Psiquiatria Biologica最新文献

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.

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.

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.

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.

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.

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.

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.

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.

Catatonia is characterized by a severe psychomotor change that, according to DSM-5, requires 3 or more of the following symptoms that is necessary to affirm its diagnosis: stupor, catalepsy, brain flexibility, mutism, negativism, posturing, mannerisms, stereotypes, agitation not influenced by external stimuli, grimaces, echolalia, or echopraxia. Clozapine is one of the second-generation antipsychotics that is recognized for its effectiveness in treating catatonia, rather than inducing it. However, its abrupt discontinuation can induce rapid clinical deterioration with multiple presentations including, psychoses or cholinergic rebound states, serotonergic syndromes, and catatonia.

Based on a clinical case, the authors intend to review the literature on catatonia associated with abrupt interruption of clozapine.

In this article, we present a case of a 34-year-old man, with a diagnosis of schizoaffective disorder, admitted to the psychiatric ward due to a psychotic decompensation, who developed a state of agitated catatonia secondary to the abrupt discontinuation of clozapine.

It is well established that the abrupt discontinuation of clozapine can trigger catatonia. This clinical case and literature review serves to emphasize the importance of educating psychiatrists on the adverse effects of psychiatric drugs and, in this case, the gradual and cautious discontinuation of clozapine in order to avoid its rebound effects.

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.