Impact of depressive symptoms on subjective well-being: the importance of patient-reported outcomes in schizophrenia

Objective: The subjective experience of psychotic patients toward treatment is a key factor in medication adherence, quality of life, and clinical outcome. The aim of this study was to assess the subjective well-being in patients with schizophrenia and to examine its relationship with the presence and severity of depressive symptoms. Methods: A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. The Subjective Well-Being under Neuroleptic Scale - short version (SWN-K) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to gather information on well-being and the presence and severity of depressive symptoms, respectively. Spearman's rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the CDSS total score. Discriminative validity was evaluated against that criterion by analysing the area under the curve (AUC). Results: Ninety-seven patients were included in the study. Mean age was 35 years (standard deviation = 10) and 72% were male. Both the total SWN-K scale and its five subscales correlated inversely and significantly with the CDSS total score (P < 0.0001). The highest correlation was observed for the total SWN-K (Spearman's rank order correlation [ rho] = -0.59), being the other correlations: mental functioning (-0.47), social integration (-0.46), emotional regulation (-0.51), physical functioning (-0.48), and self-control (-0.41). A total of 33 patients (34%) were classified as depressed. Total SWN-K showed the highest AUC when discriminating between depressive severity levels (0.84), followed by emotional regulation (0.80), social integration (0.78), physical functioning and self-control (0.77), and mental functioning (0.73). Total SWN-K and its five subscales showed a significant linear trend against CDSS severity levels (P < 0.001). Conclusion: The presence of moderate to severe depressive symptoms was relatively high, and correlated inversely with patients' subjective well-being. Routine assessment of patient-reported measures in patients with schizophrenia might reduce potential discrepancy between patient and physician assessment, increase therapeutic alliance, and improve outcome.

A short in-frame deletion in NTRK1 tyrosine kinase domain caused by a novel splice site mutation in a patient with congenital insensitivity to pain with anhidrosis

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive genetic disease characterized by the lack of reaction to noxious stimuli and anhidrosis. It is caused by mutations in the NTRK1 gene, which encodes the high affinity tyrosine kinase receptor I for Neurotrophic Growth Factor (NGF). -- Case Presentation: We present the case of a female patient diagnosed with CIPA at the age of 8 months. The patient is currently 6 years old and her psychomotor development conforms to her age (RMN, SPECT and psychological study are in the range of normality). PCR amplification of DNA, followed by direct sequencing, was used to investigate the presence of NTRK1 gene mutations. Reverse transcriptase (RT)-PCR amplification of RNA, followed by cloning and sequencing of isolated RT-PCR products was used to characterize the effect of the mutations on NTRK1 mRNA splicing. The clinical diagnosis of CIPA was confirmed by the detection of two splice-site mutations in NTRK1, revealing that the patient was a compound heterozygote at this gene. One of these alterations, c.574+1G > A, is located at the splice donor site of intron 5. We also found a second mutation, c.2206-2 A > G, not previously reported in the literature, which is located at the splice acceptor site of intron 16. Each parent was confirmed to be a carrier for one of the mutations by DNA sequencing analysis. It has been proposed that the c.574+1G > A mutation would cause exon 5 skipping during NTRK1 mRNA splicing. We could confirm this prediction and, more importantly, we provide evidence that the novel c.2206-2A > G mutation also disrupts normal NTRK1 splicing, leading to the use of an alternative splice acceptor site within exon 17. As a consequence, this mutation would result in the production of a mutant NTRK1 protein with a seven aminoacid in-frame deletion in its tyrosine kinase domain. --Conclusions: We present the first description of a CIPA-associated NTRK1 mutation causing a short interstitial deletion in the tyrosine kinase domain of the receptor. The possible phenotypical implications of this mutation are discussed.

Ajuste psicológico y salud mental de la población inmigrante : influencia del género y la cultura

481 p.

El arte como terapia en salud mental

Los planes de atención de enfermería actuales recogen nuevas intervenciones, alternativas a los cuidados convencionales y algunas de ellas poco estudiadas, como lo es el uso de distintas formas de arte como terapia complementaria a un tratamiento médico. Uno de los campos donde más fuerza tiene es en el de la salud mental, ya que permite actuar tanto de forma terapéutica como preventiva. La arteterapia engloba intervenciones con cualquier forma de arte como la pintura, la fotografía, la música o el teatro. Su terreno de actuación, además de la parte puramente asistencial, incluye el ámbito social y educativo que en muchas ocasiones son olvidados en los cuidados enfermeros. Una revisión de este tipo es necesaria para guiar las intervenciones enfermeras englobadas en la mejora de la comunicación no verbal en pacientes con los que la psicoterapia tradicional a través del diálogo no es eficaz y como herramienta de estimulación cognitiva y prevención de síntomas depresivos o ansiosos que conllevan muchas patologías médicas. El objetivo de esta revisión es mostrar una visión general de la situación actual de este tipo de terapia, repasando su evolución histórica y valorar su eficacia a partir de la evidencia científica encontrada. Para ello se realizó un análisis de las publicaciones que tratan este tema, incluyendo artículos de investigación que analizan el efecto de distintos tipos de terapias con arte sobre diversos trastornos, teniendo siempre en cuenta el tipo de artículo analizado así como la calidad científica de las publicaciones.

Análisis de las necesidades emocionales de los menores con trastorno mental grave del centro terapeútico-educativo de Ortuella y diseño de un programa de desarrollo de competencias emocionales a través de la teatralización

En el presente TFG se ha realizado un diagnóstico de las necesidades emocionales de los menores de entre 6 y 12 años diagnosticados de trastorno mental grave que acuden al Centro Terapéutico-Educativo de Ortuella. En la metodología de análisis se han utilizado dos técnicas.: la observación participante en los distintos espacios en los que se desenvuelven los usuarios y la entrevista con cada uno de los profesionales de la entidad. Este análisis ha tenido como objetivo detectar las carencias emocionales de los usuarios que requieren de mayor atención educativa. Además se realiza una propuesta de intervención cuyo eje central es desarrollar las competencias emocionales a través de la teatralización.

Prevención de enfermedades asociadas en personas con Trastorno Mental Grave (TMG): el impacto del estigma e intervenciones de enfermería

Existe una mayor prevalencia de enfermedades asociadas en los pacientes con TMG que en la población general. Esto hace que la esperanza de vida de estas personas se vea reducida. La aparición de las enfermedades adyacentes se debe al tratamiento, hábitos insaludables o la escasa interacción social. La estigmatización de la enfermedad también juega un papel crucial en la evolución del trastorno. Enfermería puede incidir sobre los hábitos de vida, así como fomentar las relaciones personales del paciente para mejorar la calidad de vida y prevenir las enfermedades asociadas. Los objetivos de este trabajo son describir la relación entre padecer un TMG con una mayor incidencia de enfermedades crónicas y realizar una propuesta de cuidados de enfermería para su prevención. Se ha realizado una revisión narrativa, acudiendo a bibliotecas y realizando búsquedas bibliográficas en bases de datos electrónicas. Entre los hábitos no saludables comunes encontramos el tabaquismo, con tasas tres veces superiores en los pacientes con esquizofrenia, mientras que el sedentarismo se da por falta de motivación, o por no encontrarse en un entorno adecuado. Esto produce diferentes enfermedades, donde la más común es la EPOC. Vemos que la intervención bio-psico-social mejora el funcionamiento personal y social de las personas con TMG, mejorando su calidad de vida y permitiendo corregir los hábitos no saludables. Los familiares también pueden verse afectados por lo que incluirlos en la intervención será de ayuda. Dados los prejuicios, ser diagnosticado de TMG genera un impacto en el individuo que rompe las expectativas de vida y futuro, tanto en su ámbito personal como en el familiar. Estos afectan en la calidad de vida del paciente, pues condicionan la aparición del autoestigma. La base para evitar que esto ocurra es la prevención, donde el rol de la enfermera adquiere una gran importancia.

Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

Background: Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods: This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results: In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better. Conclusions: Five clinical predictors easily available in the ED, and also in the primary care setting, can be used to create a simple and easily obtained score that allows clinicians to stratify patients with eCOPD upon ED arrival and guide the medical decision-making process.

Effectiveness of a Multi-Component Smoking Cessation Support Programme (McSCSP) for Patients with Severe Mental Disorders: Study Design

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.

Self-reported sitting time and physical activity: interactive associations with mental well-being and productivity in office employees

Background: Little is known about how sitting time, alone or in combination with markers of physical activity (PA), influences mental well-being and work productivity. Given the need to develop workplace PA interventions that target employees' health related efficiency outcomes; this study examined the associations between self-reported sitting time, PA, mental well-being and work productivity in office employees. Methods: Descriptive cross-sectional study. Spanish university office employees (n = 557) completed a survey measuring socio-demographics, total and domain specific (work and travel) self-reported sitting time, PA (International Physical Activity Questionnaire short version), mental well-being (Warwick-Edinburg Mental Well-Being Scale) and work productivity (Work Limitations Questionnaire). Multivariate linear regression analyses determined associations between the main variables adjusted for gender, age, body mass index and occupation. PA levels (low, moderate and high) were introduced into the model to examine interactive associations. Results: Higher volumes of PA were related to higher mental well-being, work productivity and spending less time sitting at work, throughout the working day and travelling during the week, including the weekends (p < 0.05). Greater levels of sitting during weekends was associated with lower mental well-being (p < 0.05). Similarly, more sitting while travelling at weekends was linked to lower work productivity (p < 0.05). In highly active employees, higher sitting times on work days and occupational sitting were associated with decreased mental well-being (p < 0.05). Higher sitting times while travelling on weekend days was also linked to lower work productivity in the highly active (p < 0.05). No significant associations were observed in low active employees. Conclusions: Employees' PA levels exerts different influences on the associations between sitting time, mental well-being and work productivity. The specific associations and the broad sweep of evidence in the current study suggest that workplace PA strategies to improve the mental well-being and productivity of all employees should focus on reducing sitting time alongside efforts to increase PA.