamiento activas, planificadas, controlando la emoción y uso de actividad preferentemente cognitiva; además, disminución de la ansiedad, el estrés e indicadores depresivos en los padres. Se concluye en la importancia de incorporar la temática de las estrategias de afrontamiento por parte de los padres en los talleres psicoeducativos, sobre todo en la etapa inicial del trastorno.