Psiquiatria Biologica最新文献

Background

Effective communication is one of the pillars of the doctor–patient relationship. Hyponatremia is defined as a decrease in serum sodium levels below 135 mEq/L.

Objective

To draw attention to the possible results of ineffective medical communication and the importance of active listening to the patient.

Material and methods

Descriptive study of the Case Report type, based on the Case REport guidelines.

Case description

An 85-year-old female, hospitalized from October to December 2021 in acute psychiatry for self-injurious behavior following an experiential crisis. In this episode, hyponatremia with 10 years of evolution was detected. She was evaluated by multiple medical specialties and in the last 10 years suffered from anorexia, asthenia, insomnia, and dizziness, a condition attributed to psychoactive drug-related hyponatremia. After hospitalization in psychiatry, it was found that this condition started before the introduction of psychotropic drugs and that there could be a total restriction of salt in the diet, motivated by a bias in doctor–patient communication.

Conclusion

With a careful collection of the patient's history, it is possible to deconstruct and clarify concepts and beliefs that can negatively affect her health status.

The Ekbom's syndrome or delusion of parasitosis is characterized by the firm belief of being infested, generating behavioral impacts such as the fact of presenting injuries from scratching or investing almost all of their time in disinfecting, as in the case that we describe below. Few studies have been published on this delusion, generally from specific patients. The typical presentation of the case is a middle-aged woman, who goes to the dermatologist or internist's department. The appeareance of anxious-depressive symptoms, consistent with the delusional belief, are frequent. It is known that the prognosis improves considerably when the symptomatic period prior to treatment is very short. Therefore, in order to make a good diagnosis and therapeutic management, it is important to establish close collaboration between the different health professionals.

Objective: In reference to a case of hallucinatory psychosis in an elderly individual treated by the Liaison Psychiatry Team, we will conduct a historical review of the term paraphrenia, linking it to the characteristics of this condition, its treatment, and progression.

Clinical Case: A nonagenarian woman admitted to the Internal Medicine service due to behavioral disturbances of several months' duration. She presents delusional ideas of persecution and visual and auditory hallucinations. There is no history of mental health issues or cognitive impairment. Relevant comorbidities include lumbar canal stenosis and moderate hearing loss.

Results: Additional tests ruled out brain damage, toxic psychosis, neurodegenerative disorders, and delirium. With the approach and follow-up conducted (including antipsychotic treatment), the patient showed sustained behavioral improvement and partial encapsulation of the delusion.

Conclusions: Although paraphrenia is not recognized as a distinct entity in current diagnostic classifications, there are cases that warrant consideration; patients with a well-systematized delusion, onset in late age, and bizarre perceptual phenomena of a unique pathoplasty.

Fathers may also develop depressive symptoms in perinatal period, a condition known as paternal postpartum depression (PPD). Through an intriguing case report, we intend to reflect on PPD, emphasizing the symptomatology, risk factors, and early interventions.

We present a clinical case of a 42-year-old man observed in a psychiatry emergency in the context of a suicide attempt. He reported progressive depressive symptoms since the last trimester of his wife's last pregnancy. He could not recognize any precipitating factors besides the fear of not being a good father and husband. He also refused hospitalization but accepted treatment and follow-up.

This case highlights the need to focus on fathers' emotional well-being in the perinatal period, conduct further research on PPD and the creation of appropriate diagnostic tools to assess the symptomatology of depression in males. Screening programs and tools for maternal perinatal depression, follow-up, and intervention as necessary may be valuables strategies.

Frontotemporal dementia is an insidious neurodegenerative clinical syndrome characterized by progressive deficits in behavior, executive function, and language. The initial clinical presentation of some patients with FTD may resemble bipolar mood disorder.In this case, it was planned to diagnose FTD in addition to the emergence of behavioral and cognitive problems in the patient followed up with bipolar mood disorder and to discuss the difficulties experienced in the treatment. In 2017, he was diagnosed with bipolar mood disorder due to loud speech, irritability, thinking that he was cast under a spell, increased spending, driving fast, swearing at relatives. He was followed up with lithium, olanzapine and quetiapine treatment, and he benefited from the treatment. The diagnosis of frontotemporal dementia was considered in the patient who underwent brain diffusion MRI and PET CT in December 2020, upon the onset of the complaint of forgetfulness. Informed consent was obtained from the patient and his relatives.In conclusion, in our case who was followed up with bipolar disorder, a co-diagnosis of frontotemporal dementia was made with the emergence of memory and behavioral pathologies in the later follow-ups. With the diagnosis of FTD, the severity of the patient's manic episodes, clinical presentation, and treatment response changed. Therefore, FTD should be considered in the differential diagnosis of patients who are followed up with bipolar disorder and subsequently have clinical changes.

Introduction

The rate of non-adherence to treatment in schizophrenia is between 40 and 50%. The scarcity of consistently identified variables associated with nonadherence could be due to real heterogeneity among nonadherent patients.

Objectives

Evaluate the prevalence of non-adherence in patients with schizophrenia or schizoaffective disorder. Evaluate the possible subtypes of non-adherence according to intentionality.

Methodology

110 consecutively admitted patients diagnosed with schizophrenia and schizoaffective disorder were included. They were evaluated during admission and six months after hospital discharge. Sociodemographic, clinical, psychopathological, and treatment-related variables were included. Adherence was defined as the concurrence of adherence to antipsychotic treatment and follow-up. The subtype of non-adherence was established according to the main reason for non-adherence.

Results

Non-adherence was found in 58.2% of the patients. Low socioeconomic status, cannabis use, nonadherence as a reason for relapse and admission, and severity of symptoms were independently associated with nonadherence. Low educational level, poorer treatment knowledge at six months, and use of non-psychiatric treatment at six months were independently associated with the subtype of unintentional non-adherence.

Conclusions

A high percentage of patients with schizophrenia and schizoaffective disorder do not show adherence after hospital discharge. There seem to be subtypes of non-adherence according to the intention, which suggests the need for a differentiated approach.

Background and objectives

Coronavirus disease (COVID-19) is an infectious disease that causes both physical and mental sequelae. The aim of the present study was to evaluate the quality of life and the level of depression in post-COVID-19 patients using the SF-36 Questionnaire (SF-36) and the Beck depression inventory (BDI) and to compare it with the quality of life of the general population for the same sex and age group.

Methods

A cohort, observational, and prospective study was designed with the survivors of the group of 115 patients hospitalized at Hospital Público de Monforte to whom the SF-36 and BDI were performed.

Results

60 patients responded to the questionnaires (mean age 65.24 (± 15.49) years and 40% women). In the SF-36, the summary of the physical and mental component was, respectively, 47.71(± 8.48) and 47.25(± 9.39). Women have lower scores than men in half of the components of the SF-36. The probability of depression inferred by SF-36 was 28% and applying BDI results were 81.67% of the sample were not depressed, 8.33% were mild–moderate depressed, 6,67% were moderate–severe depressed, and 3.33% were severely depressed.

Conclusions

Patients who have suffered COVID-19 predisposes to a higher frequency of depression as well as to a worse quality of life in terms of both physical and mental health. This should serve to raise awareness of the follow-up of patients with long COVID-19 in order to prevent, as far as possible, a decrease in their quality of life.

Introduction

Delirium is a neurocognitive disorder whose prevalence increases with age. Its incidence after cardiac surgery ranges between 11% and 52%. There are a large number of studies on the risk factors that affect the appearance of postoperative delirium in cardiac surgery, although most of them are oriented to physiological factors, often ignoring the possible relevance of neuropsychological aspects, such as cognitive impairment. The objective of this work was to analyze the influence of cognitive impairment as an independent risk factor (predictor) in the appearance of postoperative delirium based on the Mini Mental State Examination (MMSE), after cardiac surgery.

Development

A search was carried out in the databases PubMed, PsycInfo, Scopus and Web of Science. The search was limited to articles published between 2001 and 2022. 384 articles were obtained. Those that were repeated and not related to the topic were eliminated, leaving a total of 8 articles that met the selection criteria. This systematic review was carried out in accordance with the criteria of the PRISMA 2020 statement.

Conclusions

A statistically significant correlation was observed between the measure of cognitive impairment, the MMSE, and the different measures of postoperative delirium, in the majority of studies, so it can be concluded that possibly a mild degree of cognitive impairment may be a sufficient condition for the probability of appearance of postoperative delirium in cardiac surgeries in patients over 60 years of age. Therefore, assessment of cognitive impairment using MMSE before cardiac surgery could be useful to predict the development of postoperative delirium in people over 60 years of age.

Although most of the patients affected by COVID-19 recover their health and return to their previous situation, some of them present symptoms that can last a long time after the acute illness. The main objective of this study is to assess the correlation between symptoms of long COVID and symptoms of central sensitization. Secondarily, it will try to describe the symptoms of long COVID and its correlation with alexithymia and depression.

Methods

Prospective observational study in real clinical conditions. Include consecutively those patients who present long COVID and complete multidisciplinary evaluation by a somatic specialist and a psychiatrist, together with a battery of questionnaires.

Results

The profile we found corresponds to a woman, in the middle of her fifth decade of life, with higher education and working, who passed the SARS-CoV-2 infection 1 year earlier, without requiring hospitalization and with a severe depressive disorder and alexithymia. We found an intermediate correlation (rho .665; p < .01) between central sensitization questionnaire and the sum of symptoms of long COVID, as well as between the sum of symptoms presented and depression (rho .467; p < .01) and not between the sum of symptoms and alexithymia (rho .151; p = .359).

Conclusions

Sensitization phenomena seem to be of notable importance in the symptoms of long COVID and present a symptomatic constellation characterized by fatigue, difficulty concentrating, and memory problems. Patients with persistent COVID present more severe depressive symptoms than they are capable of perceiving o express.

Background and aims

Previous research has linked dietary patterns to depressive disorders, however, there are limited data on the association between the consumption of diets rich in phytochemicals and these disorders. This study aimed to investigate the association between dietary patterns and dietary phytochemical index (DPI) and major depression disorder (MDD) in Iranian females.

Methods

This case–control study was performed on 261 Iranian women (18–65 years, 87 cases, and 174 controls). Food intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Depression was evaluated by a psychiatrist according to DSM IV criteria. We used factor analysis to extract dietary patterns and binary logistic regression to assess the relationship between dietary pattern scores and depression.

Results

Two major dietary patterns were identified: healthy and unhealthy patterns. After controlling for these variables, participants in the highest tertile of the healthy dietary pattern had significantly lower OR for major depression (OR = 0.371; 95% CI: 0.168–0.819, p =.014). The second tertile of the unhealthy dietary pattern, compared with the lowest tertile had a higher OR for major depression (OR = 3.162; 95% CI: 1.451–6.889, p = 0.004). Also, women in the lowest tertile of DPI had a higher risk of major depression (OR 2.668; 95% CI 1.297, 5.491, p =.008) compared with those in the highest tertile.

Conclusions

We found that adherence to a healthy dietary pattern and high intakes of phytochemicals is associated with reduced risk, while an unhealthy dietary pattern is associated with an elevated risk of major depression.