Search

Introduction: In recent years, cognitive involvement in firstepisode psychosis (FEP) is becoming more important, with multiple publications in this regard, with generally heterogeneous results due to different methodologies. The solider data point to impairment in verbal and working memory, processing speed and executive function, and being them all related with negative symptoms Objectives: Preliminary results regarding cognitive function in patients with FEP are presented Methods: A longitudinal and prospective case-control study will be performed during a year. FEP patients with cannabis-use are identified as cases and FEP patients with no cannabis-use as controls. The sample will be constituted by all the patients, diagnosed of first psychotic episode, admitted during a year at the Psychiatry Unit of the HUPHM. Three evaluations will be made. The first of them will be administered on the days before the discharge, the second 6 months after and the third a year a head. Each evaluation will include different scales, cognitive impairment is assessed by SCIP-S Results: We present preliminary result of cognitive impairment in 32 consecutive FEP admitted to our center. We included 23 cases (71.8%) and 9 controls (28.1%). Result regarding SCIP percentile on the different areas were the following: all of them except verbal fluency were higher among controls (IMAGE-1). 7 subjects had a second evaluation after 6 months. Regarding total-SCIP percentil, cases suffered greater improvement compared with controls (p=0.05)(IMAGE-3) Conclusions: First cognitive evaluation in FEP can be substantially altered in cannabis-users, however, we highlight changes occurring during follow-up, being specially this group the one suffering greater total improvement in cognitive functions, compared with non-consumers. [ABSTRACT FROM AUTHOR]

Introduction: Narrative therapy in psychotic patients shows recovery as an adaptative process: the personal recovery journey. Myths have always brought cultural and institutional cohesion and bind all human beings in any era or country. Hero's Journey is a myth that appeals to any person who faces life challenges. The hero is an example of courage, strength, and resilience who resist setbacks and obstacles and in doing so experiences an identity transformation. The victory of the heroine is the victory of all mankind. When he returns from the journey he shares knowledge with the rest of the inhabitants of the "ordinary world". In Myth, this knowledge transcends intrahistory, and becomes part of popular culture outside the tale. Objectives: The aim of this work is to adapt Hero's Journey scheme to narrative psychotherapy in psychosis. Methods: The person is invited to his own-Hero's Journey and encouraged to try identities and coping strategies through narrative approach, methaphors and hope speech that normalizes recovery. The therapist doesn't show the way but motivates the individual to undertake a journey towards well-being and develop his potential overcoming difficulties along the way. Results: The journey teaches that challenges can be embraced and profitable. Narrative processing systems steered and blocked by illness are now dynamized, promoting desirable identity narratives and integrating them in one's self. Conclusions: Recovery journey is an adaptation, growth and selfrediscovery journey whose goal is individual fulfillment and wellbeing. The "psychotic" person puts himself into a position to start high personal value trips and to become the author-narrator-hero of his life story. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents developing severe disruptive behaviors and psychotic symptoms are ocasionally admited and diagnosed as severe mental ilness. Objectives: The purpose is to show a successful high dose treatment withdrawal in a young woman who was admitted to the Psychiatric Day Hospital with a previous history of 9 adolescent psychiatric unit's admissions, multidiagnosed, with bipolar and psychotic disorders among others. At the arrival her treatment was: haloperidol 4.5mg/d, quetiapine 1200mg/d, lamotrigine 125mg/d, valproic acid, 1750mg/d, melatonine 5mg/d, zolpidem 5mg/d. Methods: Stabilizer and antipsychotic drugs where gradually removed. She initially showed an illness role and a regressive attitude, with disproportionate reactions, frequent mood fluctuations, disrupting behavior and dissociative symptoms which included short self-limited hallucinatory phenomena that had complete remission with benzodiazepines. She started referring hallucinations on his first admission by copying another patient. Parent interviews reflect a rigid family system built around the daughter's illness, reacting aversively to the patients recovery and when feeling challenged during psychoeducation. We conducted a narrative approach that fosters hope, healthy aspects, and encouraged an autonomous self separated from the illness. Results: It was shown a growth in self-regulation, social interaction, life functionality with optimistic projection of the future, and disruptive behaviors ceased completely. Besides, she had a 18kg weight loss that took her from 34.3 BMI to a healthy appearance. Conclusions: During the 10 months of follow-up, no psychotic symptoms or major affective symptom were observed. Diagnosis when discharged was "previous diagnoses, currently in remission". Treatment was: fluoxetine 20 mg/d, topiramate 200 mg/d and clonazepam 0.5mg/d. [ABSTRACT FROM AUTHOR]

Introduction: Facing extreme life experiences can impoverish the ability to narrate experience and self. Descriptive psychiatry's model of psychoeducation focusing insight in psychosis may fail its purpose and threaten the already damaged patient's identity. Through the process of accepting illness, a value-bearing individual can end up being considered dysfunctional and worthless and experience guilt, shame, hopelessness, demoralization and helplessness. Elseway, denying illness would be considered proof of anosognosia. Both situations may lead to illness narratives introjection, agency loss, own beliefs and competency mistrust and stagnation. Objectives: The aim is to show narrative therapy as an advantageous complement or alternative to objective psychiatry psychoeducation in psychosis clinical practice. Reintegrate one's life narratives and retrieve recovery agency is one of the most powerful, adaptative and healing a person can accomplish. Methods: Narrative model encourages the patient to build and tell coherent and desirable stories in which recovery is promoted, from a personal point of view, and validates these. A non-pathologizing speech, normalization, externalization, empathy, respect and kindness are recomended. It is fostered to embrace different truths and alternative versions of self, promoting dialogue and cooperation between selves to dynamize identity narratives and allow choosing a preferred self in each situation. Exploiting personal resources is encouraged. Results: The person feels reauthorized in the direction of life and recovery, starts narrating personal life stories and recover the possibility of social interaction. Conclusions: Through recovery process, the person regain an integrated sense of identity, separated from illness and develop an author-narrator-protagonist role in his own life story and the recovery process. [ABSTRACT FROM AUTHOR]

The search for a biomarker for suicide risk is a longstanding pursuit in clinical psychiatry. Literature addressing the role of endocannabinoids in suicide attempters (SA) is sparse. This cross-sectional study is aimed at comparing 8 AM serum concentrations of 4 endogenous cannabinoids (anandamide, AEA; 2-arachidonoylglycerol, 2-AG; N-palmitoiletanolamida, PEA; and oleoylethanolamide, OEA) in 30 suicide attempters (SA) and 12 psychiatric controls (PC). 8 AM AEA and PEA serum levels were higher in SA compared to PC without controlling for cannabis use (n = 42) (3.58 ± 5.77 vs. 1.62 ± 2.49, F = 3.04, P = 0.089; and 3.31 ± 4.82 vs. 1.21 ± 1.20, F = 6.22, p = 0.017, respectively). Serum ACTH was higher in PC compared to SA (32.11 ± 21.60 vs. 20.05 ± 9.96, F = 9.031, p = 0.0.005). After controlling for cannabis use in the urine test (n = 28), 8 AM AEA and PEA serum levels remained higher in SA compared to PC (4.57 ± 6.38 vs. 0.64 ± 1.11, F = 4.852, P = 0.037; and 4.35 ± 5.46 vs. 1.21 ± 1.25, F = 4.125, p = 0.053, respectively). The present study offers preliminary evidence about the role of AEA and PEA in suicidal behavior (SB). Furthermore, in the context of the mental pain model of SB, our findings suggest that some endocannabinoids may play a role in the pathophysiology of SB. Our pilot study deserves replication by other studies with bigger sample sizes., Competing Interests: Conflict of Interest In the last 24 months, Hilario Blasco-Fontecilla received lecture fees from Shire. He is Principal Investigator (PI) of an iPFIS research contract (www.isciii.es; IFI16/00,039) and co-PI of a MINECO research grant (RTI2018–101,857-B-I00); recipient of: 1) a FIPSE Grant, and 2) an IDIPHIPSA intensification Grant; involved in two clinical trials (MENSIA KOALA, NEWROFEED Study; ESKETSUI2002); member of the Advisory Board of ITA Salud Mental. Fernando Sanchez is an employee of TEA ediciones. Maria Rodrigo Yanguas is the recipient of an iPFS research contract (www.isciii.es). The remaining authors do not have any conflict of interest regarding the publication of this manuscript., (Copyright © 2020. Published by Elsevier B.V.)