Psiquiatria Biologica最新文献

Autism spectrum disorder is a neurodevelopmental disorder with a current global prevalence of approximately 1%. It is common that the main symptoms of this disorder, such as deterioration in social interactions, restricted or atypical interests, and cognitive and verbal communication deficiencies, can be confused with symptoms of the psychotic sphere typical of schizophrenia. An adequate evaluation is necessary due that both entities can coexist with a variable prevalence of 12 to 50%. Moreover, both disorders can coexist with a variable prevalence of 12 to 50%. We present the clinical case of a woman who, at the age of 20, began follow-up in the mental health unit due to symptoms compatible with an obsessive-compulsive disorder along with a clinic characterized by apathy, anhedonia, abandonment of self-care and progressive functional deterioration. After several evaluation sessions, we diagnosed an autism spectrum disorder. We carry out a bibliographic review with which we conclude that the intersection of symptoms between autism and schizophrenia is common and clinical recommendations are provided to differentiate both clinical entities.

The Interpersonal Theory of Suicide states that acquired capability refers to the fact that repeated exposure to pain leads to habituation to these experiences, which is what leads the individual, if he or she also has suicidal ideation, to commit suicide. Therefore, the aim of this study is to analyze the differences in the acquired capability on the basis of the existence or not of suicidal risk. The results support those found in other studies, showing that there are statistically significant differences between those at risk and those not at risk, with those at risk having the highest mean scores. Therefore, the acquired capability variable is shown to be a variable highly related to suicidal risk.

Psychiatric disorders in childhood and adolescence may persist, change, remit or increase in adulthood. This study explores the diagnostic stability and trajectories of 311 children and adolescents aged 3-17 years into adulthood. Diagnostic stability is found to vary according to pathology. Diagnostic changes are more frequent in conduct disorder and affective disorders, while the highest diagnostic stability was found in learning difficulties, attention deficit learning disabilities, attention deficit hyperactivity disorder and autism spectrum disorders. Complete remission is more frequent in anxiety disorders. Psychiatric diagnoses have social, emotional and practical implications. Mental health resources need to be adapted to the needs of each age group.

Properly understanding a psychopathological term requires knowledge of the disorder described, the contexts and concepts from which it was coined, and its modification over time. In the case of formal thought disorder, we describe its evolution from its incorporation into psychopathology for purely descriptive purposes and associated with the influence of associationism and the idea of a direct dependence between thought and language to the present day, in which the use of computational tools and hypotheses from linguistics have promoted its use as a diagnostic tool and prognostic marker, while simultaneously leading to the incorporation of new terminology.

Background

Medical students present with elevated levels of stress, anxiety, and depression. Religious coping is an avenue for understanding and coping with negative life events that are related to the sacred. There are several studies of association between religious coping and levels of stress, anxiety and depression. The aim of the study was to determine the influence of religious coping on stress, anxiety and depression in medical students of the Universidad Andina del Cusco.

Methods

Analytical cross-sectional study in 317 medical students of the Universidad Andina del Cusco. The Depression, Anxiety and Stress Scale (DASS-21) was used to measure stressful states and the Abbreviated Religious Coping Scale (Brief RCOPE) to determine levels of positive and negative religious coping. For the expression of the results, prevalence and frequencies, Spearman's correlation and chi-square, p-value and 95% CI were calculated. All medical students who gave their informed consent and who regularly attended the 2020-I academic year were included.

Results

Of the participants, 51.5% were female. Mean age was 21.31 years. The 66.2% obtained scores of depression-moderate, severe or extremely-severe, 70.9% obtained scores of anxiety-moderate, severe or extremely-severe and 42.3% presented stress-moderate, severe or extremely-severe. Negative religious coping had a highly significant positive relationship with stress, anxiety and depression.

Interpretation

Negative religious coping was significantly (< 0.001) and positively associated with stress (0.252), anxiety (0.304) and depression (0.357), with high power (> 0.5). The study has clinical and public health implications.

This is the Spanish translation of an international guideline which proposes improving clozapine package inserts worldwide by using ancestry-based: 1) dosing and 2) titration. Adverse drug reaction (ADR) databases suggest clozapine: 1) is the third most toxic drug in the United States (US), and 2) produces worldwide pneumonia mortality four times greater than that of agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers require the lowest dose and male smokers the highest dose). Poor metabolizer (PM) status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity or inflammation with C-reactive protein (CRP) elevations. People with ancestry from Asia (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/ml. Daily doses of 300-600 mg/day are recommended in the US. Slow personalized titration may prevent early ADRs (including syncope, myocarditis and pneumonia). The core of this guideline consists of six personalized titration schedules for inpatients: 1) Asian/Amerindian ancestry with lower metabolism (in cases of obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) Asian/Amerindian ancestry with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (in cases of obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US of non-Asian/Amerindian ancestry with lower clozapine metabolism (in cases of obesity or valproate) needing 150-300 mg/day, and 6) in the US of non-Asian/Amerindian ancestry with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least 4 weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.

The present article aims to expand the clinical and neuroimaging information of Cotard Syndrome, present therapeutic approaches, as well as the limitations in its practice. The case of a 54-year-old patient with a history of bipolar disorder who was admitted to a mental health institution with a depressive clinical presentation characterized by clinophilia, accompanied by nihilistic and guilt delusions, is presented. Pharmacological treatment was initiated with antipsychotics, antidepressants, and a mood stabilizer, resulting in the resolution of the condition and an improvement in the quality of life. Currently, much remains to be known about this clinical entity. Functional neuroimaging and clinical assessment will be the pillars that allow us to elucidate the physiopathological complexities and make advances in its classification, diagnosis, and comprehensive management.

Introduction

Disruption in sleep continuity can be assessed by the sleep fragmentation index (SFI), a measure that has proven useful in the evaluation of individuals with various sleep disorders. Problems with sleep structure are present in autism spectrum disorder (ASD), but the SFI has not been evaluated in this type of population. The aim of this study was to evaluate the characteristics of the SFI in a group of children with ASD and in a group of typically developing (TD) children.

Methods

Polysomnography recordings were performed in 19 children with ASD of mean age 10.1 (± 2.5) years and in 19 children with TD of mean age 10.8 (± 2.5) years. In both groups, the Mann Whitney U test was used to compare the SFI , total sleep time, percentages of sleep stages, wake after sleep onset, sleep onset latency and REM sleep latency.

Results

Of the sleep variables evaluated, in the ASD group the percentage of REM sleep was significantly lower, while REM sleep latency was significantly higher.

Conclusions

Sleep fragmentation is not a characteristic feature of ASD. Significant variation in REM sleep provides evidence in favor of the hypothesis of REM sleep deficiency in ASD.

Schizophrenia is an illness that affects millions of individuals. It is typically accompanied by positive, negative and cognitive symptoms. These symptoms are typically associated with the onset and progression of schizophrenia. However, aside from these known symptoms, there are consequences of having schizophrenia. In particular, metabolic syndrome, early death and suicide, diseases, lowered pain perception, sexual dysfunction, aggressive behavior/victimization, stigma, and cognitive deficit are all consequences of having schizophrenia. In this paper, we review the various consequences of having schizophrenia. These consequences should be monitored for, much like the typical symptoms, but are usually omitted from treatment.