Psychosis in Parkinson's Disease: Looking Beyond Dopaminergic Treatments.

BACKGROUND: Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. The symptoms of PD are characterized not only by motor alterations but also by a spectrum of nonmotor symptoms. Some of these are psychiatric manifestations such as sleep disorders; depression; cognitive difficulties that can evolve into dementia; and symptoms of psychosis, which include hallucinations, illusions, and delusions. Parkinson's disease psychosis (PDP) occurs in 18-50% of patients with PD. Treating PDP is challenging because antipsychotic drugs tend to be inefficient or may even worsen the disease's motor symptoms. OBJECTIVE: This review aims to summarize the current understanding of the molecular mechanisms involved in PDP and recent innovative alternatives for its treatment. METHODS: This is a narrative review in which an extensive literature search was performed on the Scopus, EMBASE, PubMed, ISI Web of Science, and Google Scholar databases from inception to August 2021. The terms "Parkinson's disease psychosis", "Parkinson psychosis," "neurodegenerative psychosis", and "dopamine psychosis" were among the keywords used in the search. RESULTS: Recently, views on the etiology of hallucinations and illusions have evolved remarkably. PDP has been cemented as a multifactorial entity dependent on extrinsic and novel intrinsic mechanisms, including genetic factors, neurostructural alterations, functional disruptions, visual processing disturbances, and sleep disorders. Consequently, innovative pharmacological and biological treatments have been proposed. Pimavanserin, a selective 5-HT2A inverse agonist, stands out after its approval to treat PDP-associated hallucinations and illusions. CONCLUSION: Future results from upcoming clinical trials should further characterize the role of this drug in the management of PDP as well as other treatment options with novel mechanisms of action, such as saracatinib, SEP-363856, cannabidiol, electroconvulsive therapy, and transcranial magnetic stimulation.

Electroconvulsive Therapy in Psychiatric Disorders: A Narrative Review Exploring Neuroendocrine-Immune Therapeutic Mechanisms and Clinical Implications.

Electroconvulsive therapy (ECT) is based on conducting an electrical current through the brain to stimulate it and trigger generalized convulsion activity with therapeutic ends. Due to the efficient use of ECT during the last years, interest in the molecular bases involved in its mechanism of action has increased. Therefore, different hypotheses have emerged. In this context, the goal of this review is to describe the neurobiological, endocrine, and immune mechanisms involved in ECT and to detail its clinical efficacy in different psychiatric pathologies. This is a narrative review in which an extensive literature search was performed on the Scopus, Embase, PubMed, ISI Web of Science, and Google Scholar databases from inception to February 2022. The terms "electroconvulsive therapy", "neurobiological effects of electroconvulsive therapy", "molecular mechanisms in electroconvulsive therapy", and "psychiatric disorders" were among the keywords used in the search. The mechanisms of action of ECT include neurobiological function modifications and endocrine and immune changes that take place after ECT. Among these, the decrease in neural network hyperconnectivity, neuroinflammation reduction, neurogenesis promotion, modulation of different monoaminergic systems, and hypothalamus-hypophysis-adrenal and hypothalamus-hypophysis-thyroid axes normalization have been described. The majority of these elements are physiopathological components and therapeutic targets in different mental illnesses. Likewise, the use of ECT has recently expanded, with evidence of its use for other pathologies, such as Parkinson's disease psychosis, malignant neuroleptic syndrome, post-traumatic stress disorder, and obsessive-compulsive disorder. In conclusion, there is sufficient evidence to support the efficacy of ECT in the treatment of different psychiatric disorders, potentially through immune, endocrine, and neurobiological systems.

Psycho-Neuro-Endocrine-Immunological Basis of the Placebo Effect: Potential Applications beyond Pain Therapy.

The placebo effect can be defined as the improvement of symptoms in a patient after the administration of an innocuous substance in a context that induces expectations regarding its effects. During recent years, it has been discovered that the placebo response not only has neurobiological functions on analgesia, but that it is also capable of generating effects on the immune and endocrine systems. The possible integration of changes in different systems of the organism could favor the well-being of the individuals and go hand in hand with conventional treatment for multiple diseases. In this sense, classic conditioning and setting expectations stand out as psychological mechanisms implicated in the placebo effect. Recent advances in neuroimaging studies suggest a relationship between the placebo response and the opioid, cannabinoid, and monoaminergic systems. Likewise, a possible immune response conditioned by the placebo effect has been reported. There is evidence of immune suppression conditioned through the insular cortex and the amygdala, with noradrenalin as the responsible neurotransmitter. Finally, a conditioned response in the secretion of different hormones has been determined in different studies; however, the molecular mechanisms involved are not entirely known. Beyond studies about its mechanism of action, the placebo effect has proved to be useful in the clinical setting with promising results in the management of neurological, psychiatric, and immunologic disorders. However, more research is needed to better characterize its potential use. This review integrates current knowledge about the psycho-neuro-endocrine-immune basis of the placebo effect and its possible clinical applications.

Attitudes of Medical Students Towards Psychiatry in Venezuela: a 6-Year Longitudinal Study.

OBJECTIVE: The authors evaluated changes in attitude towards psychiatry of medical students in one medical school in Venezuela. METHODS: Balon's modified questionnaire was administered to first and sixth-year medical students to analyze their attitude towards psychiatry. The answers were compared with McNemar's test. RESULTS: The students' negative perception of psychiatry increased by the end of medical school with 45% of sixth-year students reportedly feeling uncomfortable when working with patients with psychiatric illness compared to only 8.3% of first-year medical students. Interest in specializing in psychiatry decreased from 2.6% in first-year medical students to 0% in sixth-year medical students (p=0.001). CONCLUSION: Different factors may lead to the loss of interest in psychiatry of medical students in Venezuela, such as little time spent with patients, being in contact only with patients with psychosis, stigma about psychiatry among medical doctors and friends, feeling more comfortable with other specialties, and other specialties having a higher perceived status and being better paid.

Trastornos del sueño a consecuencia de la pandemia por COVID-19 / Sleep disorders as a result of the COVID-19 pandemic

RESUMEN Las complicaciones respiratorias por la COVID-19 pueden llevar a la muerte, por lo que, dentro de las políticas de protección para evitar los contagios masivos, se han sugerido estrategias de cuarentena y confinamiento en muchos países, que han originado alteraciones en la salud mental y el sueño. A través de la siguiente revisión narrativa se pretende sistematizar los hallazgos más significativos en cuanto a la presencia de insomnio en pacientes hospitalizados con COVID-19, y de personas sanas que han estado sometidas a confinamiento como medida preventiva. Las condiciones propias de la enfermedad han hecho que los pacientes desarrollen insomnio, lo que puede empeorar su estado de salud y alterar su sistema inmunológico. Para las personas sanas en cuarentena los cambios en el estilo de vida, el miedo a contraer la enfermedad, la edad joven, el sexo femenino, los antecedentes de enfermedades mentales y una menor capacidad de afrontamiento al estrés parecen ser factores de riesgo para el insomnio. Al igual que la implementación de medidas epidemiológicas de cuidado y prevención contra el COVID-19, se debe tener en consideración promover la higiene del sueño como una estrategia de afrontamiento integral contra esta pandemia.

ABSTRACT Respiratory complications from COVID-19 can lead to death. For this reason, public health measures to curb the spread of the disease such as quarantine and other confinement strategies have been proposed in several countries, resulting in mental health and sleep disorders. We carried out a narrative review to systematize the most significant findings regarding insomnia in hospitalized patients with COVID-19, and in healthy persons who have been under confinement as a preventive measure. COVID-19-related conditions have caused insomnia in patients, which can alter the immune system and have a negative effect on health. For healthy people in quarantine, lifestyle changes, fear of becoming infected, young age, female gender, history of mental illness and reduced ability to cope with stress appear to be risk factors for insomnia. As well as the implementation of epidemiological and preventive measures, sleep hygiene should be promoted as a comprehensive coping strategy against the COVID-19 pandemic.

[Sleep disorders as a result of the COVID-19 pandemic]. / Trastornos del sueño a consecuencia de la pandemia por COVID-19.

Respiratory complications from COVID-19 can lead to death. For this reason, public health measures to curb the spread of the disease such as quarantine and other confinement strategies have been proposed in several countries, resulting in mental health and sleep disorders. We carried out a narrative review to systematize the most significant findings regarding insomnia in hospitalized patients with COVID-19, and in healthy persons who have been under confinement as a preventive measure. COVID-19-related conditions have caused insomnia in patients, which can alter the immune system and have a negative effect on health. For healthy people in quarantine, lifestyle changes, fear of becoming infected, young age, female gender, history of mental illness and reduced ability to cope with stress appear to be risk factors for insomnia. As well as the implementation of epidemiological and preventive measures, sleep hygiene should be promoted as a comprehensive coping strategy against the COVID-19 pandemic.

Las complicaciones respiratorias por la COVID-19 pueden llevar a la muerte, por lo que, dentro de las políticas de protección para evitar los contagios masivos, se han sugerido estrategias de cuarentena y confinamiento en muchos países, que han originado alteraciones en la salud mental y el sueño. A través de la siguiente revisión narrativa se pretende sistematizar los hallazgos más significativos en cuanto a la presencia de insomnio en pacientes hospitalizados con COVID-19, y de personas sanas que han estado sometidas a confinamiento como medida preventiva. Las condiciones propias de la enfermedad han hecho que los pacientes desarrollen insomnio, lo que puede empeorar su estado de salud y alterar su sistema inmunológico. Para las personas sanas en cuarentena los cambios en el estilo de vida, el miedo a contraer la enfermedad, la edad joven, el sexo femenino, los antecedentes de enfermedades mentales y una menor capacidad de afrontamiento al estrés parecen ser factores de riesgo para el insomnio. Al igual que la implementación de medidas epidemiológicas de cuidado y prevención contra el COVID-19, se debe tener en consideración promover la higiene del sueño como una estrategia de afrontamiento integral contra esta pandemia.

Medical students' attitudes towards mental disorders and their correlation with academic performance / Actitud de los estudiantes de medicina hacia las enfermedades mentales y su relación con el rendimiento académico

Medical students do not seem to be as attracted to psychiatry as a medical specialty as they are to internal medicine or surgery. They are probably not interested in mental illnesses during their studies or other kinds of factors may be causing this. Objetive. Identify which mental disorders were most interesting to a group of medical students and how that preference correlates with academic performance. Methods. After three months of theoretical lessons and a four-hour practice, 93 medicine students at the Universidad de los Andes of Venezuela, expressed and justified their preference for a specific topic of psychiatry. These data were correlated to academic performance. Results. The most popular topic was alcoholism with a 34,4% of preference, followed by bipolar disorder with 26,9%. The main reasons for selection were having had some contact with the illness and fi nding the topic interesting. A total of 52,2% “failed” students preferred alcoholism versus 28,6% of “passed” students (p=0.039). Conclusions. Students with higher academic average were attracted to bipolar disorder because they found it interesting whereas the students with lower academicaverage preferred alcoholism because family members or acquaintances exhibited the symptoms or had drinking habits...

Los estudiantes de medicina no parecen sentirse atraídos hacia la psiquiatría como especialidad con el mismo interés como medicina interna o cirugía. Es probable que durante la carrera no sean motivados por las enfermedades mentales o existan otros factores involucrados en este hecho. Objetivo. Determinar cuáles son las enfermedades mentales de mayor interés para los estudiantes de medicina y su relación con el rendimiento académico. Métodos. Luego de haber recibido clases teóricas durante tres meses y una clase práctica de cuatro horas, 93 estudiantes de medicina de la Universidad de los Andes de Venezuela, manifestaron su preferencia por un tema de psiquiatría en particular y explicaron la razón por la cual ese tema les había llamado la atención. Estos datos fueron relacionados con su promedio académico. Resultados. El tema más escogido fue alcoholismo en un 34,4%, seguido de trastorno bipolar en un 26,9%. La razón principal fue porque habían tenido contacto con la enfermedad o porque el tema les había parecido interesante. Los alumnos reprobados escogieron alcoholismo en un 52,2% versus el 28,6% de los alumnos aprobados (p=0,039). Conclusiones. Los estudiantes con mejor rendimiento académico se vieron atraídos hacia el tema de trastorno bipolar porque les había parecido interesante. Los estudiantes con bajo rendimiento académico se vieron atraídos hacia el tema de alcoholismo porque algún familiar o persona conocida presentaba los síntomas de la enfermedad o hábitos alcohólicos...

Prevalencia de trastornos psicóticos en comparación con trastornos no psicóticos en una población de pacientes de Venezuela sometida a estrés / Prevalence of Psychotic Disorders Compared to Non-psychotic Disorders in a Venezuelan Community Subjected to Stress

Objetivo: Describir la prevalencia de trastornos psicóticos en comparación con trastornos no psicóticos según procedencia y sexo en pacientes que acuden a la consulta de psiquiatría en una población venezolana sometida a estrés de secuestros, sicarios y altos índices de criminalidad. Método: Estudio retrospectivo, descriptivo, de morbilidad entre julio y diciembre de 2008 de la consulta de psiquiatría de un hospital general de Venezuela. Resultados: En la consulta se atendieron 1.801 pacientes, de los cuales 56,7% fueron mujeres. El 58% los pacientes provenía de San Cristóbal; 40,4% de otra ciudad del estado del Táchira, y 1,6% de otro estado. El diagnóstico que predominó entre todos los pacientes fue trastorno de ansiedad (19,7%). Los trastornos psicóticos (esquizofrenia, trastorno afectivo bipolar y trastorno mental orgánico) fueron diagnosticados en un 34,6%. Los trastornos no psicóticos (ansiedad, depresión y trastorno obsesivo-convulsivo) fueron diagnosticados en un 30,2%. El diagnóstico de psicosis predominó en los pacientes procedentes de San Cristóbal, en comparación con los que procedían de otra región (p<0,0001). En el sexo femenino predominaron los diagnósticos de ansiedad y depresión y en el masculino el diagnóstico de psicosis (p<0,0001). Conclusión: Los trastornos psicóticos se diagnosticaron con mayor frecuencia en los pacientes que viven en San Cristóbal, lo que sugiere que la tensión emocional que reina en la ciudad puede ser un factor de riesgo desencadenante de las crisis psicóticas de los pacientes.

Objective: To describe the prevalence of psychotic disorders compared with non-psychotic disorders sorted by residence and sex in patients attending psychiatric consultation in a Venezuelan community under stress due to kidnappings, murder and high crime rates. Method: Retrospective and descriptive study of morbidity of psychiatric disorders between July and December 2008 in the psychiatric services at a general hospital in Venezuela. Results: 1.801 patients were seen at the psychiatric services, 56.7% were women. 58% came from San Cristobal, 40.4% from other cities and 1.6% from the state of Tachira. The diagnosis that prevailed among all patients was anxiety disorder (19.7%). Psychotic disorders (schizophrenia, bipolar disorder and organic mental disorder) were diagnosed in 34.6%. Non-psychotic disorders (anxiety, depression and obsessive compulsive disorder) were diagnosed in 30.2%. The diagnosis of psychosis predominated in patients from San Cristobal in comparison with those from other areas (p<0.0001). Anxiety and depression predominated in females and the diagnosis of psychosis in male patients (p<0.0001). Conclusion: Psychotic disorders were more frequently diagnosed in patients living in San Cristobal, which might suggest that emotional tension present and experienced in urban areas could be a risk factor triggering crisis in psychotic patients.

Trastornos y hábitos de sueño en niños y adolescentes con autismo / Sleep habits and disorders in children and adolescents

Existe una alta prevalencia de trastornos del sueño en personas con autismo. El propósito de este estudio fue describir las alteraciones del sueño y malos hábitos de sueño en una población de niños y adolescentes con autismo y determinar si existen diferencias según la edad. Estudio transversal, descriptivo. Se incluyeron 14 niños y 12 adolescentes con autismo procedentes del Centro de Atención Integrada para personas con Autismo en San Cristóbal, Venezuela. Fueron evaluados con un cuestionario para padres, que registra los hábitos de sueño en un periodo de 6 meses. Se establecieron comparaciones entre niños menores de 12 años y adolescentes. El trastorno de sueño informado con mayor frecuencia en niños fue dificultad para quedarse dormido (35,7%) y en adolescentes enuresis (30%). En cuanto a malos hábitos de sueño, predominó en niños, la necesidad de estar acompañado al momento de quedarse dormido (64,3%) al igual que en los adolescentes (33,3%). En Venezuela, un alto porcentaje de niños y adolescentes con autismo presentan alteraciones del sueño superiores a la población general; tales como dormir en cama de los padres o necesitar compañía al momento de quedarse dormidos; sin embargo, muchos padres no consideran que esto sea un problema serio que afecte a la familia o al niño.

There is a high prevalence of sleep disorders in people with autism. The objective of this study was to describe sleep disturbances and poor sleep habits in a population of children and adolescents with autism in Venezuela and to determine differences by age. Descriptive, crosssectional study. 14 children and 12 adolescents with autism were assessed with a questionnaire for parents, which recorded the sleep habits from 6 months earlier in the Center of integrated care for people with autism, in San Cristobal, Venezuela. Comparisons were established between children under 12 years old and adolescents. The sleep disorder reported more frequently in children was difficulty falling asleep (35.7%) and enuresis in adolescents (30%). In regard to bad sleep habits, the need to be accompanied at the time of falling asleep predominated in children (64.3%), as well as in adolescents (33.3%). In Venezuela, a high percentage of children and adolescents with autism have more sleep disorders than the general population, as the need to sleep in parent’s bed and the need of company when falling asleep. However, many parents do not considerthis as a serious problem affecting the family or the child.

Valeriana en el tratamiento a largo plazo del insomnio / Use of Valerian in the Long-Term Treatment of Insomnia

Introducción: La valeriana se ha utilizado desde la antigua Grecia y China para inducir el sueño, debido a sus propiedades ansiolíticas. Hoy en día, aun cuando no es un producto aprobado por la Agencia de Administración de Drogas y Alimentos de Estados Unidos (FDA) para el tratamiento del insomnio, se utiliza en diferentes países con esta finalidad. Objetivo: Llevar a cabo una revisión que permita determinar la eficacia de la valeriana en el tratamiento a largo plazo del insomnio y considerarla una alternativa terapéutica posible a las benzodiazepinas y los agonistas benzodiazepínicos. Resultados: Son pocos los estudios controlados realizados con valeriana; no obstante, los resultados disponibles sugieren que su empleo facilita la reestructuración de la arquitectura del sueño después de varias semanas de tratamiento y consigue así mejorar su calidad. También hay indicios que señalan que desempeña un papel importante en la disminución del estrés y la ansiedad en aquellos pacientes donde esta condición interfi ere con el inicio y mantenimiento del sueño, así como en el tratamiento coadyuvante en la discontinuación del uso prolongado de benzodiazepinas. Conclusiones: El principal punto a favor de la valeriana es su capacidad para disminuir la latencia del sueño de ondas lentas y aumentar su porcentaje, sin provocar efectos secundarios de importancia ni dependencia; sin embargo, aún no se dispone de suficientes estudios controlados a largo plazo que permitan establecer conclusiones definitivas.

Introduction: Valerian has been used for centuries to induce drowsiness due to its anxiolytic properties. It was fi rst described being used in ancient cultures, i.e., Greece and China. Nowadays, even though it is not officially approved by the US Food and Drug Administration Agency (FDA) as a treatment for insomnia, it is widely used in different latitudes for such a purpose. Objective: To carry out an extensive review in order to establish the levels of effectiveness of valerian in the long term treatment of patients suffering from sleeplessness and consider it an alternative to the use of benzodiazepines and benzodiazepinic agonists. Results: There are very few controlled studies on the effects of valerian. Nonetheless, the available data might indicate that the use of valerian helps to restructure sleep architecture after several weeks of treatment and helps to improve sleep quality. There are also papers suggesting that valerian plays a key role in diminishing stress and anxiety in cases where these conditions disturb normal sleep patterns and is useful in discontinuing long treatments based on benzodiazepines. Conclusions: The key advantage of valerian is its capability to reduce the slow wave sleep latency and increase its percentage without causing relevant secondary effects or dependence. Still, we do not have sufficient data from long term controlled studies in order to support conclusive results.

[Antidepressant drugs in the treatment of tension-type headache]. / Fármacos antidepresivos en el tratamiento de la cefalea tensional.

Tension-type headache is the most common form of headache. Eighty percent of cases occur before 40 years of age. A wide variety of antidepressants have been used to treat it. Tricyclics are the only antidepressants that have demonstrated their effectiveness in treating chronic tension-type headache, amitriptyline being the drug of choice. Selective serotonin reuptake inhibitors and other families of antidepressants have not shown conclusive results yet. The present study is a review of the scientific evidence available on antidepressants for treatment of this kind of headache.

Fármacos antidepresivos en el tratamiento de la cefalea tensional / Antidepressant drugs in the treatment of tension-type headache

La cefalea tensional es la cefalea más frecuente. En el 80% de los casos aparece antes de los 40 años de edad. En su prevención se ha utilizado una gran variedad de fármacos antidepresivos. Los tricíclicos son los únicos antidepresivos de los que se ha demostrado eficacia en el tratamiento de la cefalea tensional crónica, y de ellos la amitriptilina es el fármaco de elección. Los inhibidores selectivos de la recaptación de serotonina y otras familias de antidepresivos no han mostrado aún resultados concluyentes. El presente trabajo es una revisión de las evidencias científicas disponibles sobre amitriptilina y otros fármacos antidepresivos en el tratamiento de esta cefalea

Tension-type headache is the most common form of headache. Eighty percent of cases occur before 40 years of age. A wide variety of antidepressants have been used to treat it. Tricyclics are the only antidepressants that have demonstrated their effectiveness in treating chronic tension-type headache, amitriptyline being the drug of choice. Selective serotonin reuptake inhibitors and other families of antidepressants have not shown conclusive results yet. The present study is a review of the scientific evidence available on antidepressants for treatment of this kind of headache