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The KDM6B mutation: Phenotype and clinical characteristics—Report of a case KDM6B突变:表型和临床特征- 1例报告
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-04-01 DOI: 10.1016/j.rpsm.2020.12.005
Inmaculada Insa Pineda , Cristina Luz Gómez González

Introduction

Alterations in the genes of lysine methylation as Lysine-specific demethylase 6B (KDM6B) have been associated with multiple neurodevelopmental disorders. Until now, there are few cases in the literature attributed to KDM6B mutations. This gap may be due to the fact that the exome sequencing technique is still being implemented in routine clinical practice.

Material and methods

A case is presented with its clinical and phenotypic characteristics. The sequence exome analysis was done with the Nimblegen SeqCap EZ MedExome capture kit + mtDNA 47Mb. The psychopathological approach from mental health was carried out through individual and family interviews, the Conner's questionnaires, ADHD rating scale, as well as the psychometry.

Results

A frameshift variant in the KDM6B gene related to neurodevelopmental disorders with facial and body dysmorphia was obtained. The case was oriented as a neurodevelopmental disorder secondary to a genetic alteration and a comorbid Attention Deficit Hyperactivity Disorder (ADHD).

Conclusions

The clinical peculiarities shared by patients identified with the KDM6B mutation, raises the need to recognize it as a particular entity. The possibility of applying the exome sequencing technique to patients with syndromic phenotype and developmental impairment may clarify its etiopathogenesis. It is highly probable that the complexity of these cases requires an approach by a multidisciplinary team that includes genetics, neurology and psychiatry, among other specialties. The coordinated approach is essential to have a comprehensive vision of the case.

赖氨酸甲基化基因作为赖氨酸特异性去甲基化酶6B (KDM6B)的改变与多种神经发育障碍有关。到目前为止,文献中很少有病例归因于KDM6B突变。这种差距可能是由于外显子组测序技术仍在常规临床实践中实施。材料与方法报告1例患者的临床和表型特征。序列外显子组分析使用Nimblegen SeqCap EZ MedExome捕获试剂盒+ mtDNA 47Mb进行。心理健康的精神病理学方法通过个人和家庭访谈、Conner's问卷、ADHD评定量表以及心理测量法进行。结果获得了一个与面部和身体畸形相关的神经发育障碍KDM6B基因移码变异。该病例被定位为继发于遗传改变的神经发育障碍和共病的注意缺陷多动障碍(ADHD)。结论KDM6B突变患者的临床特征表明,有必要将其视为一种特殊的实体。将外显子组测序技术应用于综合征表型和发育障碍患者的可能性可能阐明其发病机制。这些病例的复杂性很可能需要一个多学科团队的方法,包括遗传学、神经病学和精神病学,以及其他专业。协调一致的方法对于全面了解情况至关重要。
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引用次数: 2
Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies 首发精神病认知加工过程中的楔前叶和岛叶失活:功能磁共振成像研究的系统回顾和荟萃分析
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-04-01 DOI: 10.1016/j.rpsm.2020.08.001
Pau Soldevila-Matías , Anton Albajes-Eizagirre , Joaquim Radua , Gracián García-Martí , José M. Rubio , Diana Tordesillas-Gutierrez , Inmaculada Fuentes-Durá , Aleix Solanes , Lydia Fortea , Dominic Oliver , Julio Sanjuán

Introduction

The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP.

Methods

Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines.

Results

Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum.

Conclusions

While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.

首发精神病(FEP)中认知功能障碍的神经相关机制尚不清楚。本综述和荟萃分析提供了fmri测量的FEP患者大脑对认知过程反应异常位置的最新信息。方法系统回顾和基于体素的横断面fMRI研究,比较FEP患者和健康对照(HC)根据PRISMA指南对认知任务的神经反应。结果共纳入26项研究,其中FEP患者598例,HC患者567例。个别研究报告了背外侧前额叶皮层(6项研究)、额叶(8项研究)、扣带(6项研究)和脑岛(5项研究)的活性降低具有统计学意义。荟萃分析显示,左前叶岛、楔前叶和双侧纹状体的活性降低具有统计学意义。虽然研究倾向于强调FEP认知任务中额叶失活,但我们的meta分析结果显示,左侧楔前叶和脑岛在FEP中主要表现出异常激活,这可能与外部刺激的显著性归因有关,并与感知和调节缺陷有关。
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引用次数: 12
Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province 西班牙某省在COVID-19大流行期间增加了对饮食失调患者的紧急护理
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-04-01 DOI: 10.1016/j.rpsm.2021.11.005
María Irigoyen-Otiñano , Ana González-Pinto , Vicent Llorca-Bofí , Marina Adrados-Pérez , Laura Arenas-Pijoan , Giovanni Torterolo , Marta Sánchez-Cazalilla , Esther Buil , Eugènia Nicolau-Subires , Carla Albert-Porcar , Lucía Ibarra-Pertusa , Margarita Puigdevall-Ruestes

Introduction

The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period.

Method

We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records.

Results

Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p = 0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p < 0.001) and increasing suicidal behaviour (p = 0.016) and behavioural disorder (p = 0.022).

Conclusions

In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.

2019冠状病毒病大流行对人们的心理健康产生了巨大影响。饮食失调患者由于身心健康,对疫情也高度敏感。本研究的目的是评估COVID-19大流行可能对饮食失调患者紧急护理的原因产生的影响,并将护理原因与前一时期的原因进行比较。方法比较利莱达省饮食失调患者大流行前后急诊室就诊情况及特点。从电子病历中获得了有关社会人口状况、咨询原因、诊断、自杀行为特征和其他数据的信息。结果在急诊总就诊人数中,饮食失调从大流行前的1.7%上升到大流行期间的3.1% (p = 0.030)。关于咨询的原因,观察到模式的变化,减少咨询焦虑失代偿(p <0.001),自杀行为(p = 0.016)和行为障碍(p = 0.022)的增加。结论:在我们的研究中,我们确定了在两种警报状态下对饮食失调患者的紧急护理增加,而对焦虑症状的咨询明显减少。然而,对自杀行为的护理增加了,特别是在患有人格障碍和失业的妇女中。
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引用次数: 7
Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale 用简短阴性症状量表定义精神分裂症的阴性症状缓解
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2021.05.003
Gurpreet Rekhi , Mei San Ang , Yiong Huak Chan , Emilio Fernandez-Egea , Brian Kirkpatrick , Jimmy Lee

Introduction

This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS).

Material and methods

274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed – NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria.

Results

Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic = 0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696–0.826, p < 0.001) and 0.723 (CI: 0.656–0.790, p < 0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters.

Conclusions

Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.

本研究旨在使用简短阴性症状量表(BNSS)提出精神分裂症阴性症状缓解(NSR)的标准。材料与方法对274名被试进行Positive and Negative Syndrome Scale (PANSS)、BNSS和Social and Occupational Functioning Assessment Scale (SOFAS)评估。提出了基于BNSS域分数的NSR (NSRBNSS_DOMAINS)和基于BNSS 5个关键条目的NSR (NSRBNSS_5ITEMS)两个NSR标准。SOFAS评分61分及以上为功能缓解(FR)。Logistic回归检验FR和NSR之间的关系。采用受试者工作特征(ROC)曲线分析FR的NSR标准,采用Kappa一致性统计评价两个NSR标准之间的一致性。结果89例(32.5%)被试满足NSRBNSS_DOMAINS标准,70例(25.6%)被试满足NSRBNSS_5ITEMS标准。两种“噪音感应强”标准之间存在显著的一致性(Kappa统计量= 0.797)。61名(25.3%)参与者发生FR。无论使用何种标准,FR与NSR显著相关。预测FR时,NSRBNSS_DOMAINS和NSRBNSS_5ITEMS的曲线下面积为0.761 (CI: 0.696-0.826, p <0.001)和0.723 (CI: 0.656-0.790, p <分别为0.001)。因此,两个NSR标准都显示出区分功能性缓解者和非缓解者的公平能力。结论根据环境和需要,临床医生和研究人员可以采用完整的BNSS量表或简化的5项BNSS量表来识别精神分裂症患者的NSR。需要更多的研究来进一步检验这些标准在精神分裂症中的有效性。
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引用次数: 3
Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia 精神分裂症患者阴性症状自我评价(SNS)的欧洲西班牙文版验证
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2020.04.011
Leticia García-Álvarez , Clara Martínez-Cao , Teresa Bobes-Bascarán , Almudena Portilla , Philippe Courtet , Lorena de la Fuente-Tomás , Ángela Velasco , Leticia González-Blanco , Paula Zurrón-Madera , Eduardo Fonseca-Pedrero , Pilar A. Sáiz , María Paz García-Portilla , Julio Bobes

Introduction

Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia.

Material and methods

Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale – Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS).

Results Reliability

Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p < 0.001). For PANSS-N, the correlation was 0.437 (p < 0.005) and with the CAINS-Total was 0.478 (p < 0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r = −0.372 (p  0.001), and with SF-36 Physical and Mental Summary Component scores were r = −0.213 (p = 0.066) and r = −0.144 (p = 0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p < 0.001).

Conclusion

The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.

阴性症状可分为五个领域:冷漠/逃避、快感缺乏、社会性、痛症和情感扁平化。很少有有效的评估这五个维度的自评措施。因此,本研究旨在验证西班牙精神分裂症患者的阴性症状自我评价(SNS)。材料与方法对104例精神分裂症门诊患者进行横断面验证研究,采用西班牙语版以下量表进行评估:阴性症状临床评估面谈(CAINS)、阳性和阴性症状量表(PANSS)、精神分裂症临床总体印象量表(ci - sch)、个人与社会表现量表(PSP)、动机与愉悦量表-自我报告(MAP-SR)、36项简短健康调查(SF-36)和阴性症状自我评价(SNS)。结果信度内部一致性(Cronbach’s alpha)为0.915。收敛效度:MAP-SR与SNS总分的Pearson相关系数为0.660 (p <0.001)。PANSS-N的相关系数为0.437 (p <0.005), CAINS-Total为0.478 (p <0.005)。发散效度:SNS与PSP的Pearson相关系数为r = - 0.372 (p≤0.001),与SF-36的身心总结成分得分分别为r = - 0.213 (p = 0.066)和r = - 0.144 (p = 0.219)。判别效度:SNS总分根据CGI-SCH负性量表评定的负性症状严重程度差异有统计学意义(p <0.001)。结论社交网络是一种可靠、有效的精神分裂症患者阴性症状五域自评工具,适合在日常临床实践中作为临床医生评估的补充措施使用。
{"title":"Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia","authors":"Leticia García-Álvarez ,&nbsp;Clara Martínez-Cao ,&nbsp;Teresa Bobes-Bascarán ,&nbsp;Almudena Portilla ,&nbsp;Philippe Courtet ,&nbsp;Lorena de la Fuente-Tomás ,&nbsp;Ángela Velasco ,&nbsp;Leticia González-Blanco ,&nbsp;Paula Zurrón-Madera ,&nbsp;Eduardo Fonseca-Pedrero ,&nbsp;Pilar A. Sáiz ,&nbsp;María Paz García-Portilla ,&nbsp;Julio Bobes","doi":"10.1016/j.rpsm.2020.04.011","DOIUrl":"10.1016/j.rpsm.2020.04.011","url":null,"abstract":"<div><h3>Introduction</h3><p>Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia.</p></div><div><h3>Material and methods</h3><p>Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale – Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS).</p></div><div><h3>Results Reliability</h3><p>Internal consistency (Cronbach's <em>alpha</em>) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (<em>p</em> <!-->&lt;<!--> <!-->0.001). For PANSS-N, the correlation was 0.437 (<em>p</em> <!-->&lt;<!--> <!-->0.005) and with the CAINS-Total was 0.478 (<em>p</em> <!-->&lt;<!--> <!-->0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was <em>r</em> <!-->=<!--> <!-->−0.372 (<em>p</em> <!-->≤<!--> <!-->0.001), and with SF-36 Physical and Mental Summary Component scores were <em>r</em> <!-->=<!--> <!-->−0.213 (<em>p</em> <!-->=<!--> <!-->0.066) and <em>r</em> <!-->=<!--> <!-->−0.144 (<em>p</em> <!-->=<!--> <!-->0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (<em>p</em> <!-->&lt;<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.</p></div>","PeriodicalId":21391,"journal":{"name":"Revista de psiquiatria y salud mental","volume":"15 1","pages":"Pages 14-21"},"PeriodicalIF":9.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1888989120300367/pdfft?md5=4413150016d07160eb5ff4f46763b9e0&pid=1-s2.0-S1888989120300367-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38030617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Hábitos alimenticios y nutricionales en pacientes con esquizofrenia 精神分裂症患者的饮食和营养习惯。
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2019.10.003
Paula Zurrón Madera , Silvia Casaprima Suárez , Leticia García Álvarez , María Paz García-Portilla González , Raquel Junquera Fernández , María Teresa Lluch Canut

Background

There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia.

Objective

To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia.

Method

Cross-sectional descriptive study. Sample: 31 patients with schizophrenia (ICD-10) under outpatient treatment. Inclusion criteria: age 18-65 years, clinically stable and, written informed consent. Assessment: Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity).

Results

Mean age 43.13(SD=7.85) years, males 61.3%. Mean severity of illness was 3.94(SD=1.06), mean duration of the illness 18.42(SD=8.27) years. 74.2% used to eat weekly fat meat and 64.5% less than 3-4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1l of water. 83.9% used to drink coffee daily, 2.81(SD=2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r=-0.602, p=0.039) and vitamin K1 (r=-0.693, p=0.012) in women were related to the severity of illness.

Conclusions

Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.

很少有研究将饮食和营养习惯与精神分裂症患者的疾病严重程度和人口统计学特征联系起来。目的探讨精神分裂症患者的饮食营养习惯及其与病情严重程度的关系。方法横断面描述性研究。样本:31例门诊精神分裂症患者(ICD-10)。纳入标准:年龄18-65岁,临床稳定,书面知情同意。评估:人口统计学、临床特征(CGI-SCH、病程、BMI、腹围)、特别问卷调查(饮食、营养和身体活动)。结果平均年龄43.13(SD=7.85)岁,男性61.3%。平均病情严重程度为3.94(SD=1.06),平均病程为18.42(SD=8.27)年。74.2%的人过去每周吃肥肉,64.5%的人每天吃不到3-4份鱼,77.4%的人每天吃不到3份水果,51.6%的人每天喝不到11杯水。83.9%的人每天喝咖啡,每天2.81杯(SD=2.02)。患者的维生素A、D、E、K1、C、叶酸和镁水平较低。93.5%的人没有达到世卫组织关于身体活动的建议。女性中只有视黄醇(r=-0.602, p=0.039)和维生素K1 (r=-0.693, p=0.012)与疾病的严重程度有关。结论精神分裂症门诊患者没有遵循世卫组织建议的健康饮食和身体活动。疾病的临床严重程度、婚姻状况和同居与不良饮食习惯和营养缺乏有关。护理人员在日常临床实践中实施具体护理时应考虑到这些数据。
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引用次数: 6
Incidencia de esquizofrenia en España: más preguntas que certezas 西班牙精神分裂症的发病率:问题多于肯定
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2021.05.002
Víctor Romero-Pardo , Franco Mascayano , Ezra S. Susser , Gonzalo Martínez-Alés
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引用次数: 3
Estudio en imagen en espejo (10 años de seguimiento y 10 de pretratamiento estándar) de ingresos hospitalarios de personas con esquizofrenia grave en un programa comunitario con gestión de casos 社区病例管理项目中严重精神分裂症患者住院的镜像研究(10年随访和10年标准治疗前)
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2019.04.004
Silvia Díaz-Fernández , Danny Francisco Frías-Ortiz , Juan José Fernández-Miranda

Objectives

To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).

Method

Observational, mirror image study of ten years of follow-up and ten retrospectives (‘pre-treatment’: standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.

Results

The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p < 0,0001), as well the involuntary admissions (p < 0,001). Being on long-acting injectable antipsychotic medication was related with these results (p < 0,0001).

Conclusions

Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

目的了解重度精神分裂症患者在精神卫生中心标准治疗前和在综合、社区、病例管理方案治疗期间的精神住院情况,以及抗精神病药物(口服或长效注射)的作用。方法:观察性镜像研究,10年随访和10年回顾性研究(“治疗前”:标准),在一个以社区为基础的方案中,采用药物和社会心理综合治疗和强化病例管理(n = 344)。在治疗前和治疗期间,记录了出院的原因和精神病医院的入院情况(以及是否非自愿),并记录了处方的抗精神病药物。结果该方案的保留率很高:10年后,只有12.2%的患者自愿出院,而以前的标准治疗为84.3%。参加该方案后,入院的病人人数和因复发而入院的人数急剧减少(p <2001),以及非自愿入院(p <0001)。服用长效注射抗精神病药物与这些结果有关(p <0, 0001)。结论:以社区为基础、病例管理的综合治疗方案对严重精神分裂症患者的治疗取得了很高的保留率,与之前在精神卫生单位的标准治疗相比,有效地大大减少了精神病学住院率。接受长效注射抗精神病药物治疗显然与这些结果有关。
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引用次数: 9
Early versus late risk factors for deficit and nondeficit schizophrenia 缺乏性和非缺乏性精神分裂症的早期和晚期危险因素
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2021.03.002
Setareh Alabaf , Brian Kirkpatrick , Shanquan Chen , Rudolf N. Cardinal , Emilio Fernandez-Egea

Aim

We examined whether timing of known risk factors for schizophrenia may influence the development of schizophrenia with primary negative symptoms.

Method

This cross-sectional single-centre study in England used a clinical cohort of 167 clozapine-treated schizophrenia patients. Deficit and nondeficit schizophrenia models were used as clinical proxies of patients with and without primary negative symptoms respectively. Patients were assessed using the Schedule for the Deficit Syndrome. We examined previously replicated risk factors (family history of psychosis, advanced paternal age, male gender, birth weight <3000 g, summer birth, cannabis use, exposure to physical or sexual abuse and/or bullying) as well as other traumatic events for deficit and nondeficit schizophrenia.

Results

We found a distinct risk factor pattern for the two groups. Compared to the nondeficit group, patients with deficit schizophrenia reported a significantly lower prevalence of cannabis use (p = 0.005) at the time of first-episode psychosis (FEP), physical or sexual abuse (p = 0.033) prior to FEP, less exposure to crime-related traumatic events (p = 0.012) and significantly associated with summer birth (p = 0.017). The groups did not differ in terms of family history of psychosis, advanced paternal age, male gender, or low birth weight. To account for multiple comparisons, a confirmatory analysis was performed using logistic regression which yielded similar results except that summer birth no longer reached statistical significance.

Conclusion

Our results suggest the timing of the insult may influence the symptom presentation, with insults later in life (cannabis or traumatic events) being associated with psychotic presentation and less with primary negative symptoms.

我们研究了已知的精神分裂症危险因素的时间是否会影响原发阴性症状的精神分裂症的发展。方法在英国进行的一项横断面单中心研究纳入了167例氯氮平治疗的精神分裂症患者的临床队列。以有原发性阴性症状和无原发性阴性症状的精神分裂症患者分别采用缺陷型和非缺陷型精神分裂症模型作为临床指标。采用缺陷综合征量表对患者进行评估。我们检查了先前重复的风险因素(精神病家族史、父亲高龄、男性、出生体重(3000克)、夏季出生、大麻使用、遭受身体或性虐待和/或欺凌)以及其他创伤性事件对缺陷和非缺陷精神分裂症的影响。结果我们发现两组患者有明显的危险因素模式。与非缺陷组相比,缺陷精神分裂症患者在首次精神病发作(FEP)时使用大麻的患病率(p = 0.005),在FEP之前遭受身体或性虐待(p = 0.033),较少接触与犯罪相关的创伤事件(p = 0.012),并与夏季出生显著相关(p = 0.017)。两组在精神病家族史、父亲年龄、男性性别或低出生体重方面没有差异。为了解释多重比较,使用逻辑回归进行了验证性分析,除了夏季出生不再达到统计显著性外,结果相似。结论:我们的研究结果表明,侮辱的时间可能会影响症状的表现,晚年的侮辱(大麻或创伤事件)与精神病症状的表现有关,而与原发性阴性症状的关系较小。
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引用次数: 5
Negative Symptoms: A Brief Story and Advances in Spain 阴性症状:一个简短的故事和进展在西班牙
IF 9.2 3区 医学 Q1 PSYCHIATRY Pub Date : 2022-01-01 DOI: 10.1016/j.rpsm.2022.01.001
William T. Carpenter Jr
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引用次数: 3
期刊
Revista de psiquiatria y salud mental
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