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Trabajo fin de máster. Defendido en enero de 2019. Se ha estimado que más de la mitad de los pacientes con esquizofrenia no creen padecer ningún tipo de trastorno mental y que presentan una baja adhesión al tratamiento. Esta falta de insight tiene un impacto negativo en la recuperación. El objetivo del presente trabajo es revisar la literatura para evaluar la relación entre el insight y la adhesión al tratamiento farmacológico en pacientes con esquizofrenia. Se realizó una búsqueda de la literatura en la cual fueron seleccionados 13 artículos. La mayoría de los estudios seleccionados (69,23%), recogen una relación significativa entre el insight y la adhesión al tratamiento farmacológico. También se encontró una gran heterogeneidad en la definición de insight y métodos de medida. Abstract: It has been estimated that more than half of patients with schizophrenia do not believe they have any mental disorder and have low adherence to treatment. This lack of knowledge has a negative impact on recovery. The objective of this paper is to review the literature to evaluate the relationship between knowledge and adherence to drug treatment in patients with schizophrenia. A literature search was conducted in which 13 articles were selected. Most of the selected studies (69.23%), collect a significant relationship between knowledge and adherence to drug treatment. A great heterogeneity was also found in the definition of knowledge and measurement methods. Ordenador con navegador de Internet ; Adobe Acrobat Reader 44 p. (Según el contador de la aplicación)

Grado en Medicina., [ES]: La esquizofrenia es una enfermedad multifactorial caracterizada por una serie de síntomas postivos, negativos y cognitivos. La alteración de la vía dopaminérgica sirvió como base para el desarrollo de los fármacos antipsicóticos actuales, los cuales reducen los síntomas positivos y, en menor medida, los síntomas negativos, pero todavía hay bastante resitencia al tratamiento. Las investigaciones mas recientes en este campo apuntan a una implicación de la vía glutamatérgica en la esquizofrenia. En este trabajo se ha relizado una revisión de los ensayos preclínicos y clínicos con diversos compuestos que ejercen una acción reguladora sobe el sistema glutamtérgico. Entre las posibles dianas terapéuticas, la investigación actual se centra en la regulación de los receptores NMDA y, principalmente, en los receptores mGlu del grupo II y III. En concreto, los agonistas mGlu2/3 y antagonistas mGlu5 han mostrado eficacia en los síntomas de la esquizofrenia. También se obtuvieron resultados esperanzadores con los reguladores alostéricos positivos (PAMs). Sin embargo, en muchos casos, los compuestos glutamatérgicos no son eficaces en monoterapia y necesitan asociarse con los antipsicóticos disponibles actualmente. Además, algunos estudios son poco concluyentes y se necesita mucha información adicional para que estos fármacos puedan tener uso clínico en el futuro., [EN]: Schizophrenia is a multifactorial disease characterized by positive, negative and cognitive symptoms. Dysfunction of the dopaminergic pathway served as a basis for the development of current antipsychotic drugs, since they reduce positive symptoms and, to a lesser extent, negative symptoms, but there is still quite resistance to treatment. The latest research in this field points to the involvement of the glutamatergic pathway in schizophrenia. In this work I have done a review of preclinical and clinical trials of several compounds that exert a regulatory action on the glutamatergic system. Recent advances focus on the regulation of NMDA receptors, II and III groups of metabotropic glutamate receptors. Specifically, mGlu2/3 agonists and mGlu5 antagonists have shown efficacy in the symptoms of schizophrenia. Encouraging results were also obtained with the positive allosteric regulators (PAMs). However, in many cases, glutamatergic compounds are not effective alone and they need to be associated with clasical antipsychotics drugs. In addition, some studies are inconclusive and additional information is needed before these drugs may have clinical use in the future.

BackgroundIt has recently been suggested that auditory hallucinations are the result of a criterion shift when deciding whether or not a meaningful signal has emerged. The approach proposes that a liberal criterion may result in increased false-positive identifications, without additional perceptual deficit. To test this hypothesis, we devised a speech discrimination task and used signal detection theory (SDT) to investigate the underlying cognitive mechanisms.MethodSchizophrenia patients with and without auditory hallucinations and a healthy control group completed a speech discrimination task. They had to decide whether a particular spoken word was identical to a previously presented speech stimulus, embedded in noise. SDT was used on the accuracy data to calculate a measure of perceptual sensitivity (Az) and a measure of response bias (β). Thresholds for the perception of simple tones were determined.ResultsCompared to healthy controls, perceptual thresholds were higher and perceptual sensitivity in the speech task was lower in both patient groups. However, hallucinating patients showed increased sensitivity to speech stimuli compared to non-hallucinating patients. In addition, we found some evidence of a positive response bias in hallucinating patients, indicating a tendency to readily accept that a certain stimulus had been presented.ConclusionsWithin the context of schizophrenia, patients with auditory hallucinations show enhanced sensitivity to speech stimuli, combined with a liberal criterion for deciding that a perceived event is an actual stimulus.

AimsIn the present study, our aim was to investigate the oxidative-antioxidative systems in unmedicated first-episode psychosis (FEP) patients at the beginning and after short-term treatment. MethodsThis study consisted of 29 patients who experienced an FEP and 25 control subjects. In order to investigate the oxidative status, we determined plasma malondialdehyde (MDA) levels, oxidizability of red blood cells, oxidation and oxidizability of apolipoprotein B-containing lipoproteins (apo B-basal MDA and apo B-MDA). In order to evaluate the antioxidative defense, we measured serum total antioxidative capacity, uric acid, albumin, total bilirubin and vitamin E levels and serum paraoxonase/arylesterase, whole blood glutathione peroxidase (GPx) and red blood cell superoxide dismutase activities before and after 6 weeks of treatment in patients with FEP. ResultsPlasma MDA and apo B-basal MDA levels and red blood cell superoxide dismutase activity were significantly higher and serum arylesterase and whole blood-GPx activities were lower in the FEP group than those of the healthy control group. There were not any significant changes in the oxidative and antioxidative system parameters (except increased vitamin E levels) after treatment. ConclusionsThe results of this study suggest that FEP is accompanied by oxidative stress. However, further studies are needed to clarify the role of oxidative stress in the physiopathologic mechanisms of FEP, so that oxidative and antioxidative system parameters can be used in the management of these patients. In accordance with psychiatric evaluation, for a better management, patients with FEP may require a multidisciplinary approach, including oxidative and antioxidative system parameters.