Characterization and modulation of voltage-gated potassium channels in human lymphocytes in schizophrenia.

BACKGROUND: It is known that the immune system is dysregulated in schizophrenia, having a state similar to chronic neuroinflammation. The origin of this process is unknown, but it is known that T and B lymphocytes, which are components of the adaptive immune system, play an important role in the pathogenic mechanisms of schizophrenia. METHODS: We analysed the membrane of PBMCs from patients diagnosed with schizophrenia through proteomic analysis (n = 5 schizophrenia and n = 5 control). We found the presence of the Kv1.3 voltage-gated potassium channel and its auxiliary subunit ß1 (KCNAB1) and ß2 (KCNAB2). From a sample of 90 participants, we carried out a study on lymphocytes with whole-cell patch-clamp experiments (n = 7 schizophrenia and n = 5 control), western blot (n = 40 schizophrenia and n = 40 control) and confocal microscopy to evaluate the presence and function of different channels. Kv in both cells. RESULTS: We demonstrated the overexpression of Kv1.1, Kv1.2, Kv1.3, Kv1.6, Kv4.2, Kv4.3 and Kv7.2 channels in PBMCs from patients with schizophrenia. This study represents a groundbreaking exploration, as it involves an electrophysiological analysis performed on T and B lymphocytes from patients diagnosed of schizophrenia compared to healthy participants. We observed that B lymphocytes exhibited an increase in output current along with greater peak current amplitude and voltage conductance curves among patients with schizophrenia compared with healthy controls. CONCLUSIONS: This study showed the importance of the B lymphocyte in schizophrenia. We know that the immune system is altered in schizophrenia, but the physiological mechanisms of this system are not very well known. We suggest that the B lymphocyte may be relevant in the pathophysiology of schizophrenia and that it should be investigated in more depth, opening a new field of knowledge and possibilities for new treatments combining antipsychotics and immunomodulators. The limitation is that all participants received antipsychotic medication, which may have influenced the differences observed between patients and controls. This implies that more studies need to be done where the groups can be separated according to the antipsychotic drug.

Social cognition and emotional rehabilitation in participants with schizofrenia.

Introduction: People with schizophrenia have deficits in social cognition, emotion and social perception, as well as attributional style. The purpose of this study was to evaluate the efficacy of a multicomponent social cognition training program, e-Motional Training® (ET), in people with schizophrenia and to compare its efficacy with people who did not receive it. Therefore, a single-blind RCT was conducted in participants with a diagnosis of schizophrenia. Methods: A randomized, single-blind, clinical trial was conducted with 50 stable outparticipants with schizophrenia (registry number CHUC_2019_109). All participants (control and intervention) were treated with pharmacotherapy, case management and were on Individual Placement and Support methodology for competitive employment. The intervention group was treated with ET, an online program designed for social cognition rehabilitation. Pre and post assessment was performed using different battery of tests. General mixed models with subject identification and repeated measures over time were used. Results: Different pre and post measurements were performed in the two groups. No significant differences were found in sociodemographic characteristics between the control and intervention groups. Improvements were obtained in the intervention group in the Ekman test (p = 0.009), mainly enhanced by the improvement shown in three emotions: fear, sadness and disgust (p = 0.041, p = 0.021 and p = 0.038 respectively). Conclusion: ET is a promising online training tool for social cognition deficits in schizophrenia, in particular, for the improvement of emotions.Clinical Trial Registration: https://beta.clinicaltrials.gov, NCT05866328.

Emotion recognition through Spanish prosody in people with schizophrenia.

People with schizophrenia have deficits in the ability to identify emotions. An area of important dysfunction is the understanding of affective prosody, which can limit communication and social functionality. The objective of this study is to compare emotional recognition through prosody between a group of people with schizophrenia versus a control group without pathology, through the Reading the Mind in the Voice - Spanish Version scale (RMV-SV).

Reconocimiento de las emociones a través de la prosodia en español en personas con esquizofrenia / Emotion recognition through Spanish prosody in people with schizophrenia

Introducción: Las personas con esquizofrenia presentan déficits en lahabilidad para identificar emociones. Un área de importante disfunción es la comprensión de la prosodia afectiva, que puede limitar la comunicación y la funcionalidad social. Elobjetivo de este estudio es comparar el reconocimiento emocional a través de la prosodia entre un grupo de personas con esquizofrenia frente a un grupo control sin patología, através de la escala Reading the Mind in the Voice – SpanishVersion (RMV-SV).Metodología:Se reclutó un grupo de personas con esquizofrenia otrastorno esquizo-afectivo, clínicamente estables (n = 62).Se compararon con un grupo control (n = 63) en las características sociodemográficas, clínicas, el coeficiente intelectualy el rendimiento en la escala RMV-SV.Resultados:El grupo de casos presentó puntuaciones más bajas enla RMV-SV, con diferencias estadísticamente significativas (p< ,001) frente a los controles. En 17/22 ítems de respuestaserróneas, los enunciados contenían emociones negativas. Lacorrelación fue positiva entre RMV-SV y CI. Se correlacionó de forma inversa el RMV-SV y PANSS, principalmente lasubescala negativa, y la edad.Conclusiones:La escala RMV-SV, validada en autismo, permite detectarlas alteraciones del reconocimiento prosódico en español enla esquizofrenia, postulándose como una herramienta evaluadora de este dominio de la cognición social. (AU)

Introduction: People with schizophrenia have deficits in the ability toidentify emotions. An area of important dysfunction is theunderstanding of affective prosody, which can limit communication and social functionality. The objective of this studyis to compare emotional recognition through prosody between a group of people with schizophrenia versus a controlgroup without pathology, through the Reading the Mind inthe Voice - Spanish Version scale (RMV-SV).MethodA group of people with clinically stable schizophrenia orschizoaffective disorder was recruited (n = 62). They werecompared with a control group (n = 63) in sociodemographic, clinical characteristics, intelligence quotient, and performance on RMV-SV scale. ResultsThe case group presented lower scores on the RMV-SV,with statistically significant differences (p < .001) comparedto controls. In 17/22 items of wrong answers, the statementscontained negative emotions. The correlation was positivebetween RMV-SV and IQ. RMV-SV and PANSS, mainly thenegative subscale, and age were inversely correlated.ConclusionsThe RMV-SV scale, validated in autism, allows detectingthe alterations of prosodic recognition in Spanish in schizophrenia, postulating itself as an evaluating tool of this domain of social cognition. (AU)

Changes in the Brain Extracellular Matrix Composition in schizophrenia: A Pathophysiological Dysregulation and a Potential Therapeutic Target.

The brain extracellular matrix (ECM) is involved in crucial processes of neural support, neuronal and synaptic plasticity, extrasynaptic transmission, and neurotransmission. ECM is a tridimensional fibrillary meshwork composed of macromolecules that determine its bioactivity and give it unique characteristics. The characterization of the brain ECM is critical to understand its dynamic in SZ. Thus, a comparative study was developed with 71 patients with schizophrenia (SZ) and 70 healthy controls. Plasma of participants was analysed by label-free liquid chromatography-tandem mass spectrometry, and the results were validated using the classical western blot method. Lastly, immunostaining of post-mortem human brain tissue was performed to analyse the distribution of the brain ECM proteins by confocal microscopy. The analysis identified four proteins: fibronectin, lumican, nidogen-1, and secreted protein acidic and rich in cysteine (SPARC) as components of the brain ECM. Statistical significance was found for fibronectin (P = 0.0166), SPARC (P = 0.0003), lumican (P = 0.0012), and nidogen-1 (P < 0.0001) that were decreased in the SZ group. Fluorescence imaging of prefrontal cortex (PFC) sections revealed a lower expression of ECM proteins in SZ. Our study proposes a pathophysiological dysregulation of proteins of the brain ECM, whose abnormal composition leads to a progressive neuronal impairment and consequently to neurodegenerative processes due to lack of neurophysiological support and dysregulation of neuronal homeostasis. Moreover, the brain ECM and its components are potential pharmacological targets to develop new therapeutic approaches to treat SZ.

Perfil proteómico y metabólico de pacientes crónicos con esquizofrenia tras un programa de actividad física: estudio piloto / Proteomic and metabolic profiling of chronic patients with schizophrenia induced by a physical activity program: Pilot study

Introducción: La esquizofrenia es una enfermedad crónica que suele ir acompañada de trastornos metabólicos como la diabetes, la obesidad y problemas cardiovasculares asociados muchas veces a estilos de vida poco saludables, así como a problemas neuroendocrinos ocasionados por la propia enfermedad. Los cambios en el estilo de vida, como la práctica de ejercicio físico regular, tienen un efecto positivo sobre los trastornos metabólicos y la salud mental. Sin embargo, se desconocen los cambios moleculares y su consecuente repercusión en los pacientes diagnosticados con esquizofrenia. Con este estudio se pretenden analizar los cambios moleculares inducidos por el ejercicio físico en pacientes crónicos con esquizofrenia.MétodosVeintiún pacientes con esquizofrenia crónica fueron sometidos a un programa de entrenamiento aeróbico diario durante 6 meses. El grupo de pacientes se dividió en 2 subgrupos: un subgrupo que completó en su totalidad el programa de entrenamiento (12 pacientes) y un segundo subgrupo que abandonó el programa el primer día (9 pacientes). Se analizaron los datos bioquímicos y clínicos de cada paciente y se estudió el perfil proteómico del plasma mediante ESI-LC-MS/MS de tipo shotgun.ResultadosEl análisis proteómico reconoció 21.165 proteínas y péptidos diferentes en el plasma de los pacientes. Concretamente, 4.657 proteínas sufrieron variaciones significativas, de las cuales fueron identificadas 1.812 proteínas relacionadas con las vías metabólicas y de regulación biológica. Tras el análisis de los parámetros clínicos en estos pacientes, se encontraron diferencias significativas en el peso, el IMC, el perímetro abdominal, la presión arterial diastólica y los niveles de colesterol HDL. La puntuación en la Escala de Autoevaluación de Anhedonia fue el cambio más significativo, siendo más elevada en el subgrupo que abandonó el programa de entrenamiento en comparación con el subgrupo activo. (AU)

Introduction: Schizophrenia is a chronic illness often accompanied by metabolic disorders, diabetes, obesity and cardiovascular problems often associated with unhealthy lifestyles, as well as neuroendocrine problems caused by the disease itself. Lifestyle changes, such as regular physical exercise, have a positive effect on metabolic disorders and mental health, although the molecular changes that occur in this type of patient and how they explain the changes in their response are unknown. This study wants to analyze in a novel way the proteins and molecular pathways involved in critical plasmatic proteins in plasma to reveal the pathways involved in the implementation of physical exercise and the changes that occur among patients who participate in such programs with those who leave.MethodsTwenty-one patients with chronic schizophrenia underwent a daily, 6-month aerobic training program. We divided them into a group that completed the program (12 patients) and a second group that left the training program (9 patients). The biochemical and clinical data of each patient were analyzed and the proteomic profile of the plasma was studied using ESI-LC-MS/MS.ResultsProteomic analysis recognizes 21.165 proteins and peptides in each patient, of which we identified 1,812 proteins that varied between both groups linked to the metabolic and biological regulation pathways. After clinical analysis of each patient we found significant differences in weight, BMI, abdominal perimeter, diastolic blood pressure, and HDL cholesterol levels. The main change that vertebrates both groups is the Self-Assessment Anhedonia Scale, where we detected higher levels in the dropout group (no physical activity) compared to the active group. (AU)

Proteomic and metabolic profiling of chronic patients with schizophrenia induced by a physical activity program: Pilot study.

INTRODUCTION: Schizophrenia is a chronic illness often accompanied by metabolic disorders, diabetes, obesity and cardiovascular problems often associated with unhealthy lifestyles, as well as neuroendocrine problems caused by the disease itself. Lifestyle changes, such as regular physical exercise, have a positive effect on metabolic disorders and mental health, although the molecular changes that occur in this type of patient and how they explain the changes in their response are unknown. This study wants to analyze in a novel way the proteins and molecular pathways involved in critical plasmatic proteins in plasma to reveal the pathways involved in the implementation of physical exercise and the changes that occur among patients who participate in such programs with those who leave. METHODS: Twenty-one patients with chronic schizophrenia underwent a daily, 6-month aerobic training program. We divided them into a group that completed the program (12 patients) and a second group that left the training program (9 patients). The biochemical and clinical data of each patient were analyzed and the proteomic profile of the plasma was studied using ESI-LC-MS/MS. RESULTS: Proteomic analysis recognizes 21.165 proteins and peptides in each patient, of which we identified 1.812 proteins that varied between both groups linked to the metabolic and biological regulation pathways. After clinical analysis of each patient we found significant differences in weight, BMI, abdominal perimeter, diastolic blood pressure, and HDL cholesterol levels. The main change that vertebrates both groups is the Self-Assessment Anhedonia Scale, where we detected higher levels in the dropout group (no physical activity) compared to the active group. CONCLUSION: The benefits of physical exercise are clear in chronic patients with schizophrenia, as it substantially improves their BMI, as well as their clinical and biochemical parameters. However, our study reveals the biological and molecular pathways that affect physical exercise in schizophrenia, such as important metabolic proteins such as ApoE and ApoC, proteins involved in neuronal regulation such as tenascin and neurotrophins, neuroinflammatory regulatory pathways such as lipocalin-2 and protein 14-3-3, as well as cytoskeleton proteins of cells such as spectrins and annexines. Understanding these molecular mechanisms opens the door to future therapies in the chronicity of schizophrenia.

The Role of the Second Extracellular Loop of Norepinephrine Transporter, Neurotrophin-3 and Tropomyosin Receptor Kinase C in T Cells: A Peripheral Biomarker in the Etiology of Schizophrenia.

The neurobiology of schizophrenia is multifactorial, comprising the dysregulation of several biochemical pathways and molecules. This research proposes a peripheral biomarker for schizophrenia that involves the second extracellular loop of norepinephrine transporter (NEText), the tropomyosin receptor kinase C (TrkC), and the neurotrophin-3 (NT-3) in T cells. The study of NEText, NT-3, and TrkC was performed in T cells and plasma extracted from peripheral blood of 54 patients with schizophrenia and 54 healthy controls. Levels of NT-3, TrkC, and NET were significantly lower in plasma and T cells of patients compared to healthy controls. Co-immunoprecipitation (co-IPs) showed protein interactions with Co-IP NEText-NT-3 and Co-IP NEText-TrkC. Computational modelling of protein-peptide docking by CABS-dock provided a medium-high accuracy model for NT-3-NEText (4.6935 Å) and TrkC-NEText (2.1365 Å). In summary, immunocomplexes reached statistical relevance in the T cells of the control group contrary to the results obtained with schizophrenia. The reduced expression of NT-3, TrkC, and NET, and the lack of molecular complexes in T cells of patients with schizophrenia may lead to a peripheral dysregulation of intracellular signaling pathways and an abnormal reuptake of norepinephrine (NE) by NET. This peripheral molecular biomarker underlying schizophrenia reinforces the role of neurotrophins, and noradrenergic and immune systems in the pathophysiology of schizophrenia.

Voices 2: Improving Prosodic Recognition in Schizophrenia With an Online Rehabilitation Program.

Introduction: Emotion recognition of voices may play an important role in interpersonal communication and patients with schizophrenia present alterations in this regard. Several on-line rehabilitation tools have been developed for treatment in this area. Voices is an on-line prosodic recognition program consisting of identifying different emotional tones in neutral phrases, in different sessions of gradually increasing difficulty. This training tool has previously reported benefits, and a new version has been created called Voices 2. The main aim of this study is to test the capacity of the Voices 2 program to improve emotion recognition through prosody for adults with schizophrenia. Secondly, it seeks to observe durability effects 1 month after intervention. Method: A randomized, single-blind, multicenter clinical trial was conducted with 44 outpatients diagnosed with schizophrenia or schizoaffective disorder. The intervention group (also called Voices) was treated with Voices 2, whereas the control group was treated with auditory training that was not related to emotions. Sociodemographic and clinical data, clinical state (PANSS), Intelligence Quotient and prosodic recognition (RMV-SV) were measured at baseline. After intervention, RMV-SV and PANSS were assessed. One month later, the RMV-SV measure was repeated. Results: The control group (n = 19) and the Voices group (n = 22) did not differ on χ2, t or U tests in sociodemographic, clinical and psychometric variables at baseline or post-intervention (all p-values > 0.05). In the Voices group, statistically significant differences were observed in the RMV-SV scale applied post-intervention vs. that applied pre-intervention (Z = 2.47, p = 0.013). Similar results were observed in the 1-month follow-up RMV-SV vs. the pre-intervention RMV-SV (Z = 1.97, p = 0.049). PANSS scale was also assessed with no significant differences between pre vs. post measures in both groups. Lastly, Voices 2 was rated relatively higher, based on its ease of understanding, entertainment value, usefulness and the appropriateness of use of its emotional glossary. Discussion: Improvements were observed in prosodic recognition following intervention with Voices 2 in the Voices group. Although these results are similar to other clinical trial rehabilitation programs, specific research on the matter remains scarce. Certain aspects, such as the durability of effects or adherence should be thoroughly studied and clarified. Clinical Trial Registration: [https://doi.org/10.17605/OSF.IO/G95C4].

Plasma ß-III tubulin, neurofilament light chain and glial fibrillary acidic protein are associated with neurodegeneration and progression in schizophrenia.

Schizophrenia is a progressive disorder characterized by multiple psychotic relapses. After every relapse, patients may not fully recover, and this may lead to a progressive loss of functionality. Pharmacological treatment represents a key factor to minimize the biological, psychological and psychosocial impact of the disorder. The number of relapses and the duration of psychotic episodes induce a potential neuronal damage and subsequently, neurodegenerative processes. Thus, a comparative study was performed, including forty healthy controls and forty-two SZ patients divided into first-episode psychosis (FEP) and chronic SZ (CSZ) subgroups, where the CSZ sub group was subdivided by antipsychotic treatment. In order to measure the potential neuronal damage, plasma levels of ß-III tubulin, neurofilament light chain (Nf-L), and glial fibrillary acidic protein (GFAP) were performed. The results revealed that the levels of these proteins were increased in the SZ group compared to the control group (P < 0.05). Moreover, multiple comparison analysis showed highly significant levels of ß-III tubulin (P = 0.0002), Nf-L (P = 0.0403) and GFAP (P < 0.015) in the subgroup of CSZ clozapine-treated. In conclusion, ß-III tubulin, Nf-L and GFAP proteins may be potential biomarkers of neurodegeneration and progression in SZ.

Proteomics in Schizophrenia: A Gateway to Discover Potential Biomarkers of Psychoneuroimmune Pathways.

Schizophrenia is a severe and disabling psychiatric disorder with a complex and multifactorial etiology. The lack of consensus regarding the multifaceted dysfunction of this ailment has increased the need to explore new research lines. This research makes use of proteomics data to discover possible analytes associated with psychoneuroimmune signaling pathways in schizophrenia. Thus, we analyze plasma of 45 patients [10 patients with first-episode schizophrenia (FES) and 35 patients with chronic schizophrenia] and 43 healthy subjects by label-free liquid chromatography-tandem mass spectrometry. The analysis revealed a significant reduction in the levels of glia maturation factor beta (GMF-ß), the brain-derived neurotrophic factor (BDNF), and the 115-kDa isoform of the Rab3 GTPase-activating protein catalytic subunit (RAB3GAP1) in patients with schizophrenia as compared to healthy volunteers. In conclusion, GMF-ß, BDNF, and 115-kDa isoform of RAB3GAP1 showed significantly reduced levels in plasma of patients with schizophrenia, thus making them potential biomarkers in schizophrenia.

Improving emotion recognition in schizophrenia with "VOICES": An on-line prosodic self-training.

INTRODUCTION: Emotion recognition (ER) deficits have been extensively demonstrated in schizophrenia. These deficiencies are not only restricted to facial emotion recognition but also include emotional prosody (tone of the voice) recognition deficits. They have been significantly associated with symptom severity and poor social functioning. The aim of this study was to test the efficacy, in real clinical conditions, of an online self-training prosodic game included in the Social Cognition rehabilitation program e-Motional Training. METHOD: A randomized, single-blind multicenter clinical trial was conducted with 50 outpatients with schizophrenia or schizoaffective disorder. The control group was treated with Treatment-as-usual (TAU), based on drug therapy, case management and individual and group psychotherapy (not focused on Social Cognition). The intervention group was treated with TAU plus the employment of Voices, an online self-training program devised for prosodic rehabilitation. STATISTICAL ANALYSIS: Linear regression was used to evaluate the effectiveness of the intervention in emotion recognition measured with the Reading the Mind in the Voice-Spanish Version (RMV-SV). RESULTS: There were statistically significant differences between the intervention and control group measured with RMV-SV (ß = 3,6[IC 95%], p<0.001), with a response variable in RMV post R2 = 0,617. DISCUSSION: Voices, a prosodic rehabilitation game included in e-Motional Training, seems to be a promising tool for improving emotional voice recognition deficits in schizophrenia, filling the need for such interventions.

Entrenamiento en percepción de emociones en pacientes con esquizofrenia / Training on emotional perception for patients with schizophrenia

OBJETIVO: revaluar la eficacia de la herramienta E-Motional Training de entrenamiento en percepción emocional en pacientes con esquizofrenia en términos de mejoría clínica y de procesamiento emocional, en comparación con el tratamiento habitual. MÉTODO: se realizó un ensayo clínico aleatorizado, multicéntrico, simple ciego en 60 pacientes ambulatorios con esquizofrenia. Todos los pacientes (control e intervención) fueron tratados con terapia con medicamentos, manejo de casos y psicoterapia individual y grupal. Los pacientes fueron evaluados antes y después de la intervención. El grupo control realizó el tratamiento habitual. El grupo intervención llevó a cabo el tratamiento habitual y además una sesión semanal de una hora de duración (12 sesiones en total) con el aplicativo informático E-Motional Training, que incluye tutoriales y módulos de entrenamiento en percepción emocional y microexpresiones, así como pretest y postest para evaluar el progreso del paciente. Se recogieron variables sociodemográficas y clínicas (utilizando la escala PANSS), y se evaluó la percepción emocional mediante el test de Ekman 60 Faces Test. Se efectuó análisis descriptivo y bivariante. Se consideraron diferencias estadísticamente significativas entre los grupos con p< 0,05. Se usó el paquete estadístico SPSS 22.0 y R. RESULTADOS: el grupo sometido a entrenamiento obtuvo datos estadísticamente significativos (p< 0,05) tanto en percepción emocional, como en la reducción de la sintomatología negativa (p< 0,01) en comparación con el grupo control. DISCUSIÓN: la herramienta E-Motional Training permite el autoentrenamiento en percepción emocional en pacientes con esquizofrenia que presentan déficits de percepción emocional. Esta herramienta produce, además, una mejoría clínica en los pacientes

OBJECTIVE: to assess the efficacy of the E-Motional Training tool on emotional perception training for patients with schizophrenia in terms of clinical improvement and emotional processing, compared with standard treatment. METHOD: a randomized, multicenter, single blinded clinical trial was conducted on 60 outpatients with schizophrenia. All patients (control and intervention arms) were treated with drug therapy, case management, and individual and group psychotherapy. Patients were evaluated before and after the intervention. The control arm followed standard treatment. The intervention arm followed standard treatment, and also a weekly 1-hour session (12 sessions in total) with the E-Motional Training application, which includes tutorials and training modules on emotional perception and microexpressions, as well as a pre-test and a post-test to assess patient progress. Sociodemographical and clinical variables were collected (using the PANSS scale), and the emotional perception was evaluated through the Ekman 60 Faces Test. Descriptive and bivariate analysis was conducted. Statistically significant differences between arms were considered as p< 0.05. The statistical package SPSS 22.0 for R was used. RESULTS: the arm following training obtained statistically significant data (p< 0.05), both in emotional perception and in reduction of negative symptomatology (p< 0.01) vs. the control arm. DISCUSSION: the E-Motional Training tool allows self-training on emotional perception for patients with schizophrenia who present emotional perception deficits. This tool also leads to a clinical improvement in patients

Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes.

ABSTRACTBackground:The risks of polypharmacy can be far greater than the benefits, especially in the elderly. Comorbidity makes polypharmacy very prevalent in this population; thus, increasing the occurrence of adverse effects. To solve this problem, the most common strategy is to use lists of potentially inappropriate medications. However, this strategy is time consuming. METHODS: In order to minimize the expenditure of time, our group devised a pilot computer tool (Polimedication) that automatically processes lists of medication providing the corresponding Screening Tool of Older Persons' potentially inappropriate Prescriptions alerts and facilitating standardized reports. The drug lists for 115 residents in Santa Marta Nursing Home (Fundación San Rosendo, Ourense, Spain) were processed. RESULTS: The program detected 10.04 alerts/patient, of which 74.29% were not repeated. After reviewing these alerts, 12.12% of the total (1.30 alerts/patient) were considered relevant. The largest number of alerts (41.48%) involved neuroleptic drugs. Finally, the patient's family physician or psychiatrist accepted the alert and made medication changes in 62.86% of the relevant alerts. The largest number of changes (38.64%) also involved neuroleptic drugs. The mean time spent in the generation and review of the warnings was 6.26 minute/patient. Total changes represented a saving of 32.77 € per resident/year in medication. CONCLUSIONS: The application of Polimedication tool detected a high proportion of potentially inappropriate prescriptions in institutionalized elderly patients. The use of the computerized tool achieved significant savings in pharmaceutical expenditure, as well as a reduction in the time taken for medication review.

Randomized Clinical Trial with e-MotionalTraining® 1.0 for Social Cognition Rehabilitation in Schizophrenia.

BACKGROUND: Schizophrenia patients present deficits in social cognition (SC), emotion and social perception, theory of mind (ToM), and attributional style. This study tested the efficacy, in real clinical conditions, of a online self-training program in SC, e-Motional Training®, in comparison with treatment as usual. METHOD: A randomized single-blinded multicenter clinical trial was conducted with 60 schizophrenia stable outpatients. All patients (control and intervention) were treated with drug therapy, case management, and individual and group psychotherapy (not focused on SC). Intervention group was treated with e-Motional Training®, an online program devised for SC rehabilitation. STATISTICAL ANALYSIS: A descriptive analysis and parametric/non-parametric tests were used to compare both groups at baseline. Analysis of covariance was used to compared post-pre changes in SC between the two interventions. If the group effect was significant, follow-up univariate test (t-test for dependent samples) was carried out in each group to verify whether the effect was due to improvement in the intervention group or deterioration in the control group. We considered statistically significant differences with P < 0.05. RESULTS: Significant improvements were obtained in the intervention group in emotion recognition and most ToM variables in comparison with the control group. DISCUSSION: e-Motional Training® seems to be a promising online training tool for SC deficits in schizophrenia, covering the lack of similar intervention instruments in our community.

Influence of visual elicitation over emotion regulation: An investigation employing the heart rate variability.

Several works studied the elicitation of emotions through the exposure of individuals to relevant stimuli, using spectral analysis of Heart Rate Variability (HRV) when people are subject to emotional elicitation. If correlation exists between HRV and emotional responses, spectral analysis can be used to study emotion regulation under external stimuli. In this work, we studied the relationship between visual elicitation and emotion regulation, employing HRV. Images (with pleasant, unpleasant and neutral emotional content) were selected from the IAPS (International Affective Picture System) dataset. Ninety-eight participants were enrolled, and subject to view all images, displayed in random order for each participant. Heart rate was recorded during the experiment, and HRV analysis was performed. Spectral values were studied for the different images. The presentation order of images was relevant, mainly when unpleasant images were viewed in first place; this significantly affects HRV values. Spectral values were higher for men, being this difference stronger when pleasant pictures were displayed. Age and gender dependences of spectral indexes were found. The influence of visual elicitation, with different emotional contents, over HRV, was assessed. Results indicate that HRV parameters are affected when individuals are subject to external, emotional-based stimuli.

Sesgo "salto a las conclusiones" en pacientes con patología psiquiátrica / The "jumping to conclusions" bias in patients with psychiatric conditions

Objetivo: describir la presencia del sesgo "salto a las conclusiones" en pacientes con patología psiquiátrica y en un grupo de voluntarios sanos, y conocer si existe relación entre el sesgo "salto a las conclusiones" y los rasgos de personalidad "intolerancia a la incertidumbre" y "rigidez de ideas". Método: estudio de casos y controles, tomando como casos los pacientes ingresados en el Servicio de Psiquiatría del Complejo Hospitalario de Ourense diagnosticados de esquizofrenia, depresión o trastorno bipolar, y como controles voluntarios sanos. Instrumentos: test de las bolas, test de los dibujos o BADE (Bias Against Disconfirmatory Evidence) e inventario de creencias obsesivas. Resultados: la muestra final fue de 100 sujetos (casos: 50 con patología psiquiátrica, y controles: 50 sin patología psiquiátrica). En la tarea de bolas, los casos necesitaron una media (desviación típica) de 4,66 bolas (2,81) para tomar una decisión frente a las 2,94 (2,80) en los controles, siendo esta diferencia significativa. En el BADE los pacientes psiquiátricos valoraron de manera significativa como más plausible la opción que manifiestan en la diapositiva 1 en comparación con los sujetos sanos. Existe una correlación significativa entre las puntuaciones del test de las bolas y los rasgos de "intolerancia a la incertidumbre" (r= -0,285) y "rigidez de ideas" (r= -0,322), sin encontrarse diferencias significativas en ninguna de las variables en función del diagnóstico. Conclusiones: todos los pacientes con patología psiquiátrica del estudio presentaron el sesgo "salto a las conclusiones", mientras que los voluntarios sanos no lo poseían. La presencia de este sesgo se correlaciona con la intolerancia a la incertidumbre y la rigidez de ideas (AU)

Objective: to describe the presence of the "jumping to conclusions" bias in patients with psychiatric conditions and in a group of healthy volunteers, and to understand if there is a link between the "jumping to conclusions" bias and the personality traits "intolerance of uncertainty" and "ideological rigidity". Method: case and control study, taking as cases those patients admitted at the Psychiatry Unit of the Complejo Hospitalario de Ourense with diagnosis of schizophrenia, depression, or bipolar disorder, and healthy volunteers as control. Tools: ball test, drawing test or BADE (Bias Against Disconfirmatory Evidence), and Obsessional Beliefs Questionnaire. Results: the final sample included 100 subjects (cases: 50 with psychiatric conditions, and controls: 50 without psychiatric conditions). In the ball task, cases needed a mean (standard deviation) of 4.66 balls (2.81) in order to make a decision, vs. 2.94 (2.80) in controls; this is a significant difference. In the BADE, psychiatric patients valued significantly as more feasible the option stated in slide 1, in comparison with healthy subjects. There is a significant correlation between the scores in the ball test and the "intolerance of uncertainty" (r= -0,285) and "ideological rigidity" (r= -0,322) traits; no significant differences were found in any of the variables based on diagnosis. Conclusions: all patients with psychiatric conditions included in the study presented the "jumping to conclusions" bias, while healthy volunteers did not have it. The presence of this bias is correlated with intolerance of uncertainty and ideological rigidity (AU)

e-Motional Training®: Pilot study on a novel online training program on social cognition for patients with schizophrenia.

BACKGROUND: Patients with schizophrenia have deficits in social cognition (SC), a construct that includes emotion perception (EP), social perception (SP), theory of mind (ToM) and attributive style (AS). The aim of our study was to assess the applicability, identify potential problems and obtain preliminary data on the efficacy of a new online training program on SC called e-Motional Training (ET®), which can be remotely administered and remotely supervised by a clinician. MATERIALS AND METHODS: A pre/post intervention pilot study was conducted with 21 patients with schizophrenia in the healthcare area of Ourense, Spain (12 patients were assigned to the intervention group and 9 in the control group). The control group received standard treatment (TAU) (occupational therapy and leisure group). The intervention group received TAU plus 12 sessions (1 hour per week) with ET® (including training modules on emotional perception and a short animated cartoon for ToM and AS training, including automated metacognitive feedback). Endpoints: EP (Ekman 60 Faces Test), ToM (Hinting Task, Faux Pas, Happé), AS (Ambiguous Intentions Hostility Questionnaire). RESULTS: ET® was shown to be an understandable, viable and pleasant program for the participants. After the intervention, statistically significant data (p < 0.05) were obtained for the EP, ToM and AS variables. CONCLUSION: ET® enables self-training in SC and online follow-up by the therapist, thereby covering the lack of online intervention instruments validated for patients with SC deficits. Our preliminary results demonstrate the feasibility of ET® and its possible efficacy in improving emotion recognition, ToM and AS.

Suicide notes: Clinical and linguistic analysis from the perspective of the Interpersonal Theory of Suicide

Background and Objectives: Studying suicide notes is a strong methodology in suicidology and one of the most relevant theoretical frameworks is the Interpersonal Theory of Suicide proposed by Joiner. This study analyzed 80 suicide notes collected in Chile searching for the risk factors proposed by the theory and its implications. The clinical and sociodemographic characteristics of the notes' authors were analyzed too. Methods: The suicide notes were classified according to the presence or absence of the suicide risk factors proposed by the Interpersonal Theory of Suicide and were analyzed linguistically with the Linguistic Inquiry and Word Count program. Results: One or both interpersonal risk factors indicated by the theory were identified in 60% of the notes. The “lack of belonging” factor was the most common risk factor, and various linguistic profiles in the suicide notes were found according to the presence or absence of this factor. Conclusions: We confirmed the relevance of the interpersonal risk factors proposed as issues present in a high percentage of notes and found linguistic differences according to its presence or absence in the suicide notes (AU)

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Linguistic analysis of suicide notes in Spain

Background and Objectives: Text analysis software like “Linguistic Inquiry and Word Count” (LIWC) has been used for the analysis of suicide notes and suicidal texts in English. This is the first analysis of suicide notes using this method in Spanish and, as far as we know, its first application to suicide notes in Europe. To compare the sociodemographic and forensic characteristics of a consecutive sample of suicide victims studying the differences between those who left suicidal note and those who did not. To study a sample of suicidal notes from Spain using LIWC, comparing it’s linguistic features by gender, age and environment. Methods: 144 consecutive suicide cases were analyzed. 23 suicide notes obtained from this sample were processed using LIWC, the results were compared by gender, age and environment of the author. Results: People who left suicide notes were younger than non- writers; more frequently single, divorced or widowed and emotional troubles were reported as frequent triggers. Suicide notes written by women were significantly longer, had more emotional content, tentative expressions, denials, pronouns in first person plural and verbs in past and future tenses. Urban cases showed higher emotional expression and word complexity whereas rural cases showed a higher use of social words. Conclusions: Our study shows some differences between people who left suicide note and those who didn’t and confirms the LIWC ability to detect differences in suicidal speech by gender and by the rural/ urban background of its authors (AU)