Improved estimation of the risk of manic relapse by combining clinical and brain scan data.

INTRODUCTION: Estimating the risk of manic relapse could help the psychiatrist individually adjust the treatment to the risk. Some authors have attempted to estimate this risk from baseline clinical data. Still, no studies have assessed whether the estimation could improve by adding structural magnetic resonance imaging (MRI) data. We aimed to evaluate it. MATERIAL AND METHODS: We followed a cohort of 78 patients with a manic episode without mixed symptoms (bipolar type I or schizoaffective disorder) at 2-4-6-9-12-15-18 months and up to 10 years. Within a cross-validation scheme, we created and evaluated a Cox lasso model to estimate the risk of manic relapse using both clinical and MRI data. RESULTS: The model successfully estimated the risk of manic relapse (Cox regression of the time to relapse as a function of the estimated risk: hazard ratio (HR)=2.35, p=0.027; area under the curve (AUC)=0.65, expected calibration error (ECE)<0.2). The most relevant variables included in the model were the diagnosis of schizoaffective disorder, poor impulse control, unusual thought content, and cerebellum volume decrease. The estimations were poorer when we used clinical or MRI data separately. CONCLUSION: Combining clinical and MRI data may improve the risk of manic relapse estimation after a manic episode. We provide a website that estimates the risk according to the model to facilitate replication by independent groups before translation to clinical settings.

Do the negative symptoms of schizophrenia reflect reduced responsiveness to reward? Examination using a reward prediction error (RPE) task.

BACKGROUND: A leading theory of the negative symptoms of schizophrenia is that they reflect reduced responsiveness to rewarding stimuli. This proposal has been linked to abnormal (reduced) dopamine function in the disorder, because phasic release of dopamine is known to code for reward prediction error (RPE). Nevertheless, few functional imaging studies have examined if patients with negative symptoms show reduced RPE-associated activations. METHODS: Matched groups of DSM-5 schizophrenia patients with high negative symptom scores (HNS, N = 27) or absent negative symptoms (ANS, N = 27) and healthy controls (HC, N = 30) underwent fMRI scanning while they performed a probabilistic monetary reward task designed to generate a measure of RPE. RESULTS: In the HC, whole-brain analysis revealed that RPE was positively associated with activation in the ventral striatum, the putamen, and areas of the lateral prefrontal cortex and orbitofrontal cortex, among other regions. Group comparison revealed no activation differences between the healthy controls and the ANS patients. However, compared to the ANS patients, the HNS patients showed regions of significantly reduced activation in the left ventrolateral and dorsolateral prefrontal cortex, and in the right lingual and fusiform gyrus. HNS and ANS patients showed no activation differences in ventral striatal or midbrain regions-of-interest (ROIs), but the HNS patients showed reduced activation in a left orbitofrontal cortex ROI. CONCLUSIONS: The findings do not suggest that a generalized reduction of RPE signalling underlies negative symptoms. Instead, they point to a more circumscribed dysfunction in the lateral frontal and possibly the orbitofrontal cortex.

Repercusión del coonfinamento durante el estado de alarma por SARS - COV -2 en urgencias de un hospital psiquiátrico / Repercussion of the coonfinamento during the state of alarm by SARS - VOC-2 in the emergency room of a psychiatric hospital

Como describen Yao & Chen (2020), las personas con trastorno mental son más susceptibles a factores estresantes externos. Sobre esta premisa, nos planteamos como hipótesis que el estado de alarma había repercutido en el número y características de las visitas psiquiátricas en el Servicio de Urgencias. El objetivo general del estudio fue describir los motivos de consulta relacionados con COVID-19 en urgencias del Hospital Sagrat Cor de Martorell durante el primer estado de alarma (del 14/03/2020 al 21/06/2020). Para ello, se realizó un estudio observacional, descriptivo y transversal a partir de los datos de los informes de visitas a urgencias durante el primer confinamiento decretado en España. Seleccionamos como muestra 121 visitas relacionadas con COVID-19. El mayor porcentaje de las visitas fue durante la segunda mitad del estado de alarma, a pesar de que durante este periodo se realizaron menos ingresos en valores porcentuales. Como principal conclusión, destacaríamos la mayor proporción de ingresos psiquiátricos durante el primer periodo del estado de alarma, a pesar de que a medida que transcurre el tiempo de confinamiento se incrementa el número de visitas en urgencias (AU)

As Yao & Chen (2020) describe, people with mental disorders are more susceptible to external stressors. Based on this premise, we hypothesized that the state of emergency had an impact on the number and characteristics of psychiatric visits in the Emergency Department. The general objective of the study was to describe the reasons for consultation related to COVID-19 in the emergency room of the Hospital Sagrat Cor de Martorell during the first state of alarm (from 03/14/2020 to 06/21/2020). An observational, descriptive and cross-sectional study was carried out based on the data from the reports of visits to the emergency room during the first confinement decreed in Spain. Qualitative data on the content of the visit, diagnosis and need for admission were collected. We selected as a sample 121 visits related to COVID-19. The highest percentage of visits was during the second half of the state of alarm, despite the fact that fewer admissions were made in percentage terms during this period. As the main conclusion, we would highlight the higher proportion of psychiatric admissions during the first period of the state of alarm, despite the fact that as the time of confinement elapses, the number of visits to the emergency room increases. (AU)