Evaluation of the neuroprotective effect of antipsychotics by serum quantification of protein S100B.

OBJECTIVE: This research delves into the intricate interplay between antipsychotic medications and neuroprotection focusing on the S100B protein-a central player in the regulation of neuroapoptotic activity. METHOD: Blood samples were collected to assess serum S100B protein levels using an immunoassay of immunoelectrochemiluminescence. The first two samples were collected with a 3-month interval between each, and the third sample was obtained 6 months after the previous one. Changes in S100B protein levels throughout the study were assessed using Friedman's ANOVA test. This was followed by the Wilcoxon signed-rank test with Bonferroni correction to account for multiple comparisons. RESULTS: This study involved 40 patients diagnosed with severe mental disorders (34 schizophrenia, 4 schizoaffective disorder, 1 bipolar disorder, and 1 borderline personality disorder). These patients had been receiving antipsychotic treatment for an average duration of 17 years. The results revealed that the S100B protein remained within physiological levels (median values 39.0 ng/L for the first sample, median values 41.0 ng/L for the second sample, and median values 40.5 ng/L for the third sample) with no significant changes (p = 0.287), with all anti-psychotic medicaments values consistently below 50 ng/L, a lower value compared to maximum range of 105 ng/L. Importantly, there were no significant differences in S100B protein levels between patients on monotherapy and those on combination antipsychotic therapy (p = 0.873), suggesting that combination therapy did not increase neuroapoptotic activity. CONCLUSIONS: These findings provide compelling evidence for the potential neuroprotective effects of long-term antipsychotic treatment in individuals with severe mental disorders. By maintaining physiological levels of the S100B protein, antipsychotic medications may help protect against neuronal damage and dysfunction. This research contributes valuable insights into the neuroprotective mechanisms of antipsychotic drugs, enhancing our understanding of their potential benefits in the treatment of severe mental disorders.

Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis / Asociación entre el gen BDNF (rs6265) y predisposición a la esquizofrenia: estudio prospectivo y metaanálisis actualizado

Introduction: Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case–control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia. Method: This meta-analysis gathered data from 25 case–control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the “Leave one out” method, and we used the Egger test and Begg's funnel plot to identify publication bias. Results: Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value > .05. Conclusions: Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case–control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.(AU)

Introducción: Se sabe que los polimorfismos del gen BDNF provocan alteraciones neuronales y parecen ser un factor causal en muchos trastornos neuropsiquiátricos. Es por ello que se han llevado a cabo varios metaanálisis y estudios de casos y controles con el objetivo de evaluar la posible relación entre BDNF y la esquizofrenia. Método: Realizamos un metaanálisis de 25 estudios de casos y controles, que incluyó un total de 8.384 pacientes con esquizofrenia y 8.821 controles. Se analizó la relación entre el polimorfismo de nucleótido simple rs6265 y la esquizofrenia mediante odds ratios combinados y sus intervalos de confianza del 95% con 5 modelos genéticos diferentes. Utilizamos el método de validación cruzada dejando uno fuera («leave one out»), la prueba de Egger y el gráfico en embudo de Begg para identificar posibles sesgos de publicación. Resultados: Los estudios sobre el polimorfismo rs6265 (G/A) muestran una asociación no significativa con la esquizofrenia en los 5 modelos genéticos. En el análisis por subgrupos, no se encontró relación con las poblaciones caucásica y asiática (p > 0,05). Conclusiones: La presencia de polimorfismos rs6265 no aumenta la predisposición a desarrollar esquizofrenia. Sin embargo, se deben realizar más estudios de casos y controles sobre polimorfismos de BDNF, con muestras más numerosas y con individuos de diferentes grupos étnicos, para comprender mejor los mecanismos patogénicos de la enfermedad.(AU)

Genetic predisposition of BDNF (rs6265) gene is susceptible to Schizophrenia: A prospective study and updated meta-analysis.

INTRODUCTION: Genetic polymorphism in the BDNF gene has been found to cause neuronal alterations and has been identified as a causal factor for many neuropsychiatric disorders. Therefore, various neurological case-control studies and meta-analyses have been conducted to find the possible link between BDNF and susceptibility to schizophrenia. METHOD: This meta-analysis gathered data from 25 case-control studies including a total of 8384 patients with schizophrenia and 8821 controls in order to identify the relationship between the rs6265 single nucleotide polymorphism and the disease, evaluating the combined odds ratio and 95% confidence intervals under 5 different genetic models. Validation followed the "Leave one out" method, and we used the Egger test and Begg's funnel plot to identify publication bias. RESULTS: Research into the rs6265 (G/A) polymorphism revealed a non-significant association with schizophrenia in all 5 genetic models; in the subgroup analysis, no association was found between white and Asian populations, with a p value>.05. CONCLUSIONS: Overall, the updated meta-analysis revealed that rs6265 exonic polymorphisms do not increase susceptibility to this disease. However, to better understand the pathogenesis of the disease, there is a need for further case-control studies into the BDNF polymorphism including larger sample sizes and different ethnic groups.

Subcortical Volume Changes in Schizophrenia and Bipolar Disorder: A Quantitative MRI Study

SUMMARY: Volume abnormalities in subcortical structures, including the hippocampus, amygdala, thalamus, caudate, putamen, and globus pallidus have been observed in schizophrenia (SZ) and bipolar disorder (BD), not all individuals with these disorders exhibit such changes. In addition, the specific patterns and severity of volume changes may vary between individuals and at different stages of the disease. The study aims to compare the volumes of these subcortical structures between healthy subjects and individuals diagnosed with SZ or BD. Volumetric measurements of lateral ventricle, globus palllidus, caudate, putamen, hippocampus, and amygdale were made by MRI in 52 healthy subjects (HS), 33 patients with SZ, and 46 patients with BD. Automatic segmentation methods were used to analyze the MR images with VolBrain and MRICloud. Hippocampus, amygdala and lateral ventricle increased in schizophrenia and bipolar disorder patients in comparison with control subjects using MRIcloud. Globus pallidus and caudate volume increased in patients with schizophrenia and bipolar disorder compared control subjects using Volbrain. We suggested that our results will contribute in schizophrenia and bipolar disorder patients that assessment of the sub-cortical progression, pathology, and anomalies of subcortical brain compositions. In patients with psychiatric disorders, VolBrain and MRICloud can detect subtle structural differences in the brain.

Se han observado anomalías de volumen en las estructuras subcorticales, incluidos el hipocampo, la amígdala, el tálamo, el núcleo caudado, el putamen y el globo pálido, en la esquizofrenia (SZ) y el trastorno bipolar (BD); no todos los individuos con estos trastornos presentan tales cambios. Además, los patrones específicos y la gravedad de los cambios de volumen pueden variar entre individuos y en diferentes etapas de la enfermedad. El estudio tuvo como objetivo comparar los volúmenes de estas estructuras subcorticales entre sujetos sanos e individuos diagnosticados con SZ o BD. Se realizaron mediciones volumétricas del ventrículo lateral, globo pálido, núcleo caudado, putamen, hipocampo y amígdala mediante resonancia magnética en 52 sujetos sanos (HS), 33 pacientes con SZ y 46 pacientes con BD. Se utilizaron métodos de segmentación automática para analizar las imágenes de resonancia magnética con VolBrain y MRICloud. El hipocampo, la amígdala y el ventrículo lateral aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con sujetos de control que utilizaron MRIcloud. El globo pálido y el núcleo caudado aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con los sujetos control que utilizaron Volbrain. Sugerimos que en pacientes con esquizofrenia y trastorno bipolar, nuestros resultados contribuirán a la evaluación de la progresión subcortical, la patología y las anomalías de las composiciones cerebrales subcorticales. En pacientes con trastornos psiquiátricos, VolBrain y MRICloud pueden detectar diferencias estructurales sutiles en el cerebro.

Trayectoria del trastorno formal del pensamiento, desde la observación clínica al análisis computacional / Trajectory of formal thought disorder, from clinical observation to computational analysis

La adecuada comprensión de un término psicopatológico requiere, no solo del conocimiento de la alteración descrita, sino también de los contextos y conceptos a partir de los cuales fue acuñado y de la transformación de los mismos a lo largo del tiempo. En el caso del trastorno formal del pensamiento se describe su evolución desde su incorporación a la psicopatología con fines puramente descriptivos y asociado a la influencia del asociacionismo y a la idea de una dependencia directa entre pensamiento y lenguaje hasta la actualidad, en que el uso de herramientas computacionales y de hipótesis provenientes de la lingüística han promovido su uso como instrumento diagnóstico y marcador pronóstico, al tiempo que ha significado la incorporación de nueva terminología. (AU)

Properly understanding a psychopathological term requires knowledge of the disorder described, the contexts and concepts from which it was coined, and its modification over time. In the case of formal thought disorder, we describe its evolution from its incorporation into psychopathology for purely descriptive purposes and associated with the influence of associationism and the idea of a direct dependence between thought and language to the present day, in which the use of computational tools and hypotheses from linguistics have promoted its use as a diagnostic tool and prognostic marker, while simultaneously leading to the incorporation of new terminology. (AU)

Fármacos antipsicóticos de segunda generación y su impacto en el tejido adiposo / Second-generation antipsychotic drugs and their impact on adipose tissue

La esquizofrenia es un trastorno neuropsiquiátrico crónico que afecta a 21 millones de personas en todo el mundo. Actualmente, los fármacos antipsicóticos de segunda generación o atípicos (FASG) son los medicamentos de elección para el tratamiento de esta enfermedad. Sin embargo, a pesar de su alta eficacia en contrarrestar la sintomatología neuropsiquiátrica de la esquizofrenia, observaciones clínicas recientes en pacientes tratados con FASG evidencian un aumento en la prevalencia de diferentes alteraciones metabólicas, entre las que se incluyen el aumento de peso corporal, la hiperglucemia y la dislipidemia. A pesar de que no se conocen en detalle los mecanismos moleculares responsables de estos efectos secundarios, cada vez más investigaciones apuntan a una relación entre los tratamientos con FASG y las alteraciones en los diferentes depósitos de tejido adiposo blanco, marrón y beige. En esta revisión analizamos el conocimiento actual en esta área destacando aspectos moleculares de la biología de los adipocitos, entre los que se encuentran los procesos de diferenciación, metabolismo lipídico, función termogénica y el proceso de pardeamiento o beiging.(AU)

Schizophrenia is a chronic neuropsychiatric disorder that affects 21 million people worldwide. Currently, second-generation or atypical antipsychotics (SGAs) are the first-line medications for the treatment of this disease. However, despite its high efficacy in counteracting the neuropsychiatric symptoms of schizophrenia, recent clinical investigations in patients treated with SGAs show an increase in the prevalence of pivotal metabolic alterations, including increased body weight, hyperglycemia and dyslipidemia. Although the molecular mechanisms responsible for these side effects are not fully understood, cumulative evidences associate SGA administration with alterations in the different adipose tissue depots of white, brown and beige adipocytes. In this review, we have recapitulated the current knowledge in this area with a particular focus on the molecular aspects of the adipocyte biology, including differentiation, lipid metabolism, thermogenic function and browning processes.(AU)

Seroprevalencia de Toxoplasma gondii y su relación con trastornos mentales en adultos / Seroprevalence of Toxoplasma gondii and its Relationship with Mental Disorders in the Adult Population

El Toxoplasma gondii es un parásito que se encuentra, aproximadamente, en el 30 % de la población humana. Durante los últimos años se ha evidenciado que la infección latente puede ser un factor de riesgo para el desarrollo de trastornos mentales; particularmente para la esquizofrenia, ansiedad, trastornos bipolares y trastornos de conducta. La asociación con los trastornos neuropsiquiátricos pueden explicarse por la influencia que tiene el parásito sobre la expresión de múltiples neurotransmisores; entre ellos la dopamina. Se realizó una búsqueda en las bases de datos PubMed y SciELO de 2015 a 2023, se seleccionaron artículos originales y de revisión de revistas científicas internacionales, en idiomas inglés y español con el objetivo de describir la relación entre la seroprevalencia de T. gondii y el desarrollo de trastornos mentales en población adulta. Existe relación entre los trastornos mentales en la población adulta con la infección por Toxoplasma gondii y este aumenta la posibilidad de desarrollar esquizofrenia y depresión en individuos sin historial previo, y que podría exacerbar cuadros psiquiátricos previos con dificultad en el tratamiento. Sin embargo, no todos los datos estadísticos establecen una relación directa, algunos estudios demuestran una asociación, ciertos datos son discordantes, lo que abre una puerta para futuras investigaciones.

Toxoplasma gondii is a parasite that is found in approximately 30 % of the human population. In recent years, it has been shown that latent infection can be a risk factor for the development of mental disorders; particularly schizophrenia, anxiety, bipolar disorders, and conduct disorders. The association with neuropsychiatric disorders can be explained by the influence of the parasite on the expression of multiple neurotransmitters; among them, dopamine has received the most attention. A narrative bibliographic review article was done with the search of original and review articles in international scientific journals, in English and Spanish listing the relationship between the seroprevalence of T. gondii and the development of mental disorders in the adult population. The relationship between mental disorders in the adult population with Toxoplasma gondii infection is present and increases the possibility of developing schizophrenia and depression in individuals with no previous history, including the ability to worsen previous psychiatric conditions, making it difficult for standard management. Not all statistical data establish a direct relationship, some studies show an association and certain data are discordant, which opens a door for future research.

Neurolinguistics evidence of oral discourse in schizophrenic patients. Comparative analysis with Wernicke's aphasia

Introduction: In schizophrenia, the presence of a digressive oral discourse is very frequent, plenty of paraphasias and neologisms, provoked by the alterations of thought, which is common in thisillness. This form of empty oral discourse, full of paraphasias and neologisms, is one of the characteristic clinical manifestations of Wernicke's aphasia; with the difference that, in thesepatients, the symptomatology is linguistic, not secondary to alterations of thought. What cognitive mechanisms lead to similar verbal behaviors in both groups of patients? Objective: The purpose of this research was to obtain empirical evidence about cognitive mechanisms that underlie the alterations of verbal communication in both types of patients, from the comparative analysis of their execution in neurocognitive and neurolinguistic tests. Method: The study was implemented in a population of 70 patients organized into two groups: 35 aphasics and 35 schizophrenics. Both groups were subjected to the tests of Semantic Matching of Images, Identification of Homonymous Images and Oral Denomination of Images and Comics. Data processing involved descriptive statistics and Student's t-test for comparative analysis between groups. Results: Indicate that there are no significant differences between groups in semantic processing. In the formation of lexical concepts, schizophrenics show worse performance; while aphasics perform worse on neurolinguistic examination tests. Conclusions: Empirical evidence shows that the oral discourse of both groups of patients is markedly digressive and empty, with paraphasias and neologisms, but linguistically different.

Introducción: En la esquizofrenia es muy frecuente la presencia de un discurso oral digresivo, lleno de parafasias y neologismos, provocado por las alteraciones del pensamiento común en esta enfermedad.Esta forma de discurso oral vacío, lleno de parafasias y neologismos, es una de las manifestaciones clínicas características de la afasia de Wernicke,con la diferencia de que en estos pacientes la sintomatología es lingüística, no secundaria a alteraciones del pensamiento.¿Qué mecanismos cognitivos conducen a conductas verbales similares en ambos grupos de pacientes? Objetivo: Obtener evidencia empírica sobre los mecanismos cognitivos que subyacen a las alteraciones de la comunicación verbal en ambos tipos de pacientes, a partir del análisis comparativo de su ejecución en pruebas neurocognitivas y neurolingüísticas. Método: El estudio se implementó en una población de 70 pacientes organizados en dos grupos: 35 afásicos y 35 esquizofrénicos.Ambos grupos fueron sometidos a las pruebas de Coincidencia Semántica de Imágenes, Identificación de Imágenes Homónimas y Denominación Oral de Imágenes y Cómics.El procesamiento de datos involucró estadística descriptiva y prueba t de Student para análisis comparativo entre grupos. Resultados: Indican que no existen diferencias significativas entre grupos en el procesamiento semántico.En la formación de conceptos léxicos, los esquizofrénicos muestran peor desempeño;mientras que los afásicos obtienen peores resultados en las pruebas de examen neurolingüístico. Conclusiones: La evidencia empírica muestra que el discurso oral de ambos grupos de pacientes es marcadamente digresivo y vacío, con parafasias y neologismos, pero lingüísticamente diferentes.

Introdução: Na esquizofrenia é muito frequente a presença de um discurso oral digressivo, repleto de parafasias e neologismos, provocados pelas alterações de pensamento comuns nesta doença.Essa forma de discurso oral vazio, repleto de parafasias e neologismos, é uma das manifestações clínicas características da afasia de Wernicke,com a diferença de que, nesses pacientes, a sintomatologia é linguística e não secundária a alterações do pensamento.Que mecanismos cognitivos levam a comportamentos verbais semelhantes em ambos os grupos de pacientes? Objetivos: Obter evidências empíricas sobre os mecanismos cognitivos subjacentes às alterações da comunicação verbal em ambos os tipos de pacientes, a partir da análise comparativa da sua execução em testes neurocognitivos e neurolinguísticos. Métodos: O estudo foi implementado numa população de 70 pacientes organizados em dois grupos: 35 afásicos e 35 esquizofrênicos.Ambos os grupos foram submetidos aos testes de Emparelhamento Semântico de Imagens, Identificação de Imagens Homônimas e Denominação Oral de Imagens e Quadrinhos.O processamento dos dados envolveu estatística descritiva e teste t de Student para análise comparativa entre grupos. Resultados: Indicam que não há diferenças significativas entre os grupos no processamento semântico.Na formação de conceitos lexicais, os esquizofrênicos apresentam pior desempenho;enquanto os afásicos apresentam pior desempenho nos testes de exame neurolinguístico.Conclusões:a evidência empírica mostra que o discurso oral de ambos os grupos de pacientes é marcadamente digressivo e vazio, com parafasias e neologismos, mas linguisticamente diferente.

Experiência de adoecimento e estratégias de "tocar a vida" de pessoas com esquizofrenia acompanhadas na Atenção Primária: estudo qualitativo orientado pelo Recovery / Illness experience and strategies to "get on with life" of people with schizophrenia admitted to primary care: qualitative study oriented by the Recovery

Resumo A Reforma Psiquiátrica Brasileira produziu grandes transformações no cuidado em saúde mental, porém ainda é um desafio tornar as experiências pessoais o eixo central dos tratamentos. O movimento do Recovery, em que a remissão dos sintomas é descentralizada e a ênfase recai na busca de vida gratificante na comunidade, pode trazer ensinamentos. A pesquisa descreveu a experiência de adoecimento e estratégias para "tocar a vida" de pessoas com esquizofrenia no contexto da Atenção Primária à Saúde, conhecendo o que fazem para se ajudar na lida diária com os problemas gerados pelo transtorno mental. O cenário é uma Unidade Básica de Saúde no centro do Rio de Janeiro e a pesquisa, de inspiração etnográfica, realizou entrevistas narrativas com quatro pessoas com esquizofrenia com autonomia e acompanhadas exclusivamente na APS e dois familiares. Resultados sugerem que religiosidade, trabalho e renda foram relevantes para a recuperação dos entrevistados e o olhar da família reforçou o estigma. A análise exigiu superação de olhar esquemático sobre reabilitação psicossocial e o conceito de Recovery. A importância deste estudo é trazer para o centro da análise caminhos construídos pelos próprios sujeitos para a tocar a vida, além de debater o conceito de Recovery no cenário da APS.

Abstract The Brazilian Psychiatric Reform produced major transformations in mental health care, but it is still a challenge for personal experiences to become the central axis of treatments. The Recovery movement, in which the remission of symptoms is decentralized, and the emphasis of care is on the search for a fulfilling life in the community, can bring lessons. This research describes the illness experience and strategies to go on with the life of people with schizophrenia finding what they do to help themselves in their daily struggle. The study setting is a Basic Health Unit in the center of Rio de Janeiro. The research, which has ethnographic inspiration, conducted narrative interviews with people diagnosed with schizophrenia who preserved autonomy, followed exclusively in Primary Care and their relatives. The results suggest that religiosity, work, and income were relevant to the recovery of the interviewees and that family care reinforced the stigma of the disease. The analysis required overcoming the schematic view of psychosocial rehabilitation and the Recovery concept. The relevance of this study is to place paths that subjects built themselves to go on with life in the center of the analysis and to debate the concept of Recovery in Primary Care. Resumo: A Reforma Psiquiátrica Brasileira produziu grandes transformações no cuidado em saúde mental, porém ainda é um desafio tornar as experiências pessoais o eixo central dos tratamentos. O movimento do Recovery, em que a remissão dos sintomas é descentralizada e a ênfase recai na busca de vida gratificante na comunidade, pode trazer ensinamentos. A pesquisa descreveu a experiência de adoecimento e estratégias para "tocar a vida" de pessoas com esquizofrenia no contexto da Atenção Primária à Saúde, conhecendo o que fazem para se ajudar na lida diária com os problemas gerados pelo transtorno mental. O cenário é uma Unidade Básica de Saúde no centro do Rio de Janeiro e a pesquisa, de inspiração etnográfica, realizou entrevistas narrativas com quatro pessoas com esquizofrenia com autonomia e acompanhadas exclusivamente na APS e dois familiares. Resultados sugerem que religiosidade, trabalho e renda foram relevantes para a recuperação dos entrevistados e o olhar da família reforçou o estigma. A análise exigiu superação de olhar esquemático sobre reabilitação psicossocial e o conceito de Recovery. A importância deste estudo é trazer para o centro da análise caminhos construídos pelos próprios sujeitos para a tocar a vida, além de debater o conceito de Recovery no cenário da APS.

Miocarditis inducida por Clozapina: Revisión y protocolo de Screening

Clozapina, el gold standard en esquizofrenia refractaria, presenta algunos efectos adversos que ocasionalmente pueden ser graves. Entre ellos, la miocarditis precoz es un efecto cardiovascular severo poco frecuente que puede aparecer en las primeras 4-6 semanas. Las cifras de incidencia oscilan entre el 0,015-0.188% en el mundo, siendo más altas en Australia. La etiología es desconocida, postulándose hipersensibilidad mediada por Ig E; hipereosinofilia y hiperadrenergia. Múltiples investigaciones avalan a la ecocardiografía como una de las técnicas más útiles para el diagnóstico. La biopsia endomiocárdica es definitoria pero no viable. Existen, asimismo, criterios de RNM indicativos de inflamación miocárdica. Para facilitar el diagnóstico, se han propuesto criterios clínicos y analíticos de screening (hemograma, ECG, CK, PCR, troponinas). En caso de sospecha de miocarditis, el cese de clozapina y el tratamiento de soporte es la actitud a seguir, habitualmente con buenos resultados.

Although Clozapine is the gold standard treatment in resistant-schizophrenia, severe or even life-threatening adverse effects must be taked into account. Early myocarditis, a severe but unusual cardiovascular effect, can appear in the first 4-6 weeks of initiation. Incidence rates of myocarditis are about 0,015-0,188% around the world, being more elevated in Australia. Aethiology is unknown, suggesting Ig E mediated hipersensibility, hiperaeosinophilia and hiperadrenergy. Echocardiography seems to be one of the most helpful tools for diagnosing myocarditis. Endomyocardial biopsy is definitive, but not usually available. A role for cardiac magnetic resonance imaging (MRI) also has been proposed (findings of inflammation). In order to make an early diagnosis, several screening-criteria, considering clinical and laboratory ones, have been proposed: aeosinophylia, creatininkinase, C Reactive Proteine, troponin, and EKG. If we suspected clozapine-induced myocarditis, the drug must be removed and support medical treatment must be indicated.

Eficácia de uma intervenção de enfermagem para prevenção de comportamentos violentos de doentes psicóticos em contexto forense / Effectiveness of a nursing intervention in preventing violent behaviors among people with psychotic disorders in forensic settings / Eficacia de una intervención de enfermería para prevenir la conducta violenta en pacientes psicóticos en un contexto forense

Resumo Enquadramento: As psicoses são caraterizadas por distorções do pensamento, da perceção e emoções inadequadas. Em contexto forense, cabe ao enfermeiro especialista em saúde mental e psiquiátrica prevenir comportamentos violentos através de intervenções psicoterapêuticas. Objetivo: Caraterizar a situação clínica dos participantes relativamente às variáveis: funcionamento social, atividades socialmente úteis, relações pessoais e sociais, comportamento perturbador e agressivo, assertividade e sinais precoces de agressão; avaliar a eficácia de um programa de intervenção para treino de competências sociais e diminuição de preditores de violência. Metodologia: Estudo pré-experimental, com delineamento de pré e pós-teste com grupo único, cuja amostra foram 15 doentes internados em serviços de psiquiatria forense. Resultados: O programa demonstrou-se eficaz, observando-se mudanças estatisticamente significativas a nível das relações pessoais, dos comportamentos perturbadores e agressivos e dos sinais precoces de agressão. Conclusão: O treino de habilidades sociais e de autocontrolo traduziu-se na melhoria dos indicadores clínicos e na reabilitação psicossocial dos participantes, contribuindo para uma melhor (re)integração na família e na comunidade.

Abstract Background: Psychosis is characterized by distortions of thinking and perception, as well as inappropriate emotions. In forensic settings, psychiatric mental health nurses are responsible for preventing violent behaviors through psychotherapeutic interventions. Objective: To characterize participants' clinical situation based on the following variables: social performance, socially useful activities, personal and social relationships, disturbing and aggressive behavior, assertiveness, and early signs of aggression; and To assess the effectiveness of an intervention program for training social skills and reducing predictors of violence. Methodology: Pre-experimental study with a one-group pretest-posttest design. The sample consisted of 15 patients admitted to forensic psychiatric wards. Results: The intervention proved effective, with statistically significant changes in personal relationships, disturbing and aggressive behaviors, and early signs of aggression. Conclusion: Training social skills and self-control improved participants' clinical indicators and psychosocial rehabilitation and contributed to better (re)integrating them into their families and communities.

Resumen Marco contextual: La psicosis se caracteriza por distorsiones del pensamiento, de la percepción y de las emociones inapropiadas. En el contexto forense, es responsabilidad del enfermero especialista en salud mental y psiquiátrica prevenir las conductas violentas mediante intervenciones psicoterapéuticas. Objetivo: Caracterizar la situación clínica de los participantes en cuanto a las siguientes variables: funcionamiento social, actividades socialmente útiles, relaciones personales y sociales, comportamiento disruptivo y agresivo, asertividad y signos tempranos de agresión. Evaluar la eficacia de un programa de intervención para entrenar las competencias sociales y reducir los predictores de violencia. Metodología: Estudio preexperimental, con diseño antes y después de la prueba con un único grupo, cuya muestra estaba compuesta por 15 pacientes ingresados en los servicios de psiquiatría forense. Resultados: El programa demostró ser eficaz y se observaron cambios estadísticamente significativos en las relaciones personales, el comportamiento disruptivo y agresivo, y los primeros signos de agresión. Conclusión: El entrenamiento de las competencias sociales y del autocontrol se tradujo en la mejora de los indicadores clínicos y en la rehabilitación psicosocial de los participantes, lo que contribuyó a una mejor (re)integración en la familia y la comunidad.

Proyecto Piloto de Unidad Funcional para Mujeres con Esquizofrenia: Modelo Asistencial de Observatorio-Monitorización-Intervención / Pilot project of a functional unit for women with Schizophrenia: observatory-monitoring-intervention Care model

En los Centros de Salud Mental de Adultos (CSMAs) del Hospital Universitari Mutua Terrassa, en enero de 2023, iniciamos un proyecto piloto de innovación asistencial denominado Unidad Funcional para Mujeres con Esquizofrenia. El objetivo principal de esta comunicación es describir el proceso de designación de las mujeres diana en la unidad, y describir las funciones de los Observatorios de salud física, salud mental y de factores de riesgo psicosocial e inclusión de estas pacientes en los observatorios de salud. De forma complementaria, se describirá el diseño de las Estaciones de Monitorización /Equipos de Vigilancia y las actuaciones o intervenciones específicas centradas en la atención de las necesidades individuales. En la primera fase del proyecto (Enero-Marzo 2023) se revisan las historias clínicas de las mujeres con esquizofrenia para revisar vinculación a profesionales y programas comunitarios. Se describen necesidades de salud física y se revisan antecedentes de consumo de sustancias, uso de benzodiazepinas y opioides, así como aspectos de seguridad farmacológica. En la segunda fase del proyecto (Abril-Junio 2023) se han desarrollado 5 grupos de trabajo (Observatorios de Salud y de Riesgo Psicosocial): 1)Morbi-mortalidad somática, 2)hiperprolactinemia, 3)consumo de sustancias, 4)exclusión social y discriminación, y 5)prescripción y seguridad farmacológica. En la tercera fase del proyecto (Jumio-Septiembre 2023) se desarrollan los Equipos de Vigilancia/Monitorización en Morbi-Mortalidad Somática, hiperprolactinemia, consumo de sustancias, exclusión social/discriminación y seguridad farmacológica, así como intervenciones específicas: colaboración con otras especialidades médicas, consultoría con atención primaria, grupos de ejercicio físico y equipos de intervención en crisis.(AU)

In the context of the Adult Community Mental Health Units (CMHUs) of the Mutua Terrassa University Hospital, we initiated a pilot project of clinical innovation called the Functional Unit for Women with Schizophrenia in January 2023. The main objective of this report is to describe the process of designing a unit targeting women, to characterize the functions of the observatories of Physical Health, Mental Health, and Psychosocial Risk Factors, and to illustrate how these observatories provide surveillance of women’s health needs. The report also describes Monitoring Stations, Vigilance teams, and specific interventions.In the first phase of the project (January - March 2023), medical records from all women with schizophrenia were reviewed to ascertain compliance with clinical appointments and community programs. During this phase, we reviewed physical health records, history of substance use disorders including the use of benzodiazepines and opioid drugs, as well as related aspects of drug safety. In the second phase of the project (April - June 2023), five Observatories of health and social risk factors were developed: 1) somatic morbi-mortality, 2) hyperprolactinemia, 3) use of substances, 4) social exclusion and discrimination, and 5) prescription and drug safety. In the third phase of the project (June-September 2023), we are developing Monitoring Stations or Vigilance teams in these five areas as well as introducing specific interventions: collaboration with primary care and other medical specialties, consultation with primary care teams, physical exercise groups, and crisis intervention units.(AU)

Construction and validation of a scale of stigma against individuals diagnosed with schizophrenia

Antecedents: Individuals diagnosed with schizophrenia are not just dealing with their diagnoses. They are facing stigma due to their pathology. International research has proposed that individuals diagnosed with schizophrenia suffer more stigma than other types of mental issues. However, in Chile, a valid scale is not available to measure stigma against individuals diagnosed with schizophrenia. Objectives: To fill this gap, this research is aimed to develop and validate a scale to measure stigma against individuals diagnosed with schizophrenia. Methods: Two stages were completed to achieve the research objective. First, a pool of items was developed based on the three critical components of stigma, cognitive, affective and behavioral. Three independent judges were asked to assess the content aspects of the content validity of the items. Second, following an instrumental and longitudinal design with non-probabilistic with a quota sampling by gender (N = 607) the validity and reliability of the final scale was assessed. Results: A one-dimensional scale composed of 22 items showed good statistical boundaries. The observed factor loadings suggest that the items adequately represent the dimension (λ>, 6), and the reliability estimates are optimal (α>, 8; ω>, 8). Results suggest that the scale can be used the respondents' gender irrespectively.

Antecedentes: Las personas diagnosticadas con esquizofrenia no solo enfrentan su diagnóstico. Ellos también tienen que enfrentar el estigma producto de su patología. Investigaciones internacionales han propuesto que las personas diagnosticas con esquizofrenia sufren más de estigma que otras patologías mentales. Sin embargo, en Chile no existe una escala validada para medir el estigma hacia personas diagnosticadas con esquizofrenia. Objetivos: Para cubrir esta necesidad en la literatura, esta investigación tiene como objetivo desarrollar y validar un instrumento para medir el estigma hacia personas diagnosticadas con esquizofrenia. Métodos: Dos etapas fueron completadas para lograr el objetivo de investigación. En primer lugar, se desarrolló un set de ítems basados en los "tres componentes centrales del estigma: creencia, emoción y conducta". Se les solicitó a tres jueces independientes evaluar estas preguntas de acuerdo con su contenido y validez. En segundo lugar, siguiendo un diseño instrumental y longitudinal con muestreo no probabilístico por cuotas por género (N = 607) se evaluó la validez y confiabilidad de la escala final. Resultados: Una escala unidimensional compuesta por 22 ítems mostró buenos límites estadísticos. Las saturaciones de factores observadas sugieren que los ítems representan adecuadamente la dimensión (λ>, 6), y las estimaciones de confiabilidad son óptimas (α>, 8; ω>, 8). Los resultados sugieren que la escala se puede utilizar independientemente del género de los encuestados

Enfermedades asociadas e indicadores metabólicos en personas con esquizofrenia / Associated Diseases and Metabolic Indicators in Schizophrenic Individuals

La esquizofrenia es una enfermedad que está caracterizada por su complejidad psicopatológica agravada por una frecuente asociación de enfermedades físicas como la obesidad, la intolerancia a la glucosa, la diabetes y la dislipidemia. Además, indicadores metabólicos como la glucemia, el colesterol y los triglicéridos en sangre, así como la obesidad, tienen relevancia en estos pacientes, según lo planteado en la literatura especializada sobre el tema. Por otra parte, las enfermedades físicas asociadas como los indicadores metabólicos, tienen su impacto en el sistema nervioso central con independencia de la esquizofrenia. La suma de los trastornos mentales y físicos implica la necesidad de atender ambos problemas simultáneamente y se recomienda la intervención interdisciplinaria. El protocolo de actuación para la atención de los pacientes con esquizofrenia y psicosis relacionadas en el Hospital Clínico Quirúrgico Hermanos Ameijeiras es un ejemplo del abordaje señalado(AU)

Schizophrenia is a disease characterized by a psychopathological complexity, aggravated by frequent association of physical diseases such as obesity, glucose intolerance, diabetes and dyslipidemia. In addition, there are other metabolic indicators such as blood glucose, cholesterol and triglycerides which are relevant in these patients, and the international literature has been suggested so. On the other hand, both associated physical diseases and metabolic indicators have their impact on the central nervous system in addition to schizophrenia. The sum of mental and physical disorders implies the need to address both problems simultaneously, which is why interdisciplinary intervention is recommended. Hermanos Ameijeiras Clinical Surgical Hospital is an example of the action protocol for patients with schizophrenia and psychosis(AU)

Viés Atencional na Esquizofrenia: uma Revisão Crítica da Literatura / Attentional Bias in Schizophrenia: a Critical Review of Literature

O viés atencional, compreendido como a tendência de processar informações de acordo com a valência emocional ou significado, pode contribuir para a vulnerabilidade a transtornos psiquiátricos. Este estudo apresenta uma revisão da literatura sobre pesquisas empíricas que investigaram associações entre viés atencional e esquizofrenia. A busca foi realizada nas bases de dados PsycInfo, Web of Science, MedLine e Scopus. Um total de 641 estudos foi identificado. Após a aplicação dos critérios de elegibilidade, 16 artigos foram incluídos na amostra final, com a inclusão de um artigo a partir das referências dos estudos da amostra. Foram observados a utilização de tarefas e estímulos diversos, que apresentaram resultados variados, indicando, por um lado, a presença de viés atencional, e, por outro, interferência equivalente de estímulos emocionais em pacientes e pessoas saudáveis. São necessários mais estudos que, além de investigarem a associação entre viés atencional e esquizofrenia, permitam o controle de variáveis confundidoras.

Attentional bias, understood as the tendency to process information according to emotional valence or meaning, can contribute to vulnerability to psychiatric disorders. This study presents a review of empirical research literature that investigated the associations between attentional bias and schizophrenia. The search was conducted in the PsycInfo, Web of Science, MedLine, and Scopus databases. A total of 641 studies were identified. After applying eligibility criteria, 16 articles were included in the final sample, including one article retrieved from the references of the sample studies. Various tasks and stimuli were observed, yielding diverse results, indicating, on the one hand, the presence of attentional bias, and on the other hand, equivalent interference from emotional stimuli in patients and healthy individuals. Further studies are needed that, in addition to investigating the association between attentional bias and schizophrenia, allow for the control of confounding variables.

Frecuencia de trastornos mentales y sus características sociodemográficas en pacientes con COVID-19 ingresados en un hospital psiquiátrico de Lima Metropolitana

Introducción. La descripción de las características y los diagnósticos de pacientes psiquiátricos con COVID-19 durante la pandemia ha sido poco descrito en el Perú. Objetivo. Describir la frecuencia de diagnósticos psiquiátricos y sus características sociodemográficas en pacientes con prueba antigénica positiva a COVID-19 en un hospital psiquiátrico peruano durante julio 2020 a julio 2021. Métodos. Se realizó un estudio descriptivo basado en la revisión de 100 historias clínicas de pacientes entre 18 y 70 años. Las variables estudiadas fueron el diagnóstico de ingreso y variables sociodemográficas como edad, sexo, nivel académico, ocupación, días de estancia. Resultados. Los diagnósticos más frecuentes fueron esquizofrenia, trastornos esquizotípicos y trastornos de ideas delirantes (49%) y los trastornos del humor (37%). El 66% pertenecía a los niveles socioeconómicos más bajos y el 60% eran pacientes continuadores. El mes de abril de 2021 presentó la mayor cantidad de ingresos (n=15). Conclusión. Durante un año de observación en tiempos de emergencia sanitaria por la COVID-19, ingresaron a un hospital psiquiátrico de referencia 100 pacientes con diagnóstico psiquiátrico que además tuvieron infección por SARS-CoV-2, la mayoría de estos pacientes tuvieron trastornos psicóticos.

Introduction. The description of the characteristics and diagnoses of psychiatric patients with COVID-19 during the pandemic has been poorly described in Peru. Objective. To describe the frequency of mental disorders and the associated sociodemographic characteristics of patients with a positive antigen test for COVID-19 in a peruvian psychiatric hospital from July 2020 to July 2021. Methods. For this descriptive study we analyzed 100 medical records of patients between 18 and 70 years old. The variables studied were the diagnosis according to ICD-10 and sociodemographic features such as age, gender, educational status, employment, days of admission. Results. The most common diagnoses were "Schizophrenia, schizotypal disorders and delusional disorders" (49%) and "mood disorders" (37%), 66% belonged to the lowest socioeconomic levels and 60% were recurrent patients. The month of April 2021 presented the highest number of admissions (n=15). Conclusion. In a year of observation during the COVID-19 outbreak, 100 patients with psychiatric diagnosis who also had SARS-CoV-2 infection were admitted to a reference psychiatric hospital, most of these patients had psychotic disorders.

Rehabilitación integral en psiquiatría para la independencia física en pacientes esquizofrénicos hospitalizados

Introducción: La independencia física es cuando una persona no necesita de otra para realizar actividades de la vida diaria. La esquizofrenia está dentro de las 10 enfermedades más discapacitantes. Objetivo: Describir los cambios en la independencia física después de aplicado un programa de rehabilitación integral para el adulto esquizofrénico hospitalizado. Métodos: Investigación desarrollada entre el 20 de enero de 2018 y el 13 de febrero de 2022. Integró técnicas y procedimientos de la investigación cualitativa y cuantitativa. Se utilizó un grupo único. Fue aplicada la consulta a especialistas. Participaron 65 pacientes esquizofrénicos que tenían más de 6 meses de estadía hospitalaria, menos de 60 años y que no estaban en su fase aguda o brote. Se diseñó el programa y se aplicó en un periodo de 6 meses con la participación del equipo de salud mental, previa capacitación. Resultados: Después de aplicado el programa predominó la categoría "independiente". Se logró mejoría cognitiva, afectiva, conductual, así como de los síntomas positivos y negativos. Se lograron cambios hacia niveles superiores de rehabilitación. Primaron los pacientes satisfechos con el tratamiento recibido. Los 10 especialistas consultados consideraron el programa viable. Conclusiones: El programa de rehabilitación integral para el adulto esquizofrénico hospitalizado, mejora la independencia física, favorece los cambios positivos y es factible de ser aplicado.

Introduction: Physical independence is when a person does not need another person to carry out activities of daily living. Schizophrenia is among the 10 most disabling diseases. Objective: To describe the changes in physical independence after applying a comprehensive rehabilitation program for hospitalized schizophrenic adults. Methods: Research developed between January 20, 2018 and February 13, 2022. It integrated qualitative and quantitative research techniques and procedures. A single group was used. The consultation was applied to specialists. 65 schizophrenic patients participated who had been in hospital for more than 6 months, were less than 60 years old, and who were not in their acute phase or outbreak. The program was designed and applied over a period of 6 months with the participation of the mental health team, after training. Results: After the program was applied, the "independent" category predominated. Cognitive, affective, and behavioral improvement were achieved, as well as positive and negative symptoms. Changes were achieved towards higher levels of rehabilitation. Patients satisfied with the treatment received prevailed. The 10 specialists consulted considered the program viable. Conclusions: The comprehensive rehabilitation program for the hospitalized schizophrenic adult improves physical independence, promotes positive changes and is feasible to be applied.

Eye movement desensitisation and reprocessing (EMDR) therapy in prison and forensic services: a qualitative study of lived experience.

Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives.Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care.Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants.Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis ('giving the voices something to feed on'). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future.Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235.Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 374682.

This study canvases the lived experiences of forensic patients receiving EMDR for PTSD ­ people whose views are seldom captured. They described being profoundly impacted by trauma, developing debilitating and enduring PTSD symptoms which variably contribute to offending and psychosis.Participants did not have favourable first impressions when they first heard about EMDR, thinking it 'quackery'. However, they were surprised and delighted by results, with the majority describing marked symptom reduction and personal transformation. Having targeted some of the underlying drivers of maladaptive behaviour, people reported hope for a better future.EMDR was well suited to a forensic setting and was seen as an empowering therapy.

Esquizofrenia resistente al tratamiento: dos copos de nieve / Treatment-Resistant Schizophrenia: Two Snowflakes

Presentamos el caso de dos pacientes, con edades comprendidas entre 18 y 25 años, que han sido hospitalizados previamente en diversas instituciones debido a su resistencia a múltiples tratamientos y regímenes terapéuticos. A pesar de haber tenido intervenciones terapéuticas diversas, ninguna ha sido exitosa. Estos casos han suscitado múltiples interrogantes debido a las notables similitudes en sus presentaciones clínicas, a pesar de tener diferentes tiempos de evolución de la enfermedad. Ambos pacientes presentan delirios e ideaciones de perjuicio hacia sus perspectivas madres. SE intento, sin éxito, administrar antipsicóticos atípicos no incluidos en la lista nacional de medicamentos para ambos pacientes, sin obtener una respuesta clínica positiva. Es sorprendente que, además de compartir numerosas características clínicas, ambos pacientes son varones, fueron admitidos casi simultáneamente en nuestra institución y comparten el mismo nombre.