Serial direct sodium removal in patients with heart failure and diuretic resistance.

AIMS: Loop diuretics may exacerbate cardiorenal syndrome (CRS) in heart failure (HF). Direct sodium removal (DSR) using the peritoneal membrane, in conjunction with complete diuretic withdrawal, may improve CRS and diuretic resistance. METHODS AND RESULTS: Patients with HF requiring high-dose loop diuretics were enrolled in two prospective, single-arm studies: RED DESERT (n = 8 euvolaemic patients), and SAHARA (n = 10 hypervolaemic patients). Loop diuretics were withdrawn, and serial DSR was utilized to achieve and maintain euvolaemia. At baseline, participants required a median 240 mg (interquartile range [IQR] 200-400) oral furosemide equivalents/day, which was withdrawn in all participants during DSR (median time of DSR 4 weeks [IQR 4-6]). Diuretic response (queried by formal 40 mg intravenous furosemide challenge and 6 h urine sodium quantification) increased substantially from baseline (81 ± 37 mmol) to end of DSR (223 ± 71 mmol, p < 0.001). Median time to re-initiate diuretics was 87 days, and the median re-initiation dose was 8% (IQR 6-10%) of baseline. At 1 year, diuretic dose remained substantially below baseline (30 [IQR 7.5-40] mg furosemide equivalents/day). Multiple dimensions of kidney function such as filtration, uraemic toxin excretion, kidney injury, and electrolyte handling improved (p < 0.05 for all). HF-related biomarkers including N-terminal pro-B-type natriuretic peptide, carbohydrate antigen-125, soluble ST2, interleukin-6, and growth differentiation factor-15 (p < 0.003 for all) also improved. CONCLUSIONS: In patients with HF and diuretic resistance, serial DSR therapy with loop diuretic withdrawal was feasible and associated with substantial and persistent improvement in diuretic resistance and several cardiorenal parameters. If replicated in randomized controlled studies, DSR may represent a novel therapy for diuretic resistance and CRS. CLINICAL TRIAL REGISTRATION: RED DESERT (NCT04116034), SAHARA (NCT04882358).

The importance of forward flow and venous congestion in diuretic response in acute heart failure: Insights from the ESCAPE trial.

AIMS: Previous studies have suggested venous congestion as a stronger mediator of negative cardio-renal interactions than low cardiac output, with neither factor having a dominant role. While the influence of these parameters on glomerular filtration have been described, the impact on diuretic responsiveness is unclear. The goal of this analysis was to understand the hemodynamic correlates of diuretic response in hospitalized patients with heart failure. METHODS AND RESULTS: We analyzed patients from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) dataset. Diuretic efficiency (DE) was defined as the average daily net fluid output per doubling of the peak loop diuretic dose. We evaluated a pulmonary artery catheter hemodynamic-guided cohort (n = 190) and a transthoracic echocardiogram (TTE) cohort (n = 324) where DE was evaluated with hemodynamic and TTE parameters. Metrics of "forward flow" such as cardiac index, mean arterial pressure and left ventricular ejection fraction were not associated with DE (p > 0.2 for all). Worse baseline venous congestion was paradoxically associated with better DE as assessed by right atrial pressure (RAP), right atrial area (RAA), and right ventricular systolic and diastolic area (p < 0.05 for all). Renal perfusion pressure (capturing both congestion and forward flow) was not associated with diuretic response (p = 0.84). CONCLUSIONS: Worse venous congestion was weakly associated with better loop diuretic response. Metrics of "forward flow" did not demonstrate any correlation with diuretic response. These observations raise questions about the concept of central hemodynamic perturbations as the primary drivers of diuretic resistance on a population level in HF.

Understanding the relationship between apathy, cognition and functional outcome in schizophrenia: The significance of an ecological assessment.

In recent years there has been an increasing interest in understanding the role apathy plays in mediating the relationship between cognitive impairment and functional outcome. In general, most studies measure cognition with traditional cognitive tests that give explicit instructions and guide the participants toward generating a response. However, given that apathy is defined by a decrease in self-initiated behavior, it is crucial to evaluate cognition with ecological tasks that do not explicitly direct the patient´s motivation to generate behaviors to assess the actual effect. This study investigated whether an ecological cognitive assessment (the Jansari Executive Function Assessment, JEF©) would uniquely contribute to the relationship between cognition, apathy, and functional outcome in schizophrenia. The Apathy Evaluation Scale (AES), neuropsychological tests and the JEF© were administered to 20 patients with schizophrenia. Hierarchical multiple regression and mediation analysis were performed to test the associations between the variables of interest. Results showed that JEF© explained a significant portion of the variance in AES (25%). In addition, apathy explained 36% of the variance in functional outcome. However, AES did not mediate between cognition and functional outcome. Our results highlight the importance of assessing cognition with tasks that require integration of cognitive functions needed for real life demands.

Neurocognition in Bipolar and Depressive Schizoaffective Disorder: A Comparison with Schizophrenia.

INTRODUCTION: Schizoaffective disorder (SA) is classified into bipolar (bSA) and depressive (dSA) subtypes. Although clinical differences between both have been reported, there is no clear information regarding their specific cognitive profile. OBJECTIVE: To compare neurocognition between SA subtypes and schizophrenia (SC). METHODS: A total of 61 patients were assessed and divided into 3 groups: 35 SC, 16 bSA, and 10 dSA. All participants signed an informed consent letter. The MATRICS Consensus Cognitive Battery, Central and South American version was used to assess neurocognition. The study was performed at the Instituto Nacional de Psiquiatría "Ramón de la Fuente". Participants were identified by specialized psychiatrists. Trained neuropsychologists carried out the clinical and cognitive assessment, which lasted 2 h approximately. RESULTS: The cognitive assessment showed a significant difference in Trail Making Test part A subtest (F[2,58] = 4.043; p = 0.023]. Post hoc analyses indicated that dSA obtained a significantly higher score than SC (MD = -11.523; p = 0.018). The f test showed a large effect size (f = 0.401). No statistical differences were observed regarding other cognitive variables. CONCLUSIONS: The cognitive profile of SA subtypes and SC is similar since no differences were found in most subtests. However, dSA may be less impaired than SC in measures of processing speed. Further research with larger samples must be conducted.

Processing speed differences between schizophrenia and schizoaffective disorder: A pilot study.

We aimed to compare processing speed (PS) and its subcomponents in schizophrenia (SC) and schizoaffective disorder (SA). Thirty-five patients were divided into two groups (SC=18; SA=17). PS tasks from the MATRICS Consensus Cognitive Battery Central/South America version were used. Additional PS subcomponents were analyzed (i.e., behavioral execution, response processing, and accuracy). SA obtained significant higher scores than SC in response processing, verbal fluency and the PS general domain. Our results indicate that PS is a potential cognitive marker to differentiate between SC and SA. Further research with larger samples must be conducted.

Regulación Emocional En Pacientes Con Esquizofrenia: Un Estudio Piloto / Emotion Regulation In Schizophrenia Patients: A Pilot Study

RESUMEN Antecedentes: Se ha reportado que los pacientes con esquizofrenia presentan alteraciones en el procesamiento emocional, específicamente en la percepción de emociones. Sin embargo, poco se sabe sobre otros aspectos de este proceso, como la regulación emocional. Objetivo: Evaluar y comparar la regulación emocional y neurocognición en pacientes con esquizofrenia y sujetos control, así como identificar correlaciones entre regulación emocional, neurocognición y datos demográficos. Método: Se evaluaron nueve pacientes (GE) y nueve controles (GC). Se obtuvieron datos demográficos, para evaluar regulación emocional se utilizó la Prueba de Inteligencia Emocional Mayer-Salovey Caruso, sección Manejo de Emociones y se realizó una breve evaluación neurocognitiva. Resultados: El GE tuvo un desempeño significativamente inferior que el GC en la prueba de regulación emocional y en neurocognición (p<.05). No se encontraron correlaciones entre regulación emocional, neurocognición, datos demográficos y clínicos. Discusión y conclusión: Los pacientes con esquizofrenia presentan menor capacidad de regulación emocional y alteraciones en la neurocognición. Estos resultados son consistentes con lo descrito en la literatura.

ABSTRACT Background: It has been reported that schizophrenia patients display emotional processing impairments, specifically in the emotion perception domain. However, less is known about other domains of emotional processing, like emotion regulation. Objective: The aim of this study was to assess and compare emotion regulation abilities and neurocognition in schizophrenia patients and healthy controls, as well as to identify correlations between emotion regulation, neurocognition and demographic data. Methods: 9 patients (GE) and 9 controls (GC) were recruited. Demographic data was obtained. To assess emotion regulation, the Mayer-Salovey-Caruso Emotional Intelligence Test -Managing Emotions section- was administered. Finally, a brief neurocognitive assessment was conducted. Results: The GE showed significant poorer performance than the GC in the emotion regulation test as well as in the neurocognitive assessment (p < .05). No correlations were identified between emotion regulation, neurocognition, demographic and clinical data. Discussion and conclusion: Schizophrenia patients show emotion regulation impairment, as well as neurocognitive deficits. Our results are consistent with other studies.

Social Cognition in Schizophrenia, Unaffected Relatives and Ultra- High Risk for Psychosis: What Do We Currently Know?

INTRODUCTION: Schizophrenia patients show impairments in social cognition (SC), which is a set of cognitive processes that underlie social interactions. The research about SC in schizophrenia has identified four main domains: Theory of mind (ToM), social perception, attributional style and emotional processing. The present review aims to summarize the most recent and consistent findings about SC in patients with schizophrenia, unaffected relatives and ultra-high risk for psychosis individuals (UHR), as well as its association with clinical variables and functional outcome. METHODS: A systematic PsycINFO and Pubmed/Medline databases search was conducted. RESULTS: ToM impairments have been observed in schizophrenia patients, unaffected relatives and UHR. Emotional processing disturbance has been consistently reported in schizophrenia patients and UHR. ToM and emotional processing have been correlated with symptomatology and functional outcome. However, inconsistencies have been found across studies that assess ToM and emotional processing as predictors of psychosis. Social perception and attributional style are affected in schizophrenia, but the research in at- risk populations is scarce, and their relationship with symptoms or functional outcome is not clear. CONCLUSIONS: All domains of SC are impaired in schizophrenia. Non affected relatives and UHR also display deficits of SC. More research must be conducted to assess the reliability of SC domains as endophenotypes or predictors of conversion to psychosis in at-risk populations.

Cognición Social en Esquizofrenia, Familiares No Afectados e Individuos en Riesgo Ultra-Alto de Psicosis: ¿Qué Sabemos Actualmente? / Social Cognition in Schizophrenia, Unaffected Relatives and Ultra-High Risk for Psychosis: What Do We Currently Know?

Introducción. Los pacientes con esquizofrenia presentan alteraciones en cognición social (CS), que es un conjunto de procesos cognitivos que subyace a las interacciones sociales. En la investigación sobre CS en esquizofrenia se identifican cuatro componentes principales: teoría de la mente (TM), percepción social, estilo atributivo y procesamiento emocional. Este trabajo tiene como objetivo resumir los hallazgos más recientes y consistentes sobre la CS en pacientes con esquizofrenia, familiares no afectados e individuos en riesgo ultra-alto de psicosis (RUA), así como su asociación con variables clínicas y funcionalidad del paciente. Método.Se realizó una búsqueda sistematizada en las bases de datos PsycINFO y Pubmed/Medline. Resultados. Los déficits en TM se han observado en pacientes con esquizofrenia, familiares no afectados y sujeto en RUA. Se han reportado consistentemente alteraciones de procesamiento emocional en pacientes con esquizofrenia y RUA. La TM y el procesamiento emocional se correlacionan con sintomatología y funcionalidad. Sin embargo, existen inconsistencias en estudios sobre TM y procesamiento emocional como predictores de psicosis. La percepción social y el estilo atributivo están afectados en la esquizofrenia, pero la investigación en poblaciones en riesgo es escasa y su relación con la sintomatología y funcionalidad no es del todo clara. Conclusiones.Todos los componentes de la CS están alterados en la esquizofrenia. Los familiares no afectados y las personas en RUA también presentan déficits de CS. Se debe realizar más investigación sobre la confiabilidad de los componentes de la CS como endofenotipos o predictores de conversión a psicosis en poblaciones en riesgo (AU)

Introduction. Schizophrenia patients show impairments in social cognition (SC), which is a set of cognitive processes that underlie social interactions. The research about SC in schizophrenia has identified four main domains: Theory of mind (ToM), social perception, attributional style and emotional processing. The present review aims to summarize the most recent and consistent findings about SC in patients with schizophrenia, unaffected relatives and ultra-high risk for psychosis individuals (UHR), as well as its association with clinical variables and functional outcome. Methods. A systematic PsycINFO and Pubmed/Medline databases search was conducted. Results. ToM impairments have been observed in schizophrenia patients, unaffected relatives and UHR. Emotional processing disturbance has been consistently reported in schizophrenia patients and UHR. ToM and emotional processing have been correlated with symptomatology and functional outcome. However, inconsistencies have been found across studies that assess ToM and emotional process-ing as predictors of psychosis. Social perception and attributional style are affected in schizophrenia, but the research in at- risk populations is scarce, and their relationship with symptoms or functional outcome is not clear. Conclusions: All domains of SC are impaired in schizophrenia. Non affected relatives and UHR also display deficits of SC. More research must be conducted to assess the reliability of SC domains as endophenotypes or predictors of conversion to psychosis in at-risk populations (AU)