Mistakes are not an option: aggression from peers and other correlates of anxiety and depression in pediatricians in training.

Introduction: Pediatricians in training are a population at risk for anxiety and depression: they face long working hours, they are confronted with the suffering and death of a vulnerable population and may have personal characteristics that put them in danger. Nonetheless, few studies have looked at their prevalence and associated factors. We aimed to compare demographic, professional activities, adversities and perfectionism personality features between a group of pediatricians in training with depression and/or anxiety and a group of pediatricians in training without depression nor anxiety and, to identify the variables that increase the probabilities of depression and/or anxiety in pediatricians in training. Methods: Pediatric residents who voluntarily answered an online survey distributed via personal and institutional social media channels from October 2019 to April 2021, as part of a cross-sectional study with medical specialists and residents from Mexico were included. Demographic information, professional activities and adversities, perfectionism personality features (Multidimensional Perfectionism Scale), depression and anxiety (ICD-11 PHC) were evaluated. For comparison purposes Chi-square tests (χ2) and independent sample t-tests were used. A logistic regression analysis was used to identify those variables that increase the probabilities of depression and/or anxiety. Results: 934 pediatric residents answered the survey. 11.6% reported having depression and 20% anxiety. Being single, a history of anxious or depressive episodes, being the resident in charge of a patient who died, aggressions from colleagues and a high concern for errors were associated with current depression and/or anxiety. Discussion: Screening for depressive and anxious symptoms should be routinely performed from entry to the residency to favor early intervention. A shift from promoting perfectionism to a more compassionate training could serve a population facing so many adversities.

Human olfactory neural progenitor cells reveal differences in IL-6, IL-8, thrombospondin-1, and MCP-1 in major depression disorder and borderline personality disorder.

Background: Discovering biological markers is essential for understanding and treating mental disorders. Despite the limitations of current non-invasive methods, neural progenitor cells from the olfactory epithelium (hNPCs-OE) have been emphasized as potential biomarker sources. This study measured soluble factors in these cells in Major Depressive Disorder (MDD), Borderline Personality Disorder (BPD), and healthy controls (HC). Methods: We assessed thirty-five participants divided into MDD (n=14), BPD (n=14), and HC (n=7). MDD was assessed using the Hamilton Depression Rating Scale. BPD was evaluated using the DSM-5 criteria and the Structured Clinical Interview for Personality Disorders. We isolated hNPCs-OE, collected intracellular proteins and conditioned medium, and quantified markers and soluble factors, including Interleukin-6, interleukin-8, and others. Analysis was conducted using one-way ANOVA or Kruskal-Wallis test and linear regression. Results: We found that hNPCs-OE of MDD and BPD decreased Sox2 and laminin receptor-67 kDa levels. MASH-1 decreased in BPD, while tubulin beta-III decreased in MDD compared to controls and BPD. Also, we found significant differences in IL-6, IL-8, MCP-1, and thrombospondin-1 levels between controls and MDD, or BPD, but not between MDD and BPD. Conclusions: Altered protein markers are evident in the nhNPCs-OE in MDD and BPD patients. These cells also secrete higher concentrations of inflammatory cytokines than HC cells. The results suggest the potential utility of hNPCs-OE as an in vitro model for researching biological protein markers in psychiatric disorders. However, more extensive validation studies are needed to confirm their effectiveness and specificity in neuropsychiatric disorders.

Adverse effects of antipsychotics on sleep in patients with schizophrenia. Systematic review and meta-analysis.

Introduction: Our objective was to conduct a systematic review and meta-analysis of adverse effects on sleep in patients with schizophrenia receiving antipsychotic treatment. Methods: A systematic search was performed in PubMed, Cochrane Central, Embase, Toxline, Ebsco, Virtual Health Library, Web of Science, SpringerLink, and in Database of abstracts of Reviews of Effects of Randomized Clinical Trials to identify eligible studies published from January 1990 to October 2021. The methodological quality of the studies was evaluated using the CONSORT list, and the Cochrane bias tool. Network meta-analysis was performed using the Bayesian random-effects model, with multivariate meta-regression to assess the association of interest. Results: 87 randomized clinical trials were identified that met the inclusion criteria, and 70 articles were included in the network meta-analysis. Regarding the methodological quality of the studies, 47 had a low or moderate bias risk. The most common adverse effects on sleep reported in the studies were insomnia, somnolence, and sedation. The results of the network meta-analysis showed that ziprasidone was associated with an increased risk of insomnia (OR, 1.56; 95% credible interval CrI, 1.18-2.06). Several of the included antipsychotics were associated with a significantly increased risk of somnolence; haloperidol (OR, 1.90; 95% CrI, 1.12-3.22), lurasidone (OR, 2.25; 95% CrI, 1.28-3.97) and ziprasidone (OR, 1.79; 95% CrI, 1.06-3.02) had the narrowest confidence intervals. In addition, perphenazine (OR, 5.33; 95% CrI, 1.92-14.83), haloperidol (OR, 2.61; 95% CrI, 1.14-5.99), and risperidone (OR, 2.41; 95% CrI, 1.21-4.80) were associated with an increased risk of sedation compared with placebo, and other antipsychotics did not differ. According to the SUCRAs for insomnia, chlorpromazine was ranked as the lowest risk of insomnia (57%), followed by clozapine (20%), while flupentixol (26 %) and perospirone (22.5%) were associated with a lower risk of somnolence. On the other hand, amisulpride (89.9%) was the safest option to reduce the risk of sedation. Discussion: Insomnia, sedation, and somnolence were the most frequent adverse effects on sleep among the different antipsychotics administered. The evidence shows that chlorpromazine, clozapine, flupentixol, perospirone, and amisulpride had favorable safety profiles. In contrast, ziprasidone, perphenazine, haloperidol, and risperidone were the least safe for sleep. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017078052, identifier: PROSPERO 2017 CRD42017078052.

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico.

Background: Psychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support. Objective: The aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not. Methods: This was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey. Results: 73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support. Conclusion: Psychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health.

Facial emotion recognition and its association with symptom severity, functionality, and cognitive impairment in schizophrenia: preliminary results / Reconocimiento facial de emociones y su asociación con la gravedad sintomática, funcionalidad y deterioro cognitivo en esquizofrenia: hallazgos preliminares

Abstract Introduction There is evidence to suggest that individuals with schizophrenia have greater difficulty in recognizing facial emotions, which has been related to cognitive impairment and higher symptom severity in this disease and seems to lead to a worse functional prognosis. Objective To determine the association between facial emotion recognition and symptom severity, functionality, and cognitive impairment in a sample of schizophrenic patients. Method This is an observational, cross-sectional, and correlational study conducted on 72 patients. The following scales: PANSS, MOCA, ERI, and FACT-Sz were used to assess symptom severity in schizophrenia, cognitive functioning, facial emotion recognition, and functionality, respectively. The Pearson Correlation Coefficient was used to measure the linear association between all variables. Results Overall, moderate symptom severity and mild cognitive and functional disability were found. The most frequently recognized emotion was joy (70%) and the least frequently recognized one was anger. A positive association was also found between anger recognition and severity of the PANSS cognitive subscale (r = - .24, p = .03), sadness recognition and severity of the PANSS negative subscale (r = - .24, p = .03), and the FACT-Sz score and fear recognition (r = .31, p = .008). Discussion and conclusion The present study yields preliminary results that provide a broader perspective on facial emotion recognition and, indirectly, social interaction and functionality in people with schizophrenia.

Resumen Introducción Existe evidencia de que los pacientes con esquizofrenia tienen mayor dificultad para reconocer las emociones faciales, lo cual se ha relacionado con el deterioro cognitivo que se manifiesta en esta enfermedad y con una mayor gravedad sintomática, que parece dar lugar a un peor pronóstico funcional. Objetivo Determinar la asociación del reconocimiento facial de emociones con la gravedad sintomática, funcionalidad y deterioro cognitivo en un grupo de pacientes con esquizofrenia. Método Un estudio observacional, transversal y correlacional realizado con 72 pacientes. Se utilizaron las escalas: PANSS, MOCA, ERI y FACT-Sz para evaluar la gravedad sintomática, el funcionamiento cognitivo, el reconocimiento facial de emociones y la funcionalidad, respectivamente. Se utilizó el Coeficiente de Correlación de Pearson para medir la asociación lineal entre dichas variables. Resultados Se encontró de forma global una gravedad sintomática moderada y una discapacidad cognitiva y funcional leve. La alegría fue la emoción más reconocida (70%) y la ira la menos reconocida. Se encontró una asociación positiva entre el reconocimiento de la ira y la gravedad de la subescala cognitiva de la PANSS (r = -.24, p = .03), el reconocimiento de la tristeza y la gravedad de la subescala negativa de la PANSS (r = -.24, p = .03), y la puntuación de la FACT-Sz y el reconocimiento del miedo (r = .31, p = .008). Discusión y conclusión El presente estudio muestra algunos resultados preliminares que nos permiten tener una perspectiva más amplia de lo que ocurre con el reconocimiento facial de emociones en la esquizofrenia y, de forma indirecta, en la interacción social y la disfunción que presentan quienes lo padecen.

Development of the Mexican Version of the Empathy Quotient / Desarrollo de la versión mexicana del Cuestionario de Empatía

Abstract Introduction Empathy is defined as the ability or process to identify and understand other person's situation, feelings, and motives. These responses are essential for relationships and social behavior. Baron-Cohen et al. created the Empathy Quotient (EQ), a scale explicitly designed to have a clinical application. The instrument evaluates three constructs of empathy and several studies around worldwide, but not in Mexico. Objective To examine the psychometric properties and the factor congruence of the EQ in a community sample from Mexico City. Method Cronbach´s alpha coefficient and a correspondence factorial analysis was performed to test the relation between response options and factors from the Exploratory Factor Analysis 200 adults without Axis I disorders through the MINI, filled out the Spanish version of the short version (28-items) of the EQ. An exploratory factor analysis was performed while reliability was tested with Cronbach's alpha. In addition, correspondence factorial analysis and the factor congruence coefficient were determined. Results Five items were eliminated from the original 28-item EQ. From the 23 remaining items, only 16 were grouped in the three original proposed dimensions (cognitive empathy: 8 items, emotional reactivity: 4 items and social skills: 3 items), while one item showed communality with a different domain from the one originally proposed. Reliability was adequate (.82) as well as the congruence coefficients (.76 to .99). Discussion and conclusion The EQ Mexican 16-item version is a good tool to assess empathy in a Mexican population.

Resumen Introducción La empatía es definida como la capacidad para identificar y comprender las situaciones, sentimientos y motivaciones de otra persona. Estas respuestas son esenciales para relaciones y comportamientos sociales. Baron-Cohen et al. crearon el cociente de empatía (EQ), una escala diseñada para tener aplicación clínica. El instrumento evalúa tres constructos de empatía y ha probado sus propiedades psicométricas con resultados adecuados en varios estudios mundiales, pero no en México. Objetivo El propósito de este estudio fue examinar las propiedades psicométricas y la congruencia factorial del EQ en una muestra mexicana. Método El alpha de Cronbach y el análisis factorial fueron aplicados para probar la relación entre las opciones de respuesta y los factores en 200 adultos sin diagnóstico, a través de la entrevista MINI. Se utilizó la versión corta en español del EQ y se realizó un análisis factorial exploratorio dónde se probó la confiabilidad con el alfa de Cronbach y se determinó adecuada correspondencia y congruencia factorial. Resultados Se eliminaron cinco reactivos de la escala original de 28 reactivos. De los 23 reactivos restantes, solo 16 se agruparon en las tres dimensiones originales (empatía cognitiva: 8 reactivos, reactividad emocional: 4 reactivos y habilidades sociales: 3 reactivos) mientras que un reactivo mostró una comunalidad con un dominio diferente del original. La confiabilidad fue (.82), así como los coeficientes de congruencia (.76 a .99). Discusión y conclusión La versión del EQ es una buena herramienta para evaluar la empatía en población mexicana.

Association between prolactin serum levels and cognitive function in chronic schizophrenia patients / Asociación de los niveles de prolactina con el funcionamiento cognitivo en pacientes con esquizofrenia crónic

Abstract Introduction Several studies have explored the relationship between serum prolactin levels, symptomatology, and cognitive dysfunction in individuals at high risk for psychosis and patients with a first psychotic episode. However, the relationship between such variables is poorly understood in the case of chronic patients. Objective To assess the relationship between prolactin levels, neuropsychological impairment, and symptom severity in patients with chronic schizophrenia. Method A total of 31 patients with diagnosis of schizophrenia were evaluated between May and December 2018. The age range was 18 to 60 years, with patients receiving antipsychotic treatment during a month at least. Data was obtained from clinical records, interviews, clinimetry, and with the application of the PANSS and the MCCB battery. For the prolactin measurement, the analysis was performed on a sample of 500 microliters of serum, with a chemiluminescence technique. Results The sample was comprised mostly by men (77.4%), with a mean age of 37.65 years, 13.29 years of formal education, and disease duration of 11.58 years. No correlations were observed between prolactin levels and PANSS components and subscales. Only in male patients is there a negative correlation was found between prolactin levels with the overall combined score of the MCCB battery and cognitive domains of reasoning and verbal learning. Discussion and conclusions Men diagnosed with schizophrenia may be particularly vulnerable to the negative effects of hyperprolactinemia on cognition. These preliminary data have clinical implications for close monitoring of prolactin and cognitive decline in males with schizophrenia. Theoretically, these data are suggestive of a protective effect of hormones in women with this condition.

Resumen Introducción Diversos estudios han explorado la relación entre los niveles de prolactina sérica, la sintomatología y la disfunción cognitiva en individuos con alto riesgo de psicosis y pacientes con un primer episodio psicótico. Sin embargo, la relación entre tales variables es poco comprendida en el caso de los pacientes crónicos con esquizofrenia. Objetivo Evaluar la relación entre los niveles de prolactina, el deterioro neuropsicológico y la severidad de los síntomas en pacientes crónicos. Método Se evaluó un total de 31 pacientes. El rango de edad fue de 18 a 60 años, quienes recibieron tratamiento antipsicótico durante un mes como mínimo. Los datos se obtuvieron de entrevistas y de la aplicación de la PANSS y la MCCB. La medición de la prolactina se realizó con una muestra de 500 microlitros de suero, con una técnica de quimioluminiscencia. Resultados La muestra estuvo compuesta en su mayoría por hombres (77.4%), con una edad media de 37.65 años, 13.29 años de escolaridad y una duración de la enfermedad de 11.58 años. No se observaron correlaciones entre los niveles de prolactina y los componentes y subescalas del PANSS. Sólo en los pacientes varones se da una correlación negativa entre los niveles de prolactina con la puntuación global combinada de la batería de MCCB y los dominios cognitivos de razonamiento y aprendizaje verbal. Discusión y conclusiones Los hombres diagnosticados con esquizofrenia pueden ser particularmente vulnerables a los efectos negativos de la hiperprolactinemia sobre la cognición. Teóricamente, estos datos sugieren un efecto protector de las hormonas en las mujeres con esta enfermedad.