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The probability of response after each subcutaneous injection of esketamine in treatment-resistant depression 每次皮下注射艾氯胺酮治疗难治性抑郁症后的反应概率
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.11.003
Victor Augusto Rodovalho Fava , Luciana Maria Sarin , Ana Cecília Lucchese , Lorena Del Sant , Eduardo Magalhães , Rodrigo Simonini Delfino , Marco Aurélio Tuena , Carolina Nakahira , Andrea Parolin Jackowski , Guilherme Abdo , Juliana Surjan , Matheus Steiglich , Matheus Ghossain Barbosa , José Alberto Del Porto , Acioly Luiz Tavares Lacerda , Hugo Cogo-Moreira

Introduction

The administration of multiple esketamine doses has shown efficacy for unipolar and bipolar treatment-resistant depression (TRD). Nevertheless, the probability of responding or not after each dose in the real-world remains unknown. This study aimed to estimate it throughout four doses of esketamine, administrated via subcutaneous (SC).

Material and methods

We conducted a retrospective analysis of a case series of 70 patients with TRD who received treatment from the esketamine assistance program at Federal University of Sao Paulo, between April 2017 and December 2018. The SC injections were administrated weekly at a dose of 0.5–1.0 mg/kg, in conjunction with patients’ psychotropic drugs. Response was defined as a decrease of at least 50% in the Montgomery-Åsberg Depression Rating Scale between baseline and 24 h after dose. We used hidden Markov modeling in order to estimate de probability of response after each esketamine injection.

Results

The probability of a patient that was a “non-responder” to become a “responder” following a SC injection of esketamine was 17.30% and the probability that this patient remains a “non-responder” was 82.70%. The probability of a patient that was a “responder” to remain as a “responder” was 95%.

Conclusions

Patients with TRD who had not responded after the first dose of esketamine, still had a chance of responding after the subsequent dose administrated via SC.

多剂量艾氯胺酮治疗单极和双相难治性抑郁症(TRD)有效。然而,在现实世界中,每次剂量后反应或不反应的概率仍然未知。本研究旨在评估通过皮下(SC)给药的四个剂量的艾氯胺酮。材料与方法我们对2017年4月至2018年12月期间在圣保罗联邦大学接受艾氯胺酮辅助项目治疗的70例TRD患者进行了回顾性分析。SC注射每周给药,剂量为0.5-1.0 mg/kg,与患者的精神药物联合使用。缓解被定义为蒙哥马利-Åsberg抑郁评定量表在基线和给药后24小时之间至少下降50%。我们使用隐马尔可夫模型来估计每次注射艾氯胺酮后的反应概率。结果SC注射艾氯胺酮后,“无应答者”变为“应答者”的概率为17.30%,保持“无应答者”的概率为82.70%。曾经是“应答者”的病人保持“应答者”身份的概率是95%。结论首次给药后无反应的TRD患者,经SC给药后仍有可能出现反应。
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引用次数: 0
Lithium toxicity: The SILENT threat 锂中毒:无声的威胁
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.11.001
Álvaro Martínez-Martín , Álvaro Sánchez-Larsen , Carolina Sánchez-Mora , Rocío Sáez-Povedano , Tomás Segura
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引用次数: 1
Depression in late life: Linking the immunometabolic dysregulation with clinical features 晚年抑郁:免疫代谢失调与临床特征的联系
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.06.001
Alejandro de la Torre-Luque , Jose Luis Ayuso-Mateos
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引用次数: 0
Real clinical setting intravenous ketamine use for treatment resistant depression: 12 month follow-up after initial response 真实临床背景静脉注射氯胺酮治疗难治性抑郁症:初步反应后12个月随访
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.11.004
Nora Olazabal , Sonia Bustamante , M. Aranzazu Madrazo , Luis Osa , Ana M. O’Neill of Tyrone , Ana Catalán , Miguel Angel González-Torres
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引用次数: 0
Psychiatric patients are more vulnerable to the Spanish euthanasia law? 精神病患者更容易受到西班牙安乐死法的影响?
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2021.01.001
Adrián Alacreu-Crespo , Lucas Giner , Philippe Courtet
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引用次数: 0
Screening for anxiety and depression in Primary Care: Utility of 2 brief scales adapted to the ICD-11-PC 初级保健中焦虑和抑郁的筛查:适用于ICD-11-PC的2个简短量表的应用
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2019.12.004
Celso Iglesias García , Pilar López García , José Luis Ayuso Mateos , José Ángel García , Julio Bobes

Introduction

The World Health Organization has developed a new classification of mental disorders in Primary Health Care (PHC), the ICD-11-PHC, in which there are changes in the diagnostic criteria of anxiety and depression disorder. In addition, 2 screening instruments have been developed for the detection of anxious and depressive symptoms according to the criteria of the new classification.

Objectives

To evaluate the capacity of the Spanish version of the 2 brief scales Dep5 and Anx5 to identify cases of depression and anxiety in PHC in Spain.

Method

A cross-sectional study conducted by 37 PHC physicians who selected 284 patients with suspected emotional distress. This sample was administered the screening scales (Anx5 and Dep5) and a diagnostic instrument (Clinical Interview Schedule-Revised) contemplating the new ICD-11 criteria as used as gold standard.

Results

The Anx5, using a cut-off point of 3, showed a sensitivity of 0.75 and specificity of 0.53. Using a cut-off point of 4, the Dep5 showed a sensitivity of 0.48 and a specificity of 0.8. The 2 scales together, with a cut-off point of 3 for each, classified correctly 73,57% as cases or non-cases. The diagnosis most frequently observed was anxious depression.

Conclusions

The screening scales for anxious and depressive symptoms (Anx5 and Dep5) are simple and easy-to-use instruments for assessing anxious and depressive symptoms in PHC. The reliability and validity data of each of the scales separately are limited but the figures improve when they are used together.

世界卫生组织制定了一项新的初级卫生保健(PHC)精神障碍分类,即ICD-11-PHC,其中对焦虑和抑郁症的诊断标准进行了修改。此外,根据新分类标准,开发了2种检测焦虑和抑郁症状的筛查工具。目的评价西班牙语版Dep5和Anx5简易量表对西班牙PHC患者抑郁和焦虑的识别能力。方法37名初级保健医生选取284例疑似情绪困扰患者进行横断面研究。对该样本进行筛查量表(Anx5和Dep5)和诊断工具(临床访谈计划-修订),考虑将新的ICD-11标准作为金标准。结果Anx5的灵敏度为0.75,特异性为0.53,截断点为3。采用截断点4,Dep5的敏感性为0.48,特异性为0.8。这两个量表加在一起,每个分界点为3,正确地将73,57%分类为病例或非病例。最常见的诊断是焦虑性抑郁。结论焦虑抑郁症状筛查量表(Anx5和Dep5)是评估PHC患者焦虑抑郁症状的简单易行的工具。每个量表单独使用的信度和效度数据都是有限的,但它们一起使用时,数据得到了改善。
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引用次数: 2
Obsessive–compulsive symptoms in anxiety and depressive disorders: Influence of recent and/or traumatic life events 焦虑和抑郁障碍中的强迫症状:近期和/或创伤性生活事件的影响
Pub Date : 2021-10-01 DOI: 10.1016/j.rpsmen.2020.12.002
Arantxa Orozco , Narcís Cardoner , Cristina F. Aragón , Salvador Ruiz-Murugarren , María Vicens , Miguel Ángel Álvarez-Mon , Guillermo Lahera

Introduction

A high prevalence of obsessive–compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.

Objective

This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).

Method

We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6–12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.

Results

54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p = 0.028), the presence of TEs (p < 0.01), symptoms of post-traumatic stress disorder (p < 0.01) and the number of RLEs (p < 0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p < 0.01).

Conclusion

The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.

据报道,焦虑抑郁障碍中强迫症(OCSs)的患病率很高,从30%到67%不等。目的本研究旨在评估门诊焦虑症和抑郁症患者OCSs的存在和持续性,以及其与近期生活事件(RLEs)和/或创伤经历(TEs)的关系。方法对200名DSM-5诊断为焦虑和/或抑郁的受试者进行前瞻性、观察性、分析性研究。参与者通过连续抽样纳入,并在基线和6-12个月(平均8.5个月)随访后进行评估。通过汉密尔顿焦虑量表(HARS)和汉密尔顿抑郁评估量表(HRSD-17)评估症状严重程度,通过国际神经精神病学访谈(MINI)评估合并症。同时进行强迫强迫修正量表(OCI-R)、近期生命变化问卷(CVSV)和创伤后应激诊断量表(PDS)。结果54%的患者出现过OCSs, 30.5%的患者一生中出现过一次或多次TEs。基线访视时,OCSs的存在与抑郁症状的严重程度相关(p = 0.028), TEs的存在与抑郁症状的严重程度相关(p <0.01),创伤后应激障碍症状(p <0.01)和RLEs数量(p <0.01)。随访有效率为38%,60.5%的患者持续存在OCSs,与抑郁或焦虑症状无关,但与RLEs次数有关(p <0.01)。结论焦虑抑郁障碍患者出现OCSs的频率和持续性较高。有TEs和RLEs病史的焦虑抑郁患者OCS水平较高。这些发现强调了早期发现和使用治疗策略的重要性,重点是对压力和创伤的恢复能力。
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引用次数: 0
Waiting for Godot or the use of biomarkers in clinical practice 等待戈多或生物标志物在临床实践中的应用
Pub Date : 2021-07-01 DOI: 10.1016/j.rpsmen.2021.07.003
Emilio Fernández-Egea
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引用次数: 0
Predictive value of prolactin in first episode psychosis at ten years follow-up 催乳素对首发精神病10年随访的预测价值
Pub Date : 2021-07-01 DOI: 10.1016/j.rpsmen.2020.10.002
Manuel Delgado-Alvarado , Javier Vázquez-Bourgon , Rosa Ayesa-Arriola , Victor Ortiz-García de la Foz , Jacqueline Mayoral-van Son , Javier Labad , Benedicto Crespo-Facorro
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引用次数: 0
Four-subtest short-form of the WAIS-IV for assessment of patients diagnosed with schizophrenia 用于评估被诊断为精神分裂症的患者的WAIS-IV的四亚测试简写
Pub Date : 2021-07-01 DOI: 10.1016/j.rpsmen.2019.12.003
Carmen Dasí , Inmaculada Fuentes-Durá , Juan C. Ruiz , Marisa Navarro

Introduction

The present study aimed to obtain a short form of the Spanish version of the WAIS-IV for patients diagnosed with schizophrenia that requires about half an hour to be administered. The reduced test can be very useful in clinical and research settings when an estimation of the intelligence quotient (IQ) is required to decide about intervention programs or to describe the sample.

Materials and methods

A sample of 143 patients participated in the study, 91 out of them were the test group, and the other 52 were used for a cross-validation analysis. To increase the content validity, the decision was made to create a short form composed of a subtest of each of the four cognitive domains that the scale measures.

Results

Several analyses showed that the best combination was composed of the Information, Block Design, Arithmetic, and Symbol Search subtests. Nine different criteria were calculated to evaluate the quality of the short form.

Conclusions

The data showed very good results for the criteria: correlations, difference of means, and cross-validation. The results were satisfactory for: category agreement, band of error, clinical accuracy, and reliability.

本研究旨在获得一种简短的西班牙语版本的WAIS-IV,用于诊断为精神分裂症的患者,需要大约半小时的时间来给药。在临床和研究环境中,当需要对智商(IQ)的估计来决定干预方案或描述样本时,简化测试非常有用。材料与方法本研究共纳入143例患者,其中试验组91例,其余52例进行交叉验证分析。为了提高内容的效度,我们决定创建一个简短的表格,由量表测量的四个认知领域中的每个领域的子测试组成。结果分析表明,信息测试、块设计测试、算术测试和符号搜索测试的组合效果最好。计算了九种不同的标准来评估短文的质量。结论数据在相关性、均数差异、交叉验证等标准上均取得了较好的结果。结果令人满意:分类一致性,误差范围,临床准确性和可靠性。
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引用次数: 0
期刊
Revista de Psiquiatría y Salud Mental (English Edition)
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