Diferencias y estabilidad diagnóstica entre trastornos psicóticos inducidos por sustancias y trastornos psicóticos no inducidos / Differences between substance-induced psychotic disorders and non-substance-induced psychotic disorders and diagnostic stability

Se han propuesto distintas hipótesis para explicar la comorbilidad entre trastornos psicóticos y por consumo de sustancias, siendo una de ellas la capacidad de algunas de inducir cuadros psicóticos, aunque la transición de episodios psicóticos inducidos por sustancias a esquizofrenia ha sido menos estudiada. En este trabajo se determinan variables diferenciales entre individuos con psicosis inducidas y no inducidas, y se analiza la evolución y el cambio de diagnóstico de las inducidas a esquizofrenia en el seguimiento. Es un estudio observacional de casos y controles con 238pacientes ingresados en la unidad de agudos de un Hospital General de Madrid (España) por episodios psicóticos entre diciembre de 2003 y septiembre de 2011. Se incluyeron 127 en el grupo de trastornos psicóticos no inducidos por sustancias (TPNIS) y 111 en el de inducidos por sustancias (TPIS), según la Clasificación Internacional de Enfermedades. Se compararon características sociodemográficas, clínicas, antecedentes personales y familiares, de consumo de sustancias, estabilidad diagnóstica y evolución. El grupo de TPNIS presentó mayores puntuaciones en gravedad y sintomatología negativa mientras que el de TPIS tuvo más antecedentes personales de trastorno de personalidad y familiares de adicciones, y más sintomatología positiva. A los seis años un 40,9% de TPIS cambió a diagnóstico de esquizofrenia, presentando más antecedentes familiares de trastornos psicóticos y de adicciones, y una peor evolución con más visitas a urgencias y reingresos que los sujetos con estabilidad diagnóstica. Por tanto, habrá que prestar especial atención a este grupo de sujetos por su potencial gravedad y por el mayor riesgo de desarrollar un trastorno psicótico crónico. (AU)

Several hypotheses have been proposed to explain the comorbidity betweenpsychotic disorders and substance use, one of them being the capacity ofsome to induce psychotic symptoms, although the transition from psychoticepisodes induced by substances to schizophrenia has been less studied. In thisstudy, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011.The group of non-substance-induced psychotic disorders (NSIPD) included127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higherscores in severity and in negative symptoms and more family history ofpsychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder. (AU)

Diagnostic stability in substance-induced psychosis.

INTRODUCTION: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. MATERIAL AND METHODS: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. RESULTS: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD = 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16 years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43 months. CONCLUSIONS: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

Estabilidad diagnóstica en la psicosis inducida por sustancias / Diagnostic stability in substance-induced psychosis

Introducción: Se denomina psicosis inducida por sustancias (PIS) a la psicosis que empieza en el contexto del uso de una sustancia pero persiste días y semanas en ausencia del uso continuado de la misma. Los conocimientos sobre el curso longitudinal de las PIS son aún escasos y sugieren que un porcentaje importante son más adelante diagnosticadas de trastorno mental grave (TMG). El objetivo de este estudio es analizar la evolución de las PIS a TMG en nuestro medio y los posibles factores que puedan estar implicados en esa conversión. Material y métodos: Utilizamos un diseño retrospectivo de seguimiento de una cohorte. Se revisaron todos los diagnósticos de los pacientes dados de alta en la unidad de hospitalización de psiquiatría del Hospital Universitario de Basurto desde enero de 2002 hasta diciembre de 2015. Además de datos sociodemográficos y clínicos se recogió información sobre el consumo de cannabinoides, opiáceos, anfetaminas, cocaína y alcohol. Los datos se analizaron mediante estadística descriptiva, curvas de supervivencia Kaplan-Meier y regresión de Cox. Resultados: De los 116 pacientes incluidos el 78,4% fueron hombres, tenían una edad media de 33,0 (DE: 8,9) años y el 44,0% estaban solteros; el 31,0% tenían antecedentes familiares psiquiátricos; la sustancia más consumida fue cannabis (60,3%), seguido por cocaína (40,5%). El riesgo acumulado de conversión diagnóstica a TMG en 16años fue del 41,6% (IC95%: 32,2-52,2) en un tiempo medio de 36,43meses. Conclusiones: En las intervenciones en episodios de PIS debemos tener presente que una proporción importante evolucionará a TMG en los tres primeros años. (AU)

Introduction: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. Material and methods: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. Results: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD: 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43months. Conclusions: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years. (AU)

Estabilidad diagnóstica de niños con trastorno del espectro autista en la adolescencia (TEA). Funcionamiento ejecutivo, socio-adaptativo y conductual / Diagnostic stability of children with autism spectrum disorder in adolescence (ASD). Executive, socio-adaptive and behavioral functioning

Resumen Las características de individuos con trastornos del espectro Autista (TEA) persistente (TEA-P) o con TEA remitente (TEA-R) en el tiempo son poco conocidas. Este estudio longitudinal se planteó con tres objetivos: 1) determinar la tasa de persistencia/recuperación en la adolescencia de niños con diagnós tico TEA; 2) comparar el funcionamiento ejecutivo (FE), manifestaciones socio-adaptativas y conductuales de adolescentes TEA-P y TEA-R; y 3) identificar el porcentaje de individuos de los grupos TEA-P y TEA-R con puntuaciones normalizadas en FE y manifestaciones socio-adaptativas y conductuales en la infancia (T1) y en la adolescencia (T2). La muestra en el Tiempo 1 estuvo integrada por 45 niños con TEA (edad 7 a 11 años) de los que 32 mantenían el diagnóstico del trastorno 5 años después. Los padres y profesores cumplimentaron cuestionarios de FE, teoría de la mente (ToM), manifestaciones socio-adaptativas y conductuales en T1 y en T2. El grupo con TEA-P presentó significativamente más problemas y peor evolución en FE, características socio-adaptativas y conductuales que el grupo TEA-R. Los hallazgos destacan la variabilidad de la trayectoria evolutiva del TEA y la necesidad de realizar un seguimiento psicoeducativo y médico frecuente en este trastorno del neurodesarrollo.

Abstract The characteristics of individuals with persis tent ASD (ASD-P) and remittent ASD (ASD-R) are little known. This longitudinal study had threeobjectives1) To determine the persistence and recovery in children with autism spectrum disorder diagnosis in adolescence: 2) To compare executive functioning (EF), socio-adaptive and behavioral manifestations of ASD-P and ASD-R adolescents; and 3) to identify the percentage of normalized individuals in ADS-P and ADS-R groups in EF, socio-adaptive and behavioral manifestation in childhood and adolescence. The sample at T1 was comprised of 45 children with ASD (aged 7-11), maintaining 32 ASD diagnosis five years later. Parents and teachers completed questionnaires on EF, theory of mind, socio-adaptive and behavior difficulties, at both time points. The ASD-P group presented significantly more problems than group ASD-Rand showed worst evolution in EF, socio-adaptive and behavioral domains. Our findings highlight the variability of developmental trajectories of children with ASD.

Diagnostic Stability of Major Depressive Disorder in hospitalized patients in a University Hospital: a Brief Report

ABSTRACT Introduction: There may be a discordance between diagnoses at admission and discharge of mentally ill patients with major issues regarding their diagnostic stability. The objective of this brief report was to determine the diagnostic stability of major depressive disorder at patients' discharge and if the diagnosis of their hospital admission had been retained. Methodology: This was a pilot, descriptive, cross-sectional, and retrospective observational study. A non-probabilistic sampling of consecutive cases was used. We reviewed the medical records, at admission and discharge, of patients with an initial diagnosis of major depressive disorder, hospitalized in the Department of Psychiatry of the 'Hospital de Clínicas' of the National University of Asunción, Paraguay, during the months of October to December 2020. Results: Fifty-three patients with a diagnosis of major depression on their hospital admission were included in the study (mean age = 35.7 ± 16.5 years). 79.2 % were women, 52.8 % were single, and 37.7 % were from the Central province of Paraguay. The most frequent diagnosis at discharge was borderline personality disorder, in 35.8% of cases. Major depressive disorder was confirmed in 15.1% of cases. No significant relationship was found between any discharge diagnosis and sociodemographic data. Conclusion: The results of this study, although preliminary, described the trajectories of diagnoses in the Psychiatry Department of a University hospital, but confirmatory studies are needed.

RESUMEN Introducción: puede existir una discordancia entre los diagnósticos al ingreso y al alta de los pacientes con enfermedades mentales, con problemas importantes en cuanto a su estabilidad diagnóstica. El objetivo de este breve informe fue determinar la estabilidad diagnóstica del trastorno depresivo mayor al alta de los pacientes y si se había mantenido el diagnóstico de su ingreso hospitalario. Metodología: se trata de un estudio observacional piloto, descriptivo, transversal y retrospectivo. Se utilizó un muestreo no probabilístico de casos consecutivos. Se revisaron las historias clínicas, al ingreso y al alta, de los pacientes con diagnóstico inicial de trastorno depresivo mayor, hospitalizados en el Departamento de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción, Paraguay, durante los meses de octubre a diciembre de 2020. Resultados: se incluyeron en el estudio 53 pacientes con diagnóstico de depresión mayor a su ingreso hospitalario (edad media = 35,7 ± 16,5 años). El 79,2 % eran mujeres, el 52,8 % eran solteros y el 37,7 % eran del Departamento Central del Paraguay. El diagnóstico más frecuente al alta fue el trastorno límite de la personalidad, en el 35,8% de los casos. El trastorno depresivo mayor se confirmó en el 15,1% de los casos. No se encontró relación significativa entre ningún diagnóstico al alta y los datos sociodemográficos. Conclusiones: los resultados de este estudio, aunque preliminares, describen las trayectorias de los diagnósticos en el Departamento de Psiquiatría de un hospital universitario, pero son necesarios estudios confirmatorios.

Diagnostic stability in substance-induced psychosis. / Estabilidad diagnóstica en la psicosis inducida por sustancias.

INTRODUCTION: Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion. MATERIAL AND METHODS: We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression. RESULTS: Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD: 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16years was 41.6% (95%CI: 32.2-52.2) over a mean 36.43months. CONCLUSIONS: In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.