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1.
Schizophr Res ; 269: 86-92, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38754313

RESUMO

Hallucinations are a core feature of psychosis, and their severity during the acute phase of illness is associated with a range of poor outcomes. Various clinical and sociodemographic factors may predict hallucinations and other positive psychotic symptoms in first episode psychosis (FEP). Despite this, the precise factors associated with hallucinations at first presentation to an early intervention service have not been extensively researched. Through detailed interviews and chart reviews, we investigated sociodemographic and clinical predictors in 636 minimally-medicated patients who entered PEPP-Montréal, an early intervention service for FEP, between 2003 and 2018. Hallucinations were measured using the Scale for the Assessment of Positive Symptoms (SAPS), while negative symptoms were assessed using the Scale for the Assessment of Negative symptoms (SANS). Depressive symptoms were evaluated through the Calgary Depression Scale for Schizophrenia (CDSS), and anxiety symptoms via the Hamilton Rating Scale for Anxiety (HAS). A majority (n = 381, 59.9 %) of the sample presented with clinically significant hallucinations (SAPS global hallucinations score ≥ 3) at program entry. These patients had an earlier age at onset, fewer years of education, and a higher severity of delusions, depression and negative symptoms than those without clinical-level hallucinations. These results suggest that individuals with clinically significant hallucinations at admission tend to be younger and have a greater overall symptom burden. This makes it especially important to monitor hallucinations alongside delusions, depression and negative symptoms in order to identify who might benefit from targeted interventions. The implications of these findings for early intervention and person-centered care are discussed.


Assuntos
Intervenção Médica Precoce , Alucinações , Transtornos Psicóticos , Humanos , Alucinações/terapia , Alucinações/epidemiologia , Alucinações/etiologia , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Masculino , Feminino , Adulto , Adulto Jovem , Intervenção Médica Precoce/estatística & dados numéricos , Depressão/epidemiologia , Adolescente , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Idade de Início , Ansiedade/epidemiologia , Delusões/epidemiologia , Delusões/etiologia , Delusões/terapia , Escalas de Graduação Psiquiátrica
2.
Schizophr Bull ; 2023 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-37847817

RESUMO

BACKGROUND AND HYPOTHESIS: Suicide is a leading cause of death in first-episode psychosis (FEP), with an elevated risk during the first year following illness onset. The association between negative symptoms and suicidality remains contentious. Some studies suggest that negative symptoms may be associated with lower suicidality, while others fail to find an association between the two. No previous studies have specifically investigated suicidality in Persistent Negative Symptoms (PNS) and its associated subgroups. STUDY DESIGN: In a large cohort of FEP patients (n = 515) from an early intervention service, we investigated suicidality in those with PNS, secondary PNS (ie, sPNS; PNS with clinical-level positive, depressive, or extrapyramidal symptoms), and non-PNS (all other patients) over 24 months. Patients were categorized into PNS groups based on symptoms from month 6 to month 12, and suicidality was evaluated using the Brief Psychiatric Rating Scale (BPRS). STUDY RESULTS: Covarying for age and sex, we found that sPNS had higher suicidality relative to PNS and non-PNS throughout the 24-month period, but PNS and non-PNS did not differ. These differences were maintained after adjusting for depressive symptoms. CONCLUSION: We observed that PNS did not significantly differ from non-PNS. However, we identified sPNS as a group with elevated suicidality above and beyond depression, suggesting that sPNS would benefit from targeted intervention and that PNS categorization identifies a subgroup for whom negative symptoms are not associated with lower suicidality.

3.
Am J Case Rep ; 24: e938824, 2023 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-37337420

RESUMO

BACKGROUND Cervical incompetence and deformities contribute significantly to mid-trimester pregnancy losses and preterm births. Abdominal cerclages prevent these complications, particularly in patients with a history of failed vaginal cerclage or severe cervical deformities. However, pregnancy complications such as chorioamnionitis and fetal demise may necessitate cerclage removal. The removal methods vary, with the least invasive being the colpotomy approach, associated with lower morbidity rates than the transabdominal approach or laparoscopy. CASE REPORT We detail a case involving a 31-year-old woman with a twin pregnancy at 18 weeks gestation, complicated by COVID-19 and chorioamnionitis. This clinical scenario necessitated the removal of an abdominal cerclage. Given the patient's risk profile, a posterior colpotomy approach was deemed most suitable. CONCLUSIONS The posterior colpotomy approach provided an effective and less risky method for abdominal cerclage removal in a high-risk patient. It successfully mitigated the potential complications of general anesthesia and operative risks associated with laparoscopy/laparotomy, offering optimal operative conditions.


Assuntos
COVID-19 , Cerclagem Cervical , Corioamnionite , Gravidez , Feminino , Recém-Nascido , Humanos , Adulto , Gravidez de Gêmeos , Colpotomia , Cerclagem Cervical/métodos
4.
J Matern Fetal Neonatal Med ; 19(6): 371-3, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16801315

RESUMO

Uterine scar rupture in vaginal birth after cesarean section (VBAC) usually occurs during labor or after placental extraction. We report herein the case of a patient who had a cesarean section in her first pregnancy and a VBAC in her second. The present one also ended with a normal VBAC and a documented intact scar, which then ruptured three weeks later.


Assuntos
Transtornos Puerperais/diagnóstico , Ruptura Uterina/diagnóstico , Nascimento Vaginal Após Cesárea , Adulto , Cicatriz/diagnóstico por imagem , Cicatriz/patologia , Cicatriz/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Gravidez , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/patologia , Transtornos Puerperais/cirurgia , Ultrassonografia , Ruptura Uterina/diagnóstico por imagem , Ruptura Uterina/patologia , Ruptura Uterina/cirurgia
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