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Eficacia, seguridad y tolerabilidad de cariprazina en el trastorno depresivo mayor: una revisión sistemática y aspectos prácticos 卡哌嗪治疗重度抑郁障碍的疗效、安全性和耐受性:系统综述和实用性
Q4 Medicine Pub Date : 2024-08-29 DOI: 10.1016/j.psiq.2024.100494
Anna Giménez-Palomo , Lidia Ilzarbe , Eduard Vieta

Cariprazine is a new generation antipsychotic whose mechanism of action is based on partial agonism of dopamine D2 and D3 receptors, in addition to serotonin 5HT1A receptors. Its use has been approved by the Spanish Agency of Medicines and Medical Devices for the treatment of schizophrenia. However, the available literature has demonstrated its efficacy in the treatment of manic, mixed, and depressive episodes of bipolar disorder, all them approved indication in the United Sattes and several other countries. Likewise, there is currently evidence regarding the clinical efficacy, safety, and tolerability of cariprazine as an adjunctive treatment in major depressive disorder, which has granted this compound the approval by the Food and Drug Administration (FDA). While three clinical trials have shown negative results, two others have observed a significant reduction in depressive and anxiety symptoms, which has also been confirmed in a long-term open-label trial. Despite presenting a favorable adverse effect profile compared to other antipsychotics, cariprazine has been associated with akathisia and restlessness. Based on current evidence, the use of cariprazine as an adjunctive treatment to antidepressants may be beneficial in major depressive disorder. Future studies may address its efficacy in monotherapy, and its role in the prevention of depressive recurrences.

卡利普嗪是一种新一代抗精神病药物,其作用机制是部分激动多巴胺 D2 和 D3 受体以及血清素 5HT1A 受体。西班牙药品和医疗器械管理局已批准将其用于治疗精神分裂症。不过,现有文献也证明了它在治疗双相情感障碍的躁狂、混合和抑郁发作方面的疗效,这些都是美国和其他一些国家批准的适应症。同样,目前也有证据表明卡培拉嗪作为重度抑郁障碍的辅助治疗药物具有临床疗效、安全性和耐受性,美国食品药品管理局(FDA)因此批准了这种化合物。虽然有三项临床试验显示了负面结果,但另外两项临床试验观察到抑郁和焦虑症状明显减轻,这一点也在一项长期开放标签试验中得到了证实。尽管与其他抗精神病药物相比,卡雷普嗪具有良好的不良反应特征,但它也与运动失调和躁动不安有关。根据目前的证据,使用开浦嗪作为抗抑郁药的辅助治疗可能对重度抑郁障碍有益。未来的研究可能会探讨其在单药治疗中的疗效及其在预防抑郁复发中的作用。
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引用次数: 0
Clozapine delay results in poorer outcomes for treatment-resistant schizophrenia patients 延迟服用氯氮平导致耐药精神分裂症患者疗效更差
Q4 Medicine Pub Date : 2024-08-28 DOI: 10.1016/j.psiq.2024.100493
Kalyani Rajalingham

Treatment-resistant schizophrenia (TRS) is a condition where schizophrenia patients do not respond to at least 2 non-clozapine anti-psychotics administered in proper dosage and for a proper period of time. The typical treatment for TRS is clozapine but many alternatives are attempted prior to administering clozapine. Current research shows that the effectiveness of treatment with clozapine decreases with time in TRS patients; the longer a TRS patient waits to use clozapine, the less effective it is likely to be. In this paper, I review clozapine delay; clozapine treatment is effective if it happens within the first 3 years.

耐药性精神分裂症(TRS)是指精神分裂症患者对至少两种非氯氮平类抗精神病药物在适当剂量和适当时间内的治疗无效。TRS的典型治疗方法是氯氮平,但在使用氯氮平之前,患者会尝试多种替代疗法。目前的研究表明,使用氯氮平治疗 TRS 患者的疗效会随着时间的推移而降低;TRS 患者等待使用氯氮平的时间越长,疗效就可能越差。在本文中,笔者将对氯氮平的延迟治疗进行回顾;如果氯氮平治疗在最初 3 年内进行,则疗效显著。
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引用次数: 0
Representación del riesgo suicida y su exploración en una simulación realizada por estudiantes de Medicina 医科学生对自杀风险的表述及其在模拟中的探索
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100487
Luis Miguel Rojo-Bofill , Francisco Bellver Pradas , Pilar Benavent Rodríguez , Jose Carlos González-Piqueras , Vanessa Saiz Alarcón , Carmen Iranzo Tatay , Eduardo Jesús Aguilar García-Iturrospe

Introduction

Exploring suicide risk is a fundamental skill for medical professionals. However, university medical education typically does not include enough formal training in this area. Simulation has been used as a method for learning this skill, although most studies using this pedagogic tool focus on analysing changes in self-perceived capabilities and attitudes after receiving specific training on suicide.

Methods

A formative assessment task was carried out, consisting of recording a video in which groups of final-year medical students conducted a general psychiatric assessment with a simulated patient. The patient's diagnosis, suicide risk assessment, and exploratory questions were chosen by the students. Videos recorded over one term were studied. The chosen suicide risk assessment and exploratory questions regarding suicide risk were analysed independently and in relation to the chosen diagnosis.

Results

Out of 34 videos recorded, in 70% of those where suicide risk was explored, there was no suicidal ideation, and none had active suicidal ideation. Suicide risk was explored in 88% of the videos, but only 23.5% directly asked about the presence of suicidal ideation.

Conclusions

The task helped students integrate the importance of exploring suicide risk. The proportion of suicidal risk represented, and the exploratory questions, highlight the need to implement additional training interventions that focus on knowledge and stigma towards suicide.

导言探索自杀风险是医学专业人员的一项基本技能。然而,大学医学教育通常不包括这方面的正规培训。模拟训练已被用作学习这一技能的方法,但使用这一教学工具的大多数研究都侧重于分析接受特定自杀培训后自我认知能力和态度的变化。方法 我们开展了一项形成性评估任务,包括录制一段视频,在这段视频中,各组毕业班医学生对一名模拟病人进行了一次普通精神病学评估。病人的诊断、自杀风险评估和探索性问题均由学生自行选择。我们对一个学期内录制的视频进行了研究。结果 在录制的 34 个视频中,70% 的视频在探讨自杀风险时没有出现自杀意念,也没有出现主动自杀意念。88%的视频探讨了自杀风险,但只有23.5%的视频直接询问是否存在自杀意念。自杀风险所占的比例和探索性问题突出表明,有必要实施更多的培训干预措施,重点关注自杀知识和对自杀的耻辱感。
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引用次数: 0
Síndrome de Cotard tras la resección quirúrgica de un meningioma frontal derecho 右额脑膜瘤手术切除后的科塔德综合征
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100489
Clara Duque Casas, Elena González Rodríguez, Eduardo Delgado Parada

Objective

We present a case of Cotard's syndrome in a patient seen by the Liaison Psychiatry Team (EPE) after surgical resection of a meningioma. We carried out a historical review of the picture and its presentation in relation to structural brain damage.

Clinical case

Man in his thirties with no psychiatric history presented with insidious onset nihilistic delusional ideation with behavioral repercussions on the sixth day after neurosurgery for a right frontal meningioma. We clinically ruled out delirium.

Results

Antipsychotic and anxiolytic treatment was initiated, with progressive reduction until complete withdrawal on the tenth day due to behavioral improvement and partial encapsulation of the delirium that was maintained on an outpatient basis. The neuroradiological evolution was favorable and there were no metabolic or infectious complications. In the outpatient neuropsychological evaluation, cognitive difficulties compatible with the lesion were recorded, the presence of which could be prior to surgery.

Conclusions

Cotard's syndrome is a rare and under-researched condition that may be associated with supervening brain damage. The right hemisphere seems to play a leading role in perceptual integration and the relationship with the self, and its alterations have been related to the appearance of monothematic syndromes such as the one described here.

目的我们介绍了一例在脑膜瘤手术切除术后由精神科联络小组(EPE)接诊的科塔德综合征患者。临床病例患者三十多岁,无精神病史,在右额叶脑膜瘤神经外科手术后第六天出现隐匿性虚无主义妄想,并伴有行为反应。我们在临床上排除了谵妄的可能性。结果 开始使用抗精神病药和抗焦虑药治疗,并逐渐减少剂量,直到第十天因行为改善和谵妄部分消失而完全停药,并在门诊维持治疗。神经放射学检查结果良好,没有出现代谢性或感染性并发症。在门诊神经心理学评估中,记录到了与病变相符的认知困难,这种情况可能是在手术之前出现的。右半球似乎在感知整合以及与自我的关系方面起着主导作用,它的改变与单侧症状综合征的出现有关,如这里描述的症状。
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引用次数: 0
Depresión mayor resistente. Terapia electroconvulsiva versus esketamina. ¿Cuál debería ser el orden? A propósito de un caso 抗药性重度抑郁症。电休克疗法与斯氯胺酮:应该选择哪一种?病例报告
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100488
Belén Urbán Antón, Miguel Omaña Colmenares, Juan Fuertes Aparicio

We present a case of a 73-year-old woman with a treatment- resistant depression to several antidepressants and electroconvulsive therapy, who improved significantly with intranasal esketamine showing a decrease in the MADRS score from 43 points (severe depression) to 18 points (mild depression) after 4 months of treatment. These results raise the question of whether, in elderly patients suffering a treatment- resistant depression and suicidal ideation, we should choose either electroconvulsive therapy or intranasal esketamine.

我们介绍了一例对多种抗抑郁药和电休克疗法均有耐药性的 73 岁女性抑郁症患者的病例,经过 4 个月的治疗,她的 MADRS 评分从 43 分(重度抑郁)降至 18 分(轻度抑郁),并在鼻内注射艾司氯胺酮后病情明显好转。这些结果提出了一个问题:对于患有抗药性抑郁症并有自杀倾向的老年患者,我们是否应该选择电休克疗法或鼻内注射艾司氯胺酮?
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引用次数: 0
Síndrome de hiperémesis cannábica. A propósito de un caso 大麻剧吐综合征。关于一个病例
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100490
Elena Blanco Martín, Mar González Testón, Susana Macayo Villalobos, Marta Ramírez Bravo

A 23-year-old male daily Cannabis user came to the emergency department for cyclic hyperemesis and the need for compulsive hot showers for anxiolytic purposes. As probable antecedents, gastritis and dyspepsia related to Cannabis consumption. He has been evaluated by psychiatry for similar symptoms on several occasions and very high levels of anxiety.

一名每天吸食大麻的 23 岁男性患者因周期性呕吐和强迫性洗热水澡以达到抗焦虑目的而来到急诊科就诊。胃炎和消化不良可能与吸食大麻有关。他曾多次因类似症状和高度焦虑接受精神科评估。
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引用次数: 0
Conducta de «puerta giratoria» como compulsión. A propósito de un caso 旋转门行为是一种强迫行为。关于一个案例
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100492
Marta Ramírez Bravo, Susana Macayo Villalobos, Mar González Testón, Elena Blanco Martín

This case report discusses treatment strategies for individuals exhibiting “revolving door” behaviors in mental health, focusing on a male patient diagnosed with obsessive-compulsive disorder and personality disorder. Despite consistent treatment, the patient displayed irregular follow-up and frequent visits to the emergency department. Following the identification of compulsion as the underlying issue, a psychoeducational intervention was introduced, leading to notable enhancements in the patient's condition by decreasing emergency department visits and enhancing participation in appointments with the Mental Health Team. This case underscores the significance of psychoeducational interventions in managing patients demonstrating “revolving door” behaviors in mental health settings.

本病例报告以一名被诊断患有强迫症和人格障碍的男性患者为中心,讨论了针对在心理健康方面表现出 "旋转门 "行为的患者的治疗策略。尽管接受了持续的治疗,但该患者的随访并不规律,而且经常到急诊科就诊。在确定强迫症是根本问题后,对其进行了心理教育干预,通过减少急诊就诊次数和加强与心理健康小组的预约,患者的病情得到了明显改善。这个案例强调了心理教育干预在管理精神卫生机构中表现出 "旋转门 "行为的病人方面的重要性。
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引用次数: 0
Regulation and applied science in psychotherapies 心理疗法中的调节和应用科学
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100486
José Manuel Bertolín-Guillén

Background and objectives

Psychiatric and clinical–psychological practice must be based on the finest scientific knowledge. In Spain, the corresponding disciplines are official specialisations in the health sciences. The present article aims documentally to scrutinise the involvement of science in the psychotherapeutic activity of both.

Methods

A non-systematic study of quality scientific literature, mainly using the PubMed directory and Google Scholar, and examination of the applicable regulations.

Results

(1) Scientific method: Scientific knowledge is critical, well-founded, methodical, verifiable, and systematic. However, psychiatry and clinical psychology are hybrids of the natural and psychosocial sciences. (2) Psychotherapies and psychiatry: Psychiatry uses psychotherapies as well as various other authorised treatments. The Spanish Constitution and ministerial planning regulate the best training for health specialisations in Spain and guarantee the correct use of scientific knowledge. The US National Institute of Mental Health specifies that psychotherapies should be carried out by mental health professionals. (3) Psychotherapies and psychology: As specialised treatments, only psychiatry and clinical psychology have the optimal body of knowledge for practising psychotherapy. However, the plurality of psychological–psychotherapeutic schools is innumerable and not all of them are supported by science, although their efficacy seems to be similar. Other types of conversational interventions may accompany patients and, as they are not strictly speaking treatments, may be practised by people with a variety of qualifications or none at all.

Conclusions

Psychotherapies are non-formal health interventions. Intrusiveness is common, to the detriment of the best scientific information.

背景和目标 精神病学和临床心理学实践必须以最精湛的科学知识为基础。在西班牙,相应的学科是健康科学的官方专业。本文旨在以文件形式仔细研究科学在两者的心理治疗活动中的参与情况。方法主要通过 PubMed 目录和 Google Scholar 对高质量的科学文献进行非系统性研究,并对适用的法规进行审查:科学知识是批判性的、有根据的、有方法的、可验证的和系统的。然而,精神病学和临床心理学是自然科学和社会心理学的混合体。(2) 心理疗法和精神病学:精神病学使用心理疗法以及其他各种经授权的治疗方法。西班牙《宪法》和部级规划对西班牙卫生专业的最佳培训做出了规定,并保证正确使用科学知识。美国国家心理健康研究所规定,心理治疗应由心理健康专业人员进行。(3) 心理疗法和心理学:作为一种专门的治疗方法,只有精神病学和临床心理学才具备开展心理治疗的最佳知识体系。然而,心理疗法流派众多,尽管疗效似乎相似,但并非所有流派都有科学依据。其他类型的对话干预可能会陪伴病人,由于严格来说它们不是治疗,因此可能会由拥有各种资格或根本没有资格的人进行。心理疗法是一种非正规的健康干预措施,其侵入性很常见,这有损于最佳的科学信息。
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引用次数: 0
Agitación psicomotriz por abstinencia a benzodiacepinas agravada por un cuadro de retirada brusca de antidepresivos 由于突然停用抗抑郁药,苯二氮卓类药物戒断导致精神运动性躁动加剧。
Q4 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.psiq.2024.100491
Marta Ramírez Bravo, Susana Macayo Villalobos, Mar González Testón, Elena Blanco Martín

A 23-year-old male with a history of alcohol and cannabis use presented to the Emergency Department with symptoms of nervousness and a recent accidental injury. He admitted to consuming multiple medications without a prescription, leading to severe withdrawal symptoms. The diagnosis of "Severe benzodiazepine withdrawal syndrome exacerbated by abrupt discontinuation of antidepressants" and "Cannabis use disorder" was made, and the patient was admitted for further evaluation and treatment in both the psychiatric and internal medicine units.

一名有酗酒和吸食大麻史的 23 岁男性因精神紧张症状和最近的一次意外受伤来到急诊科就诊。他承认在没有处方的情况下服用了多种药物,导致了严重的戒断症状。诊断结果为 "因突然停用抗抑郁药而加重的严重苯二氮卓戒断综合征 "和 "大麻使用障碍",患者入院后将在精神科和内科接受进一步评估和治疗。
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引用次数: 0
What are blood cortisol levels in anxious, depressive, mixed, and healthy controls in high altitude? 高海拔地区焦虑、抑郁、混合和健康对照组的血液皮质醇水平如何?
Q4 Medicine Pub Date : 2024-05-21 DOI: 10.1016/j.psiq.2024.100485
Hesed Virto-Farfan , Carlos Virto , Gustavo E. Tafet

Objective

We aim to determine the difference in blood cortisol levels between major depression, mixed anxious depressive disorder, generalized anxiety disorder, and healthy controls during COVID-19 social isolation in Cusco (3400 m.a.s.l.).

Methods

Non-experimental, cross-sectional analytical design study, designed to determine the difference in blood cortisol levels between anxiety, depression, and mixed disorders in adults aged 25–65 living in Cusco, at the Mental Health Community Center of San Sebastian.

Results

Significant differences were found in the morning, afternoon, and ratio (Afternoon/Morning cortisol) in all the groups. All the pathological groups showed increased cortisol levels than the healthy controls. Major depression group showed a flattening of the normal regulation line of cortisol.

Conclusions

The blood cortisol test shows significant values for the discrimination of affective pathology, particularly between depressive and anxious disorders and normal controls.

目的我们旨在确定库斯科(海拔 3400 米)COVID-19 社会隔离期间重度抑郁症、混合型焦虑抑郁症、广泛性焦虑症和健康对照组之间血液皮质醇水平的差异。方法非实验性横断面分析设计研究,旨在确定居住在库斯科的圣塞巴斯蒂安心理健康社区中心的 25-65 岁成年人血液皮质醇水平在焦虑症、抑郁症和混合症之间的差异。所有病理组的皮质醇水平均高于健康对照组。结论血液皮质醇测试显示出显著的情感病理鉴别值,尤其是在抑郁和焦虑症与正常对照组之间。
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引用次数: 0
期刊
Psiquiatria Biologica
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