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Research on the use of Acceptance and Commitment Therapy (ACT) for patients with degenerative lumbar pathology awaiting surgery are limited. However, there is evidence to suggest that this psychological therapy may be effective in improving pain interference, anxiety, depression, and quality of life. This is the protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of ACT compared to treatment as usual (TAU) for people with degenerative lumbar pathology who are candidates for surgery in the short term. A total of 102 patients with degenerative lumbar spine pathology will be randomly assigned to TAU (control group) or ACT + TAU (intervention group). Participants will be assessed after treatment and at 3-, 6-, and 12-month follow-ups. The primary outcome will be the mean change from baseline on the Brief Pain Inventory (pain interference). Secondary outcomes will include changes in pain intensity, anxiety, depression, pain catastrophizing, fear of movement, quality of life, disability due to low back pain (LBP), pain acceptance, and psychological inflexibility. Linear mixed models will be used to analyze the data. Additionally, effect sizes and number needed to treat (NNT) will be calculated. We posit that ACT may be used to help patients cope with the stress and uncertainty associated with their condition and the surgery itself. [ABSTRACT FROM AUTHOR]

To characterize people who died by suicide after having previous contacts with public health system using the data available in a primary care setting. A retrospective, population-based case-control study identified through autopsy reports subjects who died from suicide between 2010 and 2015 in Barcelona province. Those who had previous interaction with primary healthcare services were selected, and 20 controls per case with similar age, sex and residence area were randomly sampled from a primary healthcare medical database; the available medical data derived from routine primary care records were anonymised and retrieved for analysis in all subjects. Of 2109 people deceased by suicide, 971 had previous primary healthcare interactions; 33.8% aged over 65 and 74% men. Of those with previous contact, 33% died during the week after and 58.5% within one month. A multivariable analysis identified several significant risk factors in the database, including previous suicide attempts, psychiatric diagnosis, number of primary healthcare visits, referrals to mental health, number of drugs prescribed, recent psychoactive drug prescriptions, and being on sick leave due to mental conditions in the previous year. Nearly half of suicide subjects contacted primary healthcare before dying but remained either undetected or not effectively managed for prevention. In cases who interacted, available data on risk factors included high frequentation and being on sick leave due to mental health disorders, in addition to other well-known factors. Routine electronic medical records represent an opportunity to provide clinical-decision support tools that could be implemented through automatized risk calculation. Most of suicide patients had a recent interaction with the healthcare system Well known risk factors were available in the routine electronic medical records Additional alerting tools could be implemented through automatized risk calculation [ABSTRACT FROM AUTHOR]

Background: Despite a large body of schizophrenia research, we still have no reliable predictors to guide treatment from illness onset. The present study aimed to identify baseline clinical or neurobiological factors — including peripheral brain-derived neurotrophic factor (BDNF) levels and amygdala or hippocampal relative volumes — that could predict negative symptomatology and persistent negative symptoms in first-episode psychosis after 1 year of follow-up. Methods: We recruited 50 drug-naive patients with first-episode psychosis and 50 age- and sex-matched healthy controls to study brain volumes. We performed univariate and multiple and logistic regression analyses to determine the association between baseline clinical and neurobiological variables, score on the PANSS negative subscale and persistent negative symptoms after 1 year of follow-up. Results: Low baseline serum BDNF levels (p = 0.011), decreased left amygdala relative volume (p = 0.001) and more severe negative symptomatology (p = 0.021) predicted the severity of negative symptoms at 1 year, as measured by the PANSS negative subscale. Low baseline serum BDNF levels (p = 0.012) and decreased left amygdala relative volume (p = 0.010) predicted persistent negative symptoms at 1 year. Limitations: We were unable to assess negative symptoms and their dimensions with next-generation scales, which were not available when the study was initiated. Conclusion: This study shows that a set of variables at baseline, including low BDNF levels, smaller left amygdala relative volume and score on the PANSS negative subscale are significant predictors of outcomes in first-episode psychosis. These findings might offer an initial step for tailoring treatments in first-episode psychosis. [ABSTRACT FROM AUTHOR]

• Most suicide attempts in this sample of FEP patients occurred during the untreated psychosis period. • A personal history of suicide attempts was associated with a higher risk of suicide attempt. • The presence of depressive symptoms, especially feeling of guilt, was a significant risk factor for suicide attempts. • Poor functionality at baseline was associated with a higher risk of suicide attempts. • Early intervention in high-risk patients could play an important role in suicide prevention in early psychosis. The risk of suicide in first-episode psychosis (FEP) is high. However, there are many unknowns about this phenomenon and the risk factors associated with higher risk are not well-understood. Therefore, we aimed to determine the baseline sociodemographic and clinical factors associated with suicide attempts in FEP patients over two-years after psychosis onset. Univariate and logistic regression analyses were performed. Between April 2013 and July 2020, 279 patients treated at the FEP Intervention Program at our hospital (Hospital del Mar, Spain) were enrolled and 267 completed the follow-up. Of these, 30 patients (11.2%) made at least one suicide attempt, mostly during the untreated psychosis period (17 patients, 48.6%). Several variables—prior history of suicide attempts and low functionality, depression, and feelings of guilt at baseline—were all significantly associated with suicide attempts. These findings suggest that targeted interventions, especially in prodromal stages, could play a key role in identifying and treating FEP patients with a high suicide risk. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Social withdrawal behaviour is a major health problem that is becoming increasingly important, being necessary studies that investigate its psychopathology and existence in different cultures. Aims: To describe the clinical and socio-demographic characteristics of hikikomori individuals in Spain. Method: Participants were 200 subjects referred to the Crisis Resolution Home Treatment (CRHT) because of social isolation. The definition of hikikomori was the state of avoiding social engagement with generally persistent withdrawal into one’s residence for at least 6 months. Socio-demographic and clinical data were analysed, including Severity of Psychiatric Illness (SPI), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and World Health Organization Disability Assessment (WHODAS) scales.Results:A total of 164 cases were evaluated. Hikikomori were predominantly young male, with the mean age at onset of hikikomori of 40 years old and a mean socially withdrawn period of 3 years. Only three people had no symptoms suggestive of mental disorder. Psychotic and anxiety were the most common comorbid disorders. The scales administered describe the presence of serious symptoms and impairment in social functioning, with a high prevalence of poor collaboration with treatment. Conclusion: This study shows the existence of hikikomori in Spain. Its difficult detection and treatment highlights the need for specialized domiciliary teams. The high comorbidity leads us to conclude that it may not be a new diagnosis, but rather a severe syndrome associated with multiple mental illnesses. Primary hikikomori also exist, but less commonly. Future cross-national studies are needed in order to describe its definition and psychopathology. [ABSTRACT FROM AUTHOR]

Background: Clinical diagnosis of depressive and anxiety disorders has poor sensitivity, and treatment is often not guideline-concordant. This longitudinal study aims to compare diagnostic validity and treatment adequacy in primary care (PC) and specialized care (SC), to assess associated risk factors, and to evaluate their impact on clinical outcome at one-month and three-month follow-ups.Methods: Two hundred twelve patients with depressive and anxious symptoms were recruited from 3 PC and 1 SC centers in Barcelona, Spain. Sensitivity and specificity were calculated comparing medical records׳ diagnoses with a reference (MINI interview). Adequate treatment was defined according to clinical guidelines. Logistic regression was used to estimate associations with risk factors. Impact on outcome was assessed with MANOVA models.Results: Valid diagnosis of depression was more frequent in patients attending SC. Sensitivity for depression was 0.75 in SC and 0.49 in PC (adjusted OR=17.34, 95% CI=4.73-63.61). Detection of anxious comorbidity in depressed patients was low (50%) in SC. Treatment adequacy of depressive disorders was higher in SC than in PC (94.4% vs. 80.6%, adjusted OR=8.11, 95% CI=1.39-47.34). Depression severity was associated with valid diagnosis.Limitations: Only four disorders (major depression, dysthymia, panic disorder and generalized anxiety disorder) were evaluated with the MINI interview in a convenience clinical sample. Treatment dosage was unavailable.Conclusions: Our results suggest that GPs need tools to improve detection of depression and its severity. Psychiatrists should enhance recognition of anxious comorbidity. Evaluation of the impact on outcome deserves further research. [ABSTRACT FROM AUTHOR]

Se presenta una carta al editor acerca de el síndrome neuroléptico maligno y el uso de los antipsicóticos.