A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot Randomized Controlled Clinical Trial.

BACKGROUND: Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia. METHODS: We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups. RESULTS: Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008). CONCLUSION: A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.

A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients.

ABSTRACT: The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention ( n = 24) or control group ( n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17-2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.

Esquizofrenia y disociación: el trauma infantil en la etiología de los síntomas / Schizophrenia and dissociation: childhood trauma in the etiology of symptoms

Introducción: En los últimos 10 años han surgido múltiples estudios que vinculan las experiencias traumáticas en la infancia con la esquizofrenia. Hay autores que postulan un subtipo de esquizofrenia de origen traumático cuyos síntomas estarían mediados por mecanismos disociativos. Observación: Presentamos el caso de una joven de 22 años con antecedentes de polivictimización durante la infancia. A los 14 años inició un cuadro clínico caracterizado por sintomatología ansiosa y depresiva y realizó un primer intento de suicidio. Posteriormente se instauraron conductas autolesivas acompañadas de síntomas disociativos, alucinaciones visuales y auditivas e ideación delirante. Actualmente, y a lo largo de los 8 años de evolución, los síntomas positivos se han mantenido a pesar de múltiples tratamientos antipsicóticos. La paciente cumple los criterios DSM IV para esquizofrenia y trastorno límite de la personalidad. Las pruebas psicométricas aplicadas indican elevada disociación; las capacidades cognitivas están preservadas, con ausencia de trastornos formales del pensamiento y de síntomas negativos, y presenta un aceptable ajuste social. Discusión: El trauma infantil se asocia a los síntomas psicóticos, al trastorno límite de personalidad y a los síntomas disociativos. Diversos estudios muestran la imposibilidad de distinguir las alucinaciones de origen psicótico de las disociativas o de las del trastorno por estrés postraumático Es necesario contemplar la posibilidad de que los síntomas que presentan los pacientes esquizofrénicos con antecedentes de trauma infantil tengan un componente disociativo. Enfatizamos el indagar sistemáticamente sobre los antecedentes de abusos en la infancia y la presencia de síntomas disociativos en los pacientes con esquizofrenia (AU)

We report the case of a 22-year-old woman with history of childhood trauma. At 14 years old, she began with a clinical syndrome, characterized by anxiety and depression and made the first suicide attempt. She continued with repeated self-harm behavior and suicide attempts, showing dissociative symptoms, visual and auditory hallucinations, and prejudiced elusions. The current examinations indicate high dissociation, preserved cognitive abilities, absence of formal thought disorder and negative symptoms, and acceptable social adjustment. Discussion: The childhood trauma has been associated with psychotic symptoms, with the borderline personality disorder and with the dissociative symptoms. Diverse studies showed the inability to distinguish the psychotic hallucinations from the dissociative hallucinations or from the post-traumatic flashbacks. Some of the symptoms of schizophrenic patients with a history of childhood abuse are likely to have a dissociative component. The childhood trauma history and the presence of dissociative symptoms should be explored in all patients with schizophrenia (AU)