Publications by authors named "Víctor Pérez-Sola"

46 Publications

Dysfunctional Brain Reward System in Child Obesity.

Cereb Cortex 2021 Apr 16. Epub 2021 Apr 16.

ISGlobal, 08003 Barcelona, Spain.

Eating habits leading to obesity may reflect nonhomeostatic behavior based on excessive immediate-reward seeking. However, it is currently unknown to what extent excess weight is associated with functional alterations in the brain's reward system in children. We tested the integrity of reward circuits using resting-state functional connectivity magnetic resonance imaging in a population of 230 children aged 8-12 years. The major components of the reward system were identified within the ventral striatum network defined on the basis of the nucleus accumbens connectivity pattern. The functional structure of the cerebral cortex was characterized using a combination of local functional connectivity measures. Higher body mass index was associated with weaker connectivity between the cortical and subcortical elements of the reward system, and enhanced the integration of the sensorimotor cortex to superior parietal areas relevant to body image formation. Obese children, unlike WHO-defined overweight condition, showed functional structure alterations in the orbitofrontal cortex and amygdala region similar to those previously observed in primary obsessive-compulsive disorder and Prader-Willi syndrome associated with obsessive eating behavior. Results further support the view that childhood obesity is not simply a deviant habit with restricted physical health consequences but is associated with reward system dysfunction characterizing behavioral control disorders.
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http://dx.doi.org/10.1093/cercor/bhab092DOI Listing
April 2021

Mapping the Synchronization Effect of Gamma-Aminobutyric Acid Inhibition on the Cerebral Cortex Using Magnetic Resonance Imaging.

Brain Connect 2021 Apr 1. Epub 2021 Apr 1.

MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.

Functional magnetic resonance imaging (fMRI) of spontaneous brain activity permits the identification of functional networks on the basis of region synchrony. The functional coupling between the elements of a neural system increases during brain activation. However, neural synchronization may also be the effect of inhibitory gamma-aminobutyric acid (GABA) neurons in states of brain inhibition such as sleep or pharmacological sedation. We investigated the effects of an oral dose of alprazolam, a classical benzodiazepine known to enhance inhibitory neurotransmission, using recently developed measures of local functional connectivity. In a randomized, double-blind, placebo-controlled, crossover design, 32 non-treatment-seeking individuals with social anxiety underwent two identical resting-state fMRI sessions on separate days after receiving 0.75 mg of alprazolam and placebo. Functional connectivity maps of the cerebral cortex were generated by using multidistance functional connectivity measures defined within iso-distant local areas. Relative to placebo, increased intracortical functional connectivity was observed in the alprazolam condition in visual, auditory, and sensorimotor cortices, and in areas of sensory integration such as the posterior insula and orbitofrontal cortex (OFC). Alprazolam significantly reduced subjective arousal compared with placebo, and the change was associated with variations in multidistance functional connectivity measures in the OFC. In conclusion, we report evidence that alprazolam significantly modifies neural activity coupling at rest in the form of functional connectivity enhancement within the cerebral cortex. The effect of alprazolam was particularly evident in the cortical sensory system, which would further suggest a differentiated effect of GABA inhibition on sensory processing.
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http://dx.doi.org/10.1089/brain.2020.0844DOI Listing
April 2021

The clinical effectiveness of using a predictive algorithm to guide antidepressant treatment in primary care (PReDicT): an open-label, randomised controlled trial.

Neuropsychopharmacology 2021 Feb 26. Epub 2021 Feb 26.

P1vital Ltd, Howbery Park, Wallingford, UK.

Depressed patients often do not respond to the first antidepressant prescribed, resulting in sequential trials of different medications. Personalised medicine offers a means of reducing this delay; however, the clinical effectiveness of personalised approaches to antidepressant treatment has not previously been tested. We assessed the clinical effectiveness of using a predictive algorithm, based on behavioural tests of affective cognition and subjective symptoms, to guide antidepressant treatment. We conducted a multicentre, open-label, randomised controlled trial in 913 medication-free depressed patients. Patients were randomly assigned to have their antidepressant treatment guided by a predictive algorithm or treatment as usual (TaU). The primary outcome was the response of depression symptoms, defined as a 50% or greater reduction in baseline score of the QIDS-SR-16 scale, at week 8. Additional prespecified outcomes included symptoms of anxiety at week 8, and symptoms of depression and functional outcome at weeks 8, 24 and 48. The response rate of depressive symptoms at week 8 in the PReDicT (55.9%) and TaU (51.8%) arms did not differ significantly (odds ratio: 1.18 (95% CI: 0.89-1.56), P = 0.25). However, there was a significantly greater reduction of anxiety in week 8 and a greater improvement in functional outcome at week 24 in the PReDicT arm. Use of the PReDicT test did not increase the rate of response to antidepressant treatment estimated by depressive symptoms but did improve symptoms of anxiety at week 8 and functional outcome at week 24. Our findings indicate that personalisation of antidepressant treatment may improve outcomes in depressed patients.
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http://dx.doi.org/10.1038/s41386-021-00981-zDOI Listing
February 2021

The Prevalence and Clinical and Sociodemographic Factors of Problem Online Gambling: A Systematic Review.

J Gambl Stud 2021 Jan 29. Epub 2021 Jan 29.

Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Office 202, PRBB Building, Charles Darwin Sq. (SN), 08003, Barcelona, Catalonia, Spain.

The emergence and spread of new technologies have allowed for the introduction of new forms of gambling. Problem online gambling has specific characteristics, and its prevalence may differ from traditional forms of gambling. This paper systematically reviews studies that include data relevant to problem online gambling and to the sociodemographic and comorbidity variables related to it. A systematic literature search was conducted from Medline database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, preliminary search resulted in 427 articles, from which 20 were included in this systematic review based on pre-determined criteria. The reported prevalence of problem online gambling varied widely across the different studies. This heterogeneity is due to large variations in settings, instruments, and definitions of problem online gambling, which rules out a meta-analytic approach to the results. The sources of variability in the prevalence, the sociodemographic and comorbidity factors, and the implications for future research are discussed.
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http://dx.doi.org/10.1007/s10899-021-09999-wDOI Listing
January 2021

The Prevalence and Clinical and Sociodemographic Factors of Problem Online Gambling: A Systematic Review.

J Gambl Stud 2021 Jan 29. Epub 2021 Jan 29.

Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Office 202, PRBB Building, Charles Darwin Sq. (SN), 08003, Barcelona, Catalonia, Spain.

The emergence and spread of new technologies have allowed for the introduction of new forms of gambling. Problem online gambling has specific characteristics, and its prevalence may differ from traditional forms of gambling. This paper systematically reviews studies that include data relevant to problem online gambling and to the sociodemographic and comorbidity variables related to it. A systematic literature search was conducted from Medline database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, preliminary search resulted in 427 articles, from which 20 were included in this systematic review based on pre-determined criteria. The reported prevalence of problem online gambling varied widely across the different studies. This heterogeneity is due to large variations in settings, instruments, and definitions of problem online gambling, which rules out a meta-analytic approach to the results. The sources of variability in the prevalence, the sociodemographic and comorbidity factors, and the implications for future research are discussed.
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http://dx.doi.org/10.1007/s10899-021-09999-wDOI Listing
January 2021

Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey.

Rev Psiquiatr Salud Ment 2020 Dec 10. Epub 2020 Dec 10.

Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium.

Introduction: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain.

Methods: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders.

Results: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).

Conclusions: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.
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http://dx.doi.org/10.1016/j.rpsm.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726524PMC
December 2020

Largest scale dissociation of brain activity at propofol-induced loss of consciousness.

Sleep 2021 01;44(1)

Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain.

The brain is a functional unit made up of multilevel connected elements showing a pattern of synchronized activity that varies in different states. The wake-sleep cycle is a major variation of brain functional condition that is ultimately regulated by subcortical arousal- and sleep-promoting cell groups. We analyzed the evolution of functional MRI (fMRI) signal in the whole cortex and in a deep region including most sleep- and wake-regulating subcortical nuclei at loss of consciousness induced by the hypnotic agent propofol. Optimal data were obtained in 21 of the 30 healthy participants examined. A dynamic analysis of fMRI time courses on a time-scale of seconds was conducted to characterize consciousness transition, and functional connectivity maps were generated to detail the anatomy of structures showing different dynamics. Inside the magnet, loss of consciousness was marked by the participants ceasing to move their hands. We observed activity synchronization after loss of consciousness within both the cerebral cortex and subcortical structures. However, the evolution of fMRI signal was dissociated, showing a transient reduction of global cortico-subcortical coupling that was restored during the unconscious state. An exception to cortico-subcortical decoupling was a brain network related to self-awareness (i.e. the default mode network) that remained connected to subcortical brain structures. Propofol-induced unconsciousness is thus characterized by an initial, transitory dissociated synchronization at the largest scale of brain activity. Such cortico-subcortical decoupling and subsequent recoupling may allow the brain to detach from waking activity and reorganize into a functionally distinct state.
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http://dx.doi.org/10.1093/sleep/zsaa152DOI Listing
January 2021

A prospective longitudinal study searching for predictors of response to group psychoeducation in bipolar disorder.

J Affect Disord 2020 09 28;274:1113-1121. Epub 2020 Feb 28.

Mental Health Research Group, IMIM-Parc de Salut Mar, CIBERSAM, Auotonomous University of Barcelona (Department of Clinical and Health Psychology), Office 202, PRBB Building, Charles Darwin Sq. (SN) 08003, Barcelona, Catalonia, Spain. Electronic address:

Background: The efficacy of adjunctive group psychoeducation in bipolar disorder has been proven although treatment response differ among individuals. The aim of this study was to characterize responders and non-responders to group psychoeducation in order to identify baseline variables that could predict treatment response.

Methods: The sample was composed of 103 medicated euthymic patients with bipolar disorder referred to 21 sessions of group psychoeducation (6 months). Sociodemographic and clinical variables, temperament, circadian rhythms, BDNF, cognitive and psychosocial functioning were collected. At the 18-month endpoint, the patients were split in two groups on the basis of having suffered any recurrence. Significant group differences were included in a logistic regression analysis.

Results: Ninety patients out of 103 engaged in group psychoeducation, 47 of whom (52.2%) responded to psychoeducation and 43 (47.8%) did not. Recurrences occurred more often in the follow-up, the most common being depression. Responders and non-responders differed in gender, age at diagnosis, latency of diagnosis, temperament, attention composite score and BDNF. Lower age at diagnosis of bipolar disorder, lower cyclothimic temperament scores and being male -which was associated with bipolar type I and a trend to more previous manic episodes- were significantly related to a better response to psychoeducation in the regression analysis.

Limitations: No control group.

Conclusions: This study identifies age at diagnosis as a significant modifiable risk factor of treatment response, highlighting the need for early identification of bipolar disorder. Existing programs should be adjusted to the characteristics of specific subpopulations in the framework of a personalized approach.
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http://dx.doi.org/10.1016/j.jad.2020.02.047DOI Listing
September 2020

A prospective longitudinal study searching for predictors of response to group psychoeducation in bipolar disorder.

J Affect Disord 2020 09 28;274:1113-1121. Epub 2020 Feb 28.

Mental Health Research Group, IMIM-Parc de Salut Mar, CIBERSAM, Auotonomous University of Barcelona (Department of Clinical and Health Psychology), Office 202, PRBB Building, Charles Darwin Sq. (SN) 08003, Barcelona, Catalonia, Spain. Electronic address:

Background: The efficacy of adjunctive group psychoeducation in bipolar disorder has been proven although treatment response differ among individuals. The aim of this study was to characterize responders and non-responders to group psychoeducation in order to identify baseline variables that could predict treatment response.

Methods: The sample was composed of 103 medicated euthymic patients with bipolar disorder referred to 21 sessions of group psychoeducation (6 months). Sociodemographic and clinical variables, temperament, circadian rhythms, BDNF, cognitive and psychosocial functioning were collected. At the 18-month endpoint, the patients were split in two groups on the basis of having suffered any recurrence. Significant group differences were included in a logistic regression analysis.

Results: Ninety patients out of 103 engaged in group psychoeducation, 47 of whom (52.2%) responded to psychoeducation and 43 (47.8%) did not. Recurrences occurred more often in the follow-up, the most common being depression. Responders and non-responders differed in gender, age at diagnosis, latency of diagnosis, temperament, attention composite score and BDNF. Lower age at diagnosis of bipolar disorder, lower cyclothimic temperament scores and being male -which was associated with bipolar type I and a trend to more previous manic episodes- were significantly related to a better response to psychoeducation in the regression analysis.

Limitations: No control group.

Conclusions: This study identifies age at diagnosis as a significant modifiable risk factor of treatment response, highlighting the need for early identification of bipolar disorder. Existing programs should be adjusted to the characteristics of specific subpopulations in the framework of a personalized approach.
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http://dx.doi.org/10.1016/j.jad.2020.02.047DOI Listing
September 2020

Deep brain stimulation in treatment resistant schizophrenia: A pilot randomized cross-over clinical trial.

EBioMedicine 2020 Jan 8;51:102568. Epub 2020 Jan 8.

Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.

Background: Up to 30% of patients with schizophrenia are resistant to antipsychotic drug treatment, with 60% of such cases also failing to respond to clozapine. Deep brain stimulation (DBS) has been used in treatment resistant patients with other psychiatric disorders, but there is a lack of trials in schizophrenia, partly due to uncertainties over where to site the electrodes. This trial aimed to examine the effectiveness of nucleus accumbens (NAcc) and subgenual anterior cingulate cortex (subgenual ACC) targeted DBS; the primary outcome measure was PANSS total score, as assessed fortnightly.

Methods: Eight patients with schizophrenia, who met criteria for treatment resistance and were also resistant to/intolerant of clozapine, were randomly assigned using central allocation to receive DBS in the NAcc or subgenual ACC. An open stabilization phase lasting at least six months was followed by a randomized double-blind crossover phase lasting 24 weeks in those who met symptomatic improvement criteria. The primary end-point was a 25% improvement in PANSS total score. (ClinicalTrials.gov Identifier: NCT02377505; trial completed).

Findings: One implanted patient did not receive DBS due to complications of surgery. Of the remaining 7 patients, 2/3 with NAcc and 2/4 with subgenual ACC electrode placements met the symptomatic improvement criteria (58% and 86%, and 37% and 68% improvement in PANSS total score, respectively). Three of these patients entered the crossover phase and all showed worsening when the stimulation was discontinued. The fourth patient worsened after the current was switched off accidentally without her or the investigators' knowledge. Physical adverse events were uncommon, but two patients developed persistent psychiatric adverse effects (negative symptoms/apathy and mood instability, respectively).

Interpretation: These preliminary findings point to the possibility of DBS having therapeutic effects in patients with schizophrenia who do not respond to any other treatment. Larger trials with careful attention to blinding will be necessary to establish the extent of the benefits and whether these can be achieved without psychiatric side-effects.
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http://dx.doi.org/10.1016/j.ebiom.2019.11.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953640PMC
January 2020

Expert consensus on information sheet proposals for patients under treatment with lithium.

Rev Psiquiatr Salud Ment 2021 Jan-Mar;14(1):27-39. Epub 2019 Dec 25.

Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, IDIBELL, CIBERSAM, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.

Introduction: Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium.

Material And Methods: A modified Delphi method in two rounds was used. The Scientific Committee-made up by nine psychiatrists-created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3].

Results: A high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists.

Conclusions: This study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.
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http://dx.doi.org/10.1016/j.rpsm.2019.11.001DOI Listing
December 2019

Brain activity during traditional textbook and audiovisual-3D learning.

Brain Behav 2019 10 30;9(10):e01427. Epub 2019 Sep 30.

MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.

Introduction: Audiovisual educational tools have increasingly been used during the past years to complement and compete with traditional textbooks. However, little is known as to how the brain processes didactic information presented in different formats. We directly assessed brain activity during learning using both traditional textbook and audiovisual-3D material.

Methods: A homogeneous sample of 30 young adults with active study habits was assessed. Educational material on the subject of Cardiology was adapted to be presented during the acquisition of functional MRI.

Results: When tested after image acquisition, participants obtained similar examination scores for both formats. Evoked brain activity was robust during both traditional textbook and audiovisual-3D lessons, but a greater number of brain systems were implicated in the processing of audiovisual-3D information, consistent with its multisource sensory nature. However, learning was not associated with group mean brain activations, but was instead predicted by distinct functional MRI signal changes in the frontal lobes and showed distinct cognitive correlates. In the audiovisual-3D version, examination scores were positively correlated with late-evoked prefrontal cortex activity and working memory, and negatively correlated with language-related frontal areas and verbal memory. As for the traditional textbook version, the fewer results obtained suggested the opposite pattern, with examination scores negatively correlating with prefrontal cortex activity evoked during the lesson.

Conclusions: Overall, the results indicate that a similar level of knowledge may be achieved via different cognitive strategies. In our experiment, audiovisual learning appeared to benefit from prefrontal executive resources (as opposed to memorizing verbal information) more than traditional textbook learning.
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http://dx.doi.org/10.1002/brb3.1427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790317PMC
October 2019

Prospective cohort study of early biosignatures of response to lithium in bipolar-I-disorders: overview of the H2020-funded R-LiNK initiative.

Int J Bipolar Disord 2019 Sep 25;7(1):20. Epub 2019 Sep 25.

Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University Hospital of Copenhagen, Copenhagen, Denmark.

Background: Lithium is recommended as a first line treatment for bipolar disorders. However, only 30% of patients show an optimal outcome and variability in lithium response and tolerability is poorly understood. It remains difficult for clinicians to reliably predict which patients will benefit without recourse to a lengthy treatment trial. Greater precision in the early identification of individuals who are likely to respond to lithium is a significant unmet clinical need.

Structure: The H2020-funded Response to Lithium Network (R-LiNK; http://www.r-link.eu.com/ ) will undertake a prospective cohort study of over 300 individuals with bipolar-I-disorder who have agreed to commence a trial of lithium treatment following a recommendation by their treating clinician. The study aims to examine the early prediction of lithium response, non-response and tolerability by combining systematic clinical syndrome subtyping with examination of multi-modal biomarkers (or biosignatures), including omics, neuroimaging, and actigraphy, etc. Individuals will be followed up for 24 months and an independent panel will assess and classify each participants' response to lithium according to predefined criteria that consider evidence of relapse, recurrence, remission, changes in illness activity or treatment failure (e.g. stopping lithium; new prescriptions of other mood stabilizers) and exposure to lithium. Novel elements of this study include the recruitment of a large, multinational, clinically representative sample specifically for the purpose of studying candidate biomarkers and biosignatures; the application of lithium-7 magnetic resonance imaging to explore the distribution of lithium in the brain; development of a digital phenotype (using actigraphy and ecological momentary assessment) to monitor daily variability in symptoms; and economic modelling of the cost-effectiveness of introducing biomarker tests for the customisation of lithium treatment into clinical practice. Also, study participants with sub-optimal medication adherence will be offered brief interventions (which can be delivered via a clinician or smartphone app) to enhance treatment engagement and to minimize confounding of lithium non-response with non-adherence.

Conclusions: The paper outlines the rationale, design and methodology of the first study being undertaken by the newly established R-LiNK collaboration and describes how the project may help to refine the clinical response phenotype and could translate into the personalization of lithium treatment.
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http://dx.doi.org/10.1186/s40345-019-0156-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760458PMC
September 2019

Psychotic disorders versus other psychiatric diagnoses in consultation-liaison psychiatry: 10 years of a single-center experience.

Actas Esp Psiquiatr 2019 Jul 1;47(4):149-57. Epub 2019 Jul 1.

Department of Psychiatry. Institut de Neurociències. Hospital Clínic i Provincial de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Universitat de Barcelona. CERCA Programme/Generalitat de Catalunya. Barcelona. Spain.

Introduction: The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings.

Objectives: To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs).

Materials And Methods: Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs.

Results: We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care.

Conclusions: Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs.
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July 2019

Neuropsychiatric Symptoms as Predictors of Clinical Course in Neurodegeneration. A Longitudinal Study.

Front Aging Neurosci 2019 24;11:176. Epub 2019 Jul 24.

Departments of Psychiatry, Physiology and Institute for Studies on the Aging, Pontificia Universidad Javeriana, Bogotá, Colombia.

: To study the extent to which neuropsychiatric symptoms (NPS) influence the cognitive and functional decline in frontotemporal degeneration (FTD) and Alzheimer's disease (AD). : We assessed the progression of NPS and their influence on cognitive and functional progression in a group of FTD ( = 36) and AD patients ( = 47) at two different stages of the disease (2.5 years). A standardized scale was used to assess NPS-the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD)-which tracks different symptoms including depression, psychotic symptoms, as well as sleep and conduct problems. In addition, in a subsample of patients (AD = 14 and FTD = 14), we analyzed another group of NPS by using the Neuropsychiatric Inventory (NPI). Cognitive declines were tracked by using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), while functionality was tracked by using the Lawton scale and the Barthel Index. : The presence of NPS impacts cognitive and functional decline in both groups of patients 2.5 years after disease onset. However, we observed a dissociable profile of the affectation of NPS in each group. In the AD group, results indicate that the progression of depressive symptoms and sleep problems predict cognitive and functional decline. In contrast, the progression of a mixed group of NPS, including conduct problems and delusions, predicts cognitive and functional decline in FTD. : The presence of NPS has a critical impact on the prediction of cognitive decline in FTD and AD patients after 2.5 years of disease progression. Our results demonstrate the importance of assessing different types of NPS in neurodegenerative disorders which, in turn, predict disease progression. Future studies should assess the role of NPS in predicting different neurocognitive pathways and in neurodegeneration.
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http://dx.doi.org/10.3389/fnagi.2019.00176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668630PMC
July 2019

Lithium: The survivor that came from the stars.

Bipolar Disord 2019 08 24;21(5):470-471. Epub 2019 May 24.

Psychiatry Department, Hospital del Mar, Barcelona, Spain.

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http://dx.doi.org/10.1111/bdi.12792DOI Listing
August 2019

Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona.

Rev Psiquiatr Salud Ment 2019 Oct - Dec;12(4):207-212. Epub 2019 Jan 19.

Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, España; Medical Research Institute (IMIM), Hospital del Mar , Barcelona; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España.

Introduction: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit.

Material And Methods: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes.

Results: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients.

Conclusions: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.
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http://dx.doi.org/10.1016/j.rpsm.2018.09.003DOI Listing
May 2020

Clinical improvement of somatic and affective symptoms in a patient with complex trauma through the use of EMDR. Report of a clinical case.

Actas Esp Psiquiatr 2018 Nov 1;46(6):242-8. Epub 2018 Nov 1.

Centre Emili Mira, Institute of Neuropsychiatry and Addictions (INAD) Parc de Salut Mar, Barcelona, Spain Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain Institute of Neuropsychiatry and Addictions (INAD) Hospital del Mar, Barcelona, Spain Department of Psychiatry, Autonomous University of Barcelona, Spain CIBERSAM, Madrid, Spain.

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November 2018

OpenSIMPLe: A real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder.

J Affect Disord 2018 12 14;241:436-445. Epub 2018 Aug 14.

Mental Health Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques)-Hospital del Mar,CIBERSAM, Barcelona, Catalonia, Spain.

Background: Few evidence-based mental health apps are widely available to patients and, conversely, many of the available apps have not been appropriately evaluated. Given that the ultimate goal is to scale-up and open internet-based platforms (IBP), it is crucial to appropriately evaluate their real-world feasibility beforehand. We aimed to evaluate the implementation feasibility of a smartphone-based psychoeducational programme for bipolar disorder, exploring its long-term retention, usability, perceived helpfulness and satisfaction, alongside its impact on secondary health outcomes.

Methods: Participants were recruited via the project website after completing an online screening questionnaire. They were requested to complete web-based questionnaires before using the app and after 6 months of use which included sociodemographic, illness and treatment variables, the world health organisation-five well-being index (WHO-5) and the short form health survey (SF-36). The follow-up questionnaires also contained satisfaction and usefulness questions.

Results: 201 participants took part in the study. According to their retention, 66.2% of the participants were classified as noncompleters and 33.8% as completers. The only predictor significantly associated with higher odds of retention was older age (OR = 1.021, p < 0.001). 62% of the users reported they were satisfied with the programme with a higher percentage among completers. Who-5 baseline and follow-up scores showed a significant improvement as well as 6 out of 8 domains of the SF-36.

Limitations: Screening and outcome measures were administered using exclusively self-reported online methods.

Conclusion: The 6-month attrition rate of the programme was high. Positive outcomes regarding satisfaction were found predominantly among completers. The optimal dosage and retention of IBP mental health programmes remain challenging issues that need further research.
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http://dx.doi.org/10.1016/j.jad.2018.08.048DOI Listing
December 2018

Clinical features of a sample of inpatients with adjustment disorder referred to a consultation-liaison psychiatry service over 10 years.

Gen Hosp Psychiatry 2018 Nov - Dec;55:98-99. Epub 2018 Aug 10.

Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.genhosppsych.2018.08.003DOI Listing
July 2019

Translational research in psychiatry: The Research Domain Criteria Project (RDoC).

Rev Psiquiatr Salud Ment 2019 Jul - Sep;12(3):187-195. Epub 2018 Jun 23.

Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra (UPF), Barcelona, España; Centro de Investigación Biomédica en Red de Salud Pública (CIBERESP), Madrid, España; Grupo de Investigación en Servicios Sanitarios, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España. Electronic address:

Despite the consensus achieved in the homogenization of clinical criteria by categorical psychiatric classification systems (DEM and CIE), they are criticized for a lack of validity and inability to guide clinical treatment and research. In this review article we introduce the Research Domain Criteria (RDoC) framework as an alternative framework for translational research in psychiatry. The RDOC framework systematizes both research targets and methodology for research in psychiatry. RDoC is based on a catalogue of neurobiological and neurocognitive evidence of behaviour, and conceives psychopathology as the phenotypic expression of alterations of functional domains that are classified into 5psychobiological systems. The RdoC framework also proposes that domains must be validated with evidence in 7levels of analysis: genes, molecules, cells, nerve circuits, physiology, behaviour and self-reports. As opposed to categorical systems focused on diagnosis, RDoC focuses on the study of psychopathology as a correlate of detectable functional, biological and behavioural disruption of normal processes. In order to build a useful psychiatric nosology for guiding clinical interventions, the RDoC research framework links the neurobiological basis of mental processes with phenotypical manifestations. Although the RDoC findings have not yet been articulated into a specific model for guiding clinical practice, they provide a useful transition system for creating clinical, basic and epidemiological research hypotheses.
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http://dx.doi.org/10.1016/j.rpsm.2018.04.002DOI Listing
May 2020

Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-yearperiod.

Actas Esp Psiquiatr 2018 Mar 1;46(2):58-67. Epub 2018 Mar 1.

Consultation-Liaison Service. Department of Psychiatry. Institut de Neurociències. Hospital Clínic i Provincial de Barcelona. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - Universitat de Barcelona. CERCA Programme/Generalitat de Catalunya. Barcelona. Spain.

Objective: Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005–2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years.

Methods: Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service.

Results: 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes.

Conclusions: Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty.
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March 2018

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

BMC Health Serv Res 2017 Dec 13;17(1):821. Epub 2017 Dec 13.

Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain.

Background: Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice.

Methods: Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care.

Design: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system.

Participants: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia).

Intervention: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework.

Measures: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact.

Discussion: This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society.

Trial Registration: ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.
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http://dx.doi.org/10.1186/s12913-017-2774-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729287PMC
December 2017

A multi-centre, randomised, double-blind, placebo-controlled clinical trial of methylphenidate in the initial treatment of acute mania (MEMAP study).

Eur Neuropsychopharmacol 2018 01 23;28(1):185-194. Epub 2017 Nov 23.

Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany.

Based on many clinical and preclinical findings the 'vigilance regulation model of mania' postulates that an unstable regulation of wakefulness is a pathogenetic factor in both mania and Attention Deficit Hyperactivity Disorder (ADHD) and induces hyperactivity and sensation seeking as an autoregulatory attempt to stabilize wakefulness. Accordingly, stimulant medications with their vigilance stabilizing properties could have rapid antimanic effects similar to their beneficial effects in ADHD. The MEMAP study - a multi-center, double-blind, placebo-controlled and randomized clinical trial (RCT) - assessed the antimanic efficacy and safety of a 2.5-day treatment with methylphenidate (20-40mg/day). Of 157 screened patients with acute mania, 42 were randomly assigned to receive 20-40mg per day of methylphenidate in one or two applications, or placebo. The primary outcome was the change in Young Mania Rating Scale (YMRS) sum scores from baseline to day 2.5 in the methylphenidate group compared to the placebo group. A group sequential design was chosen to justify early RCT termination based on efficacy or futility at an interim analysis after inclusion of 40 patients. In the interim analysis, the change from baseline in the YMRS total score at day 2.5 was not significantly different between both groups (F(1,37)=0.23; p=0.64). Thus, futility was declared for methylphenidate and the RCT was stopped. In summary, although methylphenidate was well tolerated and safe in the full analysis set, it failed to show efficacy in the treatment of acute mania.

Trial Registration: clinicaltrials.gov (URL: http://www.clinicaltrials.gov; registration number: NCT01541605).
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http://dx.doi.org/10.1016/j.euroneuro.2017.11.003DOI Listing
January 2018

Systematic review of depression in patients with multiple sclerosis and its relationship to interferonβ treatment.

Mult Scler Relat Disord 2017 Oct 12;17:138-143. Epub 2017 Jul 12.

Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, passeig marítim 25-29, 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.

Background: Multiple sclerosis is a chronic disease considered the major cause of neurological disability in young adults worldwide. While depression is considered a determinant factor of impaired quality of life and poorer prognosis among patients with multiple sclerosis, it is very often dismissed and undertreated by physicians. Depression has been related to treatment with some immunomodulatory drugs, such as IFNβ. Data from patients who committed suicide during the pivotal study of interferon used as a disease modifying treatment in multiple sclerosis support this association. Moreover, there is plenty of evidence of neuropsychiatric toxicity caused by the use of IFNα as a treatment for other medical conditions. Although this link still remains relatively unknown, the presence of warnings regarding the possible relationship between depression and IFNβ led to restriction in medical indications in these patients. The purpose of this paper is to try to understand the reasons for an increased prevalence in depression in multiple sclerosis and to examine the impact that IFNβ treatment has on their mood.

Methods: We performed a literature search on MEDLINE and Google Scholar databases applying PRISMA guidelines for systematic reviews. Studies were included if the participants were diagnosed with MS and prescribed IFNβ as the main treatment. We excluded non-english and full-text non available papers, as well as the articles where mental health was assessed exclusively as a feature of quality of life. The sample includes articles from 1980 to 2014, although filtration by year of publication was not applied and contains data from IFNβ-1a and IFNβ-1b. The Cochrane Collaboration Tool assessing risk of bias was used to determine the quality of the studies.

Results: Ten studies met full criteria for inclusion and final data extraction. The articles have heterogeneity regarding the samples, the methodology used and the expression of the results. Only three studies support the evidence of a relationship between depression and interferon, which is statistically significant in some patients at the beginning of the treatment. They suggest that only patients on IFNβ treatment with a past history of depression may develop a major depression episode during the first six months. The remaining articles reviewed (including BENEFIT, BEYOND, and LTF trials) suggest the absence of an association.

Conclusion: The reviewed studies conclude that there is not a clear relationship between IFNβ and depression. A history of depression is a risk factor for developing depression during the first 6 months of treatment, nevertheless, it is not sufficient to contraindicate it. The development of new strategies is crucial for early detection of depressive symptoms. An adequate treatment can both improve the mood and deal with the neurological disease by increasing treatment adherence and interfering with inflammation. Chronic destructive brain changes and serotonergic depletion due to inflammatory factors have been proposed as the underlying cause of depression in these patients. It is suggested that these patients would have fewer functional reserve remaining to deal with stressful life events, which could precipitate a depressive disorder.
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http://dx.doi.org/10.1016/j.msard.2017.07.008DOI Listing
October 2017

Is a SIMPLe smartphone application capable of improving biological rhythms in bipolar disorder?

J Affect Disord 2017 12 10;223:10-16. Epub 2017 Jul 10.

Mental Health Group, IMIM-Hospital del Mar, CIBERSAM, Barcelona, Catalonia, Spain.

Background: Biological rhythms (BR) disturbance has been suggested as a potential mediator of mood episodes in Bipolar Disorder (BD). The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was designed as an assessment tool to evaluate BR domains comprehensively. In the context of a trial evaluating a smartphone application delivering personalized psychoeducational contents for BD (SIMPLe 1.0), the main aim of this study is to evaluate the potential impact of SIMPLe 1.0 in BR regulation using the BRIAN scale.

Methods: 51 remitted BD patients were asked to use the application for 3 months. Paired t-test analyses were employed to compare baseline and follow-up BRIAN´s total and domains scores. The sample was divided into completers and non-completers of the study to evaluate differences between groups regarding BRIAN scores using ANCOVA analyses.

Results: The BRIAN's mean total score of the whole sample significantly decreased from baseline to post-intervention (35.89 (SD 6.64) vs. 31.18 (SD 6.33), t = 4.29, p = 0.001). At post-intervention, there was a significant difference between groups regarding the total BRIAN mean score (29.47 (SD 6.21) completers vs. 35.92 (SD 3.90) non-completers, t = 2.50, p = 0.02). This difference was maintained after conducting a one-way ANCOVA controlling for pre-intervention BRIAN scores, F (1, 46) = 10.545, p=0.002.

Limitations: A limited sample, pre-post measures, and a short study timeframe could have affected the results. Additional factors affecting BR, such as medication, could not be ruled out.

Conclusion: Our results suggest that there are potential positive effects of a psychoeducational smartphone application as an adjunctive to treatment as usual on BD patients' BR.
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http://dx.doi.org/10.1016/j.jad.2017.07.028DOI Listing
December 2017

A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors.

Schizophr Res 2017 11 22;189:61-68. Epub 2017 Feb 22.

Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.

Objective: 1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables.

Methods: 248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables.

Results: Around 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors.

Conclusions: Results confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self-reflection or strategic metacognition.
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http://dx.doi.org/10.1016/j.schres.2017.02.016DOI Listing
November 2017

Sleep study in Disruptive Mood Dysregulation Disorder and Bipolar children.

Actas Esp Psiquiatr 2017 Jan 1;45(1):12-20. Epub 2017 Jan 1.

Servei de Psiquiatria i Psicologia Infantil i Juvenil, Hospital Clínic i Provincial, Barcelona.

Introduction: Decreased need for sleep has been proposed as a core symptom of mania and it has been associated with the pathogenesis of Bipolar Disorder. The emergence of Disruptive Mood Dysregulation Disorder (DMDD) as a new diagnostic has been controversial and much has been speculated about its relationship with the bipolar spectrum. REM sleep fragmentation could be a biomarker of affective disorders and it would help us to differentiate them from other disorders.

Method: Polysomnographic cross-sectional study of children with DMDD, bipolar disorder and Attention Deficit Hyperactivity Disorder (ADHD). All participants underwent a psychiatric semi-structured interview to obtain the diagnosis, comorbidities and primary sleep disorders. DMDD’s sample was performed following DSM5 criteria.

Goals: Perform polysomnography in a sample of bipolar, DMDD and ADHD children and compare their profiles to provide more evidence about the differences or similarities between bipolar disorder and DMDD.

Results: Bipolar group had the highest REM density values while ADHD had the lowest. REM density was not statiscally different between bipolar phenotypes. REM density was associated with antidepressant treatment, episodes of REM and their interaction. REM latency was associated with antipsychotic treatment and school performance. Bipolar patients had higher scores on the depression scale than DMDD and ADHD groups.

Conclusions: No significant differences between the two compared affective disorders were found. However there were differences in REM density between bipolar and ADHD groups. REM sleep study could provide a new theoretical framework to better understand the pathogenesis of pediatric bipolar disorder.
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January 2017

Sluggish Cognitive Tempo in a Child and Adolescent Clinical Outpatient Setting.

J Psychiatr Pract 2016 09;22(5):355-62

CAMPRODON-ROSANAS: Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí i La Mina, Parc de Salut Mar, and Departament de Psiquiatria i de Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain BATLLE, ESTRADA-PRAT, ACEÑA-DÍAZ, PETRIZAN-ALEMAN, PUJALS, and MARTIN-LÓPEZ: Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí i La Mina, Parc de Salut Mar, Barcelona PÉREZ-SOLÁ: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); Departament de Psiquiatria i de Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain RIBAS-FITÓ: CSMIJ Gavà. Fundació Orienta.

Sluggish cognitive tempo (SCT) symptoms have largely emerged from investigations of attention-deficit/hyperactivity disorder (ADHD). Recent research has demonstrated the relevance of SCT symptoms in the field of clinical child and adolescent psychiatry. The goal of this research was to study the symptoms of SCT in a clinical child and adolescent sample and to define its features and comorbid conditions. We reviewed 834 clinical records of patients referred to Child and Adolescent Mental Health Services and examined SCT symptoms and their relation with sociodemographic data, clinical diagnosis, comorbid conditions, Child Behavior Checklist dimensions, and intelligence quotient. Of the 515 patients (age range, 4 to 17 y, 62.5% male) for whom a fully completed Child Behavior Checklist for Children and Adolescents was available, 20.8% showed high levels of SCT symptoms. SCT symptoms were strongly associated with age, internalizing symptoms, learning disabilities, and ADHD inattentive subtype (ADHD-I). No significant correlations with intelligence quotient were found. We concluded that SCT symptoms are highly prevalent in a clinical sample, and that these symptoms might be related to the difficulties that some individuals have in responding to demands in their environments, such as academic or social demands, as they increase over time.
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http://dx.doi.org/10.1097/PRA.0000000000000177DOI Listing
September 2016