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López-Díaz Á, Palermo-Zeballos FJ, Gutierrez-Rojas L, Alameda L, Gotor-Sánchez-Luengo F, Garrido-Torres N, Métrailler J, Alerci L, Bonnarel V, Cano-Domínguez P, Avanesi-Molina E, Soto-Ontoso M, Torrecilla-Olavarrieta R, Muñoz-Manchado LI, Torres-Hernández P, González-Higueras F, Prados-Ojeda JL, Herrera-Cortés M, Meca-García JM, Gordillo-Urbano RM, Sánchez-Robles C, Delgado-Durán T, Soriano-Peña MF, Golay P, Conus P, Crespo-Facorro B, Ruiz-Veguilla M. Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records. BJPsych Open 2024; 10:e22. [PMID: 38179604 PMCID: PMC10790217 DOI: 10.1192/bjo.2023.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
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Affiliation(s)
- Álvaro López-Díaz
- Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Fernanda Jazmín Palermo-Zeballos
- Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain
| | - Luis Gutierrez-Rojas
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; Mental Health Clinical Management Unit, San Cecilio University Hospital, Granada, Spain; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Spain; and Department of Psychiatry, University of Granada, Spain
| | - Luis Alameda
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Francisco Gotor-Sánchez-Luengo
- Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Nathalia Garrido-Torres
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Johann Métrailler
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Livia Alerci
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vincent Bonnarel
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Pablo Cano-Domínguez
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Elma Avanesi-Molina
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Miguel Soto-Ontoso
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Torrecárdenas University Hospital, Almería, Spain
| | - Rocio Torrecilla-Olavarrieta
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, Spain
| | - Leticia Irene Muñoz-Manchado
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, Spain
| | - Pedro Torres-Hernández
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, Spain
| | - Fermín González-Higueras
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, Spain
| | - Juan Luis Prados-Ojeda
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - Mario Herrera-Cortés
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - José Miguel Meca-García
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Poniente University Hospital, Almería, Spain
| | - Rafael Manuel Gordillo-Urbano
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Infanta Margarita Hospital, Córdoba, Spain
| | - Cristina Sánchez-Robles
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - Tomás Delgado-Durán
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | - María Felipa Soriano-Peña
- First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, San Agustín University Hospital, Linares, Spain
| | - Philippe Golay
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Benedicto Crespo-Facorro
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, Spain
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2
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Alvarez-Mon MA, Ortega MA, García-Montero C, Fraile-Martinez O, Lahera G, Monserrat J, Gomez-Lahoz AM, Molero P, Gutierrez-Rojas L, Rodriguez-Jimenez R, Quintero J, Alvarez-Mon M. Differential malondialdehyde (MDA) detection in plasma samples of patients with major depressive disorder (MDD): A potential biomarker. J Int Med Res 2022; 50:3000605221094995. [PMID: 35615790 PMCID: PMC9149615 DOI: 10.1177/03000605221094995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/30/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To measure plasma levels of malondialdehyde (MDA), a marker of oxidative stress (OS), in patients with major depressive disorder (MDD) compared with healthy control (HC) subjects in order to determine if it is a possible biomarker of depression. METHODS This prospective cross-sectional study enrolled patients with MDD and HC subjects. The plasma levels of MDA were measured using a commercially-available colorimetric assay. RESULTS A total of 30 patients with MDD and 20 HC subjects with similar sex, age and body mass index distribution were enrolled in the study. Patients with MDD had significantly higher plasma levels of MDA than the HC subjects. Receiver operating characteristic curve analysis for plasma MDA levels in patients with MDD demonstrated an area under the curve of 0.9767. CONCLUSION The findings of this current study provide further evidence of the role pathophysiological relevance of OS and MDA in MDD. This study provides the basis for the use of MDA as a biomarker for MDD.
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Affiliation(s)
- Miguel A Alvarez-Mon
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
- Department of Psychiatry and Mental Health, Hospital
Universitario Infanta Leonor, Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
- Cancer Registry and Pathology Department, Hospital Universitario
Principe de Asturias, Alcala de Henares, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
- Cancer Registry and Pathology Department, Hospital Universitario
Principe de Asturias, Alcala de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
- Psychiatry Service, Centre for Biomedical Research in the Mental
Health Network, University Hospital Príncipe de Asturias, Alcala de Henares,
Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
| | - Ana M Gomez-Lahoz
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
| | - Patricio Molero
- Department of Psychiatry and Medical Psychology, University
Clinic of Navarra, Pamplona, Spain
| | - Luis Gutierrez-Rojas
- Department of Psychiatry, Faculty of Medicine, University of
Granada, Granada, Spain
| | - Roberto Rodriguez-Jimenez
- Department of Legal Medicine and Psychiatry, Complutense
University, Madrid, Spain
- Institute for Health Research Hospital 12 de Octubre (IMAS 12),
CIBERSAM, Madrid, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital
Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense
University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, University of
Alcala, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid,
Spain
- Immune System Diseases-Rheumatology, Oncology Service an
Internal Medicine, University Hospital Príncipe de Asturias (CIBEREHD), Alcala
de Henares, Spain
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3
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Piñar Morales R, Carrasco Garcia M, Gutierrez-Rojas L, Barrero Hernández FJ. Progressive Multifocal Leukoencephalopathy and Immune Reconstitution Inflammatory Syndrome after Discontinuation of Fingolimod. Case Rep Neurol 2022; 14:38-43. [PMID: 35350291 PMCID: PMC8921886 DOI: 10.1159/000521944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare complication of immunosuppressive treatment in MS patients. Immune reconstitution inflammatory syndrome (IRIS) appears after the withdrawal of certain drugs such as natalizumab (NTZ) or fingolimod. The development of PML-IRIS after NTZ treatment has been described, and its diagnosis is made by clinical and radiological criteria and the determination of the John Cunningham virus in CSF. We present a clinical case of a patient with MS who, after the withdrawal of fingolimod, developed PML-IRIS despite sustained lymphopenia. This is important for pharmacovigilance purposes, not only for NTZ but also for alternative drugs used in MS treatment.
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Affiliation(s)
- Raquel Piñar Morales
- Servicio de Neurología, Hospital Clínico Universitario San Cecilio, Granada, Spain
- Departamento Medicina, Universidad de Granada, Granada, Spain
| | | | - Luis Gutierrez-Rojas
- Departamento Medicina, Universidad de Granada, Granada, Spain
- Unidad de Salud Mental, Hospital Clínico Universitario San Cecilio, Granada, Spain
| | - Francisco Javier Barrero Hernández
- Servicio de Neurología, Hospital Clínico Universitario San Cecilio, Granada, Spain
- Departamento Medicina, Universidad de Granada, Granada, Spain
- *Francisco Javier Barrero Hernández,
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4
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de Anta L, Alvarez-Mon MA, Ortega MA, Salazar C, Donat-Vargas C, Santoma-Vilaclara J, Martin-Martinez M, Lahera G, Gutierrez-Rojas L, Rodriguez-Jimenez R, Quintero J, Alvarez-Mon M. Areas of Interest and Social Consideration of Antidepressants on English Tweets: A Natural Language Processing Classification Study. J Pers Med 2022; 12:jpm12020155. [PMID: 35207644 PMCID: PMC8879287 DOI: 10.3390/jpm12020155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Antidepressants are the foundation of the treatment of major depressive disorders. Despite the scientific evidence, there is still a sustained debate and concern about the efficacy of antidepressants, with widely differing opinions among the population about their positive and negative effects, which may condition people’s attitudes towards such treatments. Our aim is to investigate Twitter posts about antidepressants in order to have a better understanding of the social consideration of antidepressants. Methods: We gathered public tweets mentioning antidepressants written in English, published throughout a 22-month period, between 1 January 2019 and 31 October 2020. We analysed the content of each tweet, determining in the first place whether they included medical aspects or not. Those with medical content were classified into four categories: general aspects, such as quality of life or mood, sleep-related conditions, appetite/weight issues and aspects around somatic alterations. In non-medical tweets, we distinguished three categories: commercial nature (including all economic activity, drug promotion, education or outreach), help request/offer, and drug trivialization. In addition, users were arranged into three categories according to their nature: patients and relatives, caregivers, and interactions between Twitter users. Finally, we identified the most mentioned antidepressants, including the number of retweets and likes, which allowed us to measure the impact among Twitter users. Results: The activity in Twitter concerning antidepressants is mainly focused on the effects these drugs may have on certain health-related areas, specifically sleep (20.87%) and appetite/weight (8.95%). Patients and relatives are the type of user that most frequently posts tweets with medical content (65.2%, specifically 80% when referencing sleep and 78.6% in the case of appetite/weight), whereas they are responsible for only 2.9% of tweets with non-medical content. Among tweets classified as non-medical in this study, the most common subject was drug trivialization (66.86%). Caregivers barely have any presence in conversations in Twitter about antidepressants (3.5%). However, their tweets rose more interest among other users, with a ratio 11.93 times higher than those posted by patients and their friends and family. Mirtazapine is the most mentioned antidepressant in Twitter (45.43%), with a significant difference with the rest, agomelatine (11.11%). Conclusions: This study shows that Twitter users that take antidepressants, or their friends and family, use social media to share medical information about antidepressants. However, other users that do not talk about antidepressants from a personal or close experience, frequently do so in a stigmatizing manner, by trivializing them. Our study also brings to light the scarce presence of caregivers in Twitter.
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Affiliation(s)
- Laura de Anta
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (L.d.A.); (M.M.-M.); (J.Q.)
| | - Miguel Angel Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (L.d.A.); (M.M.-M.); (J.Q.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (G.L.); (M.A.-M.)
- Correspondence: (M.A.A.-M.); (M.A.O.)
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (G.L.); (M.A.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Correspondence: (M.A.A.-M.); (M.A.O.)
| | - Cristina Salazar
- Departamento Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Escuela Técnica Superior de Ingeniería de Telecomunicación, Universidad Rey Juan Carlos, 28942 Fuenlabrada, Spain;
| | - Carolina Donat-Vargas
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine (IMM), Karolinska Institute, 171 77 Stockholm, Sweden;
| | | | - Maria Martin-Martinez
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (L.d.A.); (M.M.-M.); (J.Q.)
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (G.L.); (M.A.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), 22807 Madrid, Spain;
- Psychiatry Service, Príncipe de Asturias University Hospital, 28805 Alcalá de Henares, Spain
| | | | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), 22807 Madrid, Spain;
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (L.d.A.); (M.M.-M.); (J.Q.)
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (G.L.); (M.A.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Oncology Service, University Hospital Príncipe de Asturias, CIBEREHD, 28805 Alcalá de Henares, Spain
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5
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Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, Garrido-Torres N, Álvarez-Gil P, Martínez-Molina I, Martín-Gil VE, Ruiz-Ruiz E, Mota-Molina M, Algarín-Moriana MP, Guzmán-del Castillo AH, Ruiz-Arcos Á, Gómez-Coronado R, Galiano-Rus S, Rosa-Ruiz A, Prados-Ojeda JL, Gutierrez-Rojas L, Crespo-Facorro B, Ruiz-Veguilla M. Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study. Eur Arch Psychiatry Clin Neurosci 2022; 272:5-15. [PMID: 33811552 PMCID: PMC8019303 DOI: 10.1007/s00406-021-01256-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
This study aimed to characterize the clinical profile of patients with brief psychotic disorders (BPD) triggered by the psychosocial distress derived from the COVID-19 crisis. A multicenter study was conducted from March 14 to May 14, 2020 (the peak weeks of the pandemic in Europe). All consecutive patients presenting non-affective psychotic episodes with a duration of untreated psychosis of less than 1 month and whose onset was related to the COVID-19 crisis were recruited, but only those patients meeting Diagnostic Statistical Manual 5th edition (DSM-5) criteria for "BPD with marked stressors" (DSM-5 code: 298.8) during follow-up were finally included. Patients' sociodemographic and clinical characteristics were collected at baseline and summarized with descriptive statistics. During the study period, 57 individuals with short-lived psychotic episodes related to the emotional stress of the COVID-19 pandemic were identified, of whom 33 met DSM-5 criteria for "BPD with marked stressors". The mean age was 42.33 ± 14.04 years, the gender distribution was almost the same, and the majority were rated as having good premorbid adjustment. About a quarter of the patients exhibited suicidal symptoms and almost half presented first-rank schizophrenia symptoms. None of them were COVID-19 positive, but in more than half of the cases, the topic of their psychotic features was COVID-19-related. The coronavirus pandemic is triggering a significant number of BPD cases. Their risk of suicidal behavior, their high relapse rate, and their low temporal stability make it necessary to closely monitor these patients over time.
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Affiliation(s)
| | - Álvaro López-Díaz
- grid.411375.50000 0004 1768 164XVirgen Macarena University Hospital, Seville, Spain ,grid.414816.e0000 0004 1773 7922Institute of Biomedicine of Seville (IBiS), Seville, Spain ,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain
| | | | | | - Paula Álvarez-Gil
- grid.411380.f0000 0000 8771 3783Virgen de las Nieves University Hospital, Granada, Spain
| | - Iván Martínez-Molina
- grid.411109.c0000 0000 9542 1158Virgen del Rocío University Hospital, Seville, Spain
| | | | - Elena Ruiz-Ruiz
- grid.411349.a0000 0004 1771 4667Reina Sofía University Hospital, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | - Benedicto Crespo-Facorro
- Institute of Biomedicine of Seville (IBiS), Seville, Spain. .,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain. .,Virgen del Rocío University Hospital, Seville, Spain. .,Department of Psychiatry, University of Seville, Seville, Spain.
| | - Miguel Ruiz-Veguilla
- grid.414816.e0000 0004 1773 7922Institute of Biomedicine of Seville (IBiS), Seville, Spain ,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain ,grid.411109.c0000 0000 9542 1158Virgen del Rocío University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229Department of Psychiatry, University of Seville, Seville, Spain
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6
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Linares-Gonzalez L, Lozano-Lozano I, Gutierrez-Rojas L, Lozano-Lozano M, Rodenas-Herranz T, Ruiz-Villaverde R. Sexual Dysfunction and Atopic Dermatitis: A Systematic Review. Life (Basel) 2021; 11:life11121314. [PMID: 34947845 PMCID: PMC8708093 DOI: 10.3390/life11121314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease of the skin whose main symptom is pruritus and may affect all age ranges. Regarding the prevalence, it has been estimated at around 10% of the world population. Many concomitant diseases have been associated with AD, but the causal relationship between AD and psychological impairment has not been clearly established. Scientific literature studying the probable association between male or female sexual dysfunction and dermatological pathology is limited, even more so in AD. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines and the Cochrane Collaboration methodology for systematic reviews. All relevant articles in English were identified through a search from inception to 10 December 2020, including the following databases: Medline (via PubMed), Scopus, Web of Science Core Collection, and SciELO. The results of the search were compiled using the COVIDENCE software for systematic reviews. The methodological quality of the included studies was done using the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” and the “Quality Assessment of Case-Control Studies” developed by the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH). Our search yielded potentially relevant studies. Five studies that evaluated the prevalence of sexual dysfunction in atopic dermatitis were retrieved after applying the selection criteria. The present systematic review achieved data from 8088 patients with atopic dermatitis from four articles. Sample sizes for atopic dermatitis patients ranged from 266 to 3997. We identified one cohort study with four years of follow-up, three studies with a cross-sectional design, and one case-control study. Three studies reported data disaggregated by the severity of atopic dermatitis. Two studies included healthy controls with a total sample size of 1,747,755 subjects. Two studies compared data with other dermatological conditions such as psoriasis. In conclusion, we can establish that unlike other psychological comorbidities such as anxiety and depression, sexual dysfunction is a field scarcely explored in the literature. This sexual dysfunction focuses on the male sex in large population studies and in clinical diagnoses without exploring it through specific and validated questionnaires in this regard. Further studies focused on both genders are needed. It is important to correlate this sexual dysfunction with the severity of the disease, previous treatments, and cardiovascular comorbidities.
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Affiliation(s)
- Laura Linares-Gonzalez
- Department of Dermatology, Hospital Universitario San Cecilio, 18016 Granada, Spain; (I.L.-L.); (T.R.-H.); (R.R.-V.)
- Biohealth Research Institute in Granada (ibs.GRANADA), 18012 Granada, Spain;
- Correspondence:
| | - Ignacio Lozano-Lozano
- Department of Dermatology, Hospital Universitario San Cecilio, 18016 Granada, Spain; (I.L.-L.); (T.R.-H.); (R.R.-V.)
| | - Luis Gutierrez-Rojas
- Department of Psychiatry, University of Granada, 18011 Granada, Spain;
- Psychiatry Service, Hospital Clínico San Cecilio, 18016 Granada, Spain
- CTS-549 Research Group, Institute of Neuroscience, University of Granada, 18016 Granada, Spain
| | - Mario Lozano-Lozano
- Biohealth Research Institute in Granada (ibs.GRANADA), 18012 Granada, Spain;
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, 18011 Granada, Spain
- Sport and Health Joint University Institute (iMUDS), University of Granada, 18011 Granada, Spain
- ‘Cuídate’ Support Unit for Oncology Patients, 18011 Granada, Spain
| | - Teresa Rodenas-Herranz
- Department of Dermatology, Hospital Universitario San Cecilio, 18016 Granada, Spain; (I.L.-L.); (T.R.-H.); (R.R.-V.)
- Biohealth Research Institute in Granada (ibs.GRANADA), 18012 Granada, Spain;
| | - Ricardo Ruiz-Villaverde
- Department of Dermatology, Hospital Universitario San Cecilio, 18016 Granada, Spain; (I.L.-L.); (T.R.-H.); (R.R.-V.)
- Biohealth Research Institute in Granada (ibs.GRANADA), 18012 Granada, Spain;
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7
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Gonzalez-Domenech P, Romero-Béjar JL, Gutierrez-Rojas L, Jimenez-Fernandez S, Diaz-Atienza F. Behavioural Difficulties in Children and Adolescents with Mental Disorders under Extreme Situations. J Clin Med 2021; 10:jcm10214876. [PMID: 34768396 PMCID: PMC8584948 DOI: 10.3390/jcm10214876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
In 2020, the Governments of many countries maintained different levels of confinement of the population due to the pandemic that produced the COVID-19. There are few studies published on the psychological impact in the child and adolescent population diagnosed with mental disorders, especially during the home confinement stage. Explanatory models based on socio-demographic and clinical variables provide an approximation to level changes in different dimensions of behavioural difficulties. A categorical-response logistic ordinal regression model, based on a cross-sectional study with 139 children and adolescents diagnosed with mental disorders is performed for each dimension under analysis. Most of the socio-demographic and clinical explanatory variables considered (24 of 26) were significant at population level for at least one of the four dimensions of behavioural difficulties (15 response variables) under analysis. Odds-ratios were interpreted to identify risk or protective factors increasing or decreasing severity in the response variable. This analysis provides useful information, making it possible to more readily anticipate critical situations due to extreme events, such as a confinement, in this population.
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Affiliation(s)
- Pablo Gonzalez-Domenech
- Faculty of Medicine, University of Granada, Avenida Ilustración, 60, 18016 Granada, Spain; (P.G.-D.); (L.G.-R.); (S.J.-F.); (F.D.-A.)
| | - José Luis Romero-Béjar
- Department of Statistics and Operational Research, University of Granada, Avda Fuentenueva, 18071 Granada, Spain
- Correspondence:
| | - Luis Gutierrez-Rojas
- Faculty of Medicine, University of Granada, Avenida Ilustración, 60, 18016 Granada, Spain; (P.G.-D.); (L.G.-R.); (S.J.-F.); (F.D.-A.)
| | - Sara Jimenez-Fernandez
- Faculty of Medicine, University of Granada, Avenida Ilustración, 60, 18016 Granada, Spain; (P.G.-D.); (L.G.-R.); (S.J.-F.); (F.D.-A.)
| | - Francisco Diaz-Atienza
- Faculty of Medicine, University of Granada, Avenida Ilustración, 60, 18016 Granada, Spain; (P.G.-D.); (L.G.-R.); (S.J.-F.); (F.D.-A.)
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8
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Linares-Gonzalez L, Lozano-Lozano I, Gutierrez-Rojas L, Ruiz-Villaverde R, Lozano-Lozano M. Sexual dysfunction in a cohort of patients with moderate-to-severe atopic dermatitis. Influence of dupilumab treatment. Int J Dermatol 2021; 61:607-610. [PMID: 34633064 DOI: 10.1111/ijd.15938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Atopic dermatitis is a systemic and immune-mediated dermatological disease that comprises a wide group of physiological and psychological comorbidities. Within the latter, the evaluation of anxiety and depression has been the subject of numerous studies, but sexual dysfunction (SD) is a fact that is rarely addressed in the literature. The objective of the present study is to assess the prevalence of SD in a cohort of patients with moderate-to-severe atopic dermatitis (AD) and to establish the possible impact of dupilumab therapy on it. MATERIAL AND METHODS A cross-sectional study was performed. Recruited patients had been diagnosed with moderate-to-severe AD at the Dermatology Unit of the Hospital Universitario San Cecilio, Granada, Spain, from July 1, 2019, through June 30, 2020. They were followed up for a 6-month period during which the impact of dupilumab treatment was measured. The main variable under study, sexual dysfunction, was evaluated differently according to gender. Regarding the male patients, the International Index Erectile Function (IIEF-5) was applied, whereas for female patients, the questionnaire "Female Sexual Function Index" was used. RESULTS Our study included 31 patients, 18 men and 13 women. Men's mean age was 35 +/- 14.55 years, while that of women was 33 +/- 10.46 years. Seventy-nine percent of patients in our series (n = 22) had SD compared to 29% (n = 9) who did not. A total of 66.9% of males and 76.9% (n = 10) of females sampled, suffered from SD. Six months after initiation of treatment, none of the patient had stopped it due to efficacy or safety issues. All severity indices (SCORAD, EASI, VAS pruritus, and DLQI) had significantly improved by more than 50% from baseline. The improvement in the sexual dysfunction index had improved by four points, both in the male and female patients. DISCUSSION Many large population studies on SD in patients with moderate-to-severe atopic AD only focus on male gender and clinical diagnoses, rather than specific and validated questionnaires. Dupilumab treatment in patients with moderate-to-severe AD has shown a positive impact on the levels of SD in both male and female populations. Further studies focused on populations with mild atopic AD and with larger sample sizes are required to corroborate these preliminary results.
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Affiliation(s)
- Laura Linares-Gonzalez
- Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Ignacio Lozano-Lozano
- Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Luis Gutierrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry Service, Hospital Clínico San Cecilio, Granada, Spain.,CTS-549 Research Group, Institute of Neuroscience, Granada, Spain
| | - Ricardo Ruiz-Villaverde
- Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain.,Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
| | - Mario Lozano-Lozano
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain.,Department of Physical Therapy, Faculty of Health Sciences, and University of Granada, Sport and Health Joint University Institute (iMUDS), Granada, Spain.,''Cuídate'' Support Unit for Oncological Patients (UAPO-Cuídate), Granada, Spain
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9
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Porras Segovia A, Guerrero-Jiménez M, Carrillo de Albornoz Calahorro CM, Gutierrez-Rojas L. Psychosis and Dandy-Walker syndrome: a case report and review of the literature. Gen Psychiatr 2021; 34:e100254. [PMID: 33937630 PMCID: PMC8054076 DOI: 10.1136/gpsych-2020-100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/03/2022] Open
Abstract
Dandy-Walker syndrome (DWS) is a group of brain malformations which sometimes present with psychotic symptoms. We present the case of a patient diagnosed with Dandy-Walker variant who presented with schizophrenia-like psychosis. A man in his 30s was admitted to an acute psychiatric unit presenting with persecutory delusions, auditory hallucinations and violent behaviour. The MRI performed showed the typical alterations of Dandy-Walker variant: vermian hypoplasia and cystic dilatation of the fourth ventricle. He also suffered from mild intellectual disability. After being treated with olanzapine 10 mg/d for a month, his psychotic symptoms greatly improved and he was discharged. In conclusion, DWS may cause psychosis through a dysfunction in the circuit connecting prefrontal, thalamic and cerebellar areas. The association between these two conditions may contribute to the understanding of the aetiopathogenesis of schizophrenia.
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10
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Jaen-Moreno MJ, Feu N, Del Pozo GI, Gómez C, Carrión L, Chauca GM, Guler I, Montiel FJ, Sánchez MD, Alcalá JA, Gutierrez-Rojas L, Molina V, Bobes J, Balanzá-Martínez V, Ruiz-Rull C, Sarramea F. Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking. Eur Psychiatry 2021; 64:e22. [PMID: 33632347 PMCID: PMC8057420 DOI: 10.1192/j.eurpsy.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. Method A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention. Results The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. Conclusion In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.
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Affiliation(s)
- M J Jaen-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain
| | - N Feu
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - G I Del Pozo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - C Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, JaénSpain
| | - L Carrión
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - G M Chauca
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - I Guler
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Área de gestión de la investigación, Córdoba, Spain
| | - F J Montiel
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, JaénSpain
| | - M D Sánchez
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, JaénSpain
| | - J A Alcalá
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L Gutierrez-Rojas
- Grupo de Investigación Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada, Granada, Spain
| | - V Molina
- Psychiatry Department, School of Medicine, University of Valladolid, Valladolid, Spain; Psychiatry Service, Clinical Hospital of Valladolid, Valladolid, Spain.,Neurosciences Institute of Castilla y Leon (INCYL), University of Salamanca, Salamanca, Spain; Instituto de Investigacion Biomedica de Salamanca (IBSAL), Salamanca, Spain.,CIBERSAM (Biomedical Research Network in Mental Health), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Bobes
- Faculty of Medicine and Health Sciences-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - V Balanzá-Martínez
- Unitat Docent de Psiquiatría i Psicología Médica, Departament de Medicina, Universitat de València, CIBERSAM, Valencia, Spain
| | - C Ruiz-Rull
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Medicina Familiar y Comunitaria, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain
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Carrillo de Albornoz CM, Guerrero-Jimenez M, Gutierrez-Rojas L. [Antypsychotic-induced central pontine myelinolysis in a congenital adrenal hyperplasia subject]. Rev Neurol 2017; 64:235-236. [PMID: 28229445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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12
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Fagiolini A, Alfonsi E, Amodeo G, Cenci M, Di Lella M, Farinella F, Ferraiuolo F, Fraguas D, Loparco N, Gutierrez-Rojas L, Mignone ML, Pataracchia G, Pillai G, Russo F, Sanchez-Gistau V, Spinogatti F, Toscano M, Villari V, De Filippis S. Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists. Expert Opin Drug Saf 2016; 15:449-55. [DOI: 10.1517/14740338.2016.1155553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea Fagiolini
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Emilia Alfonsi
- Department of Mental Health, National Health Service, Ancona, Italy
| | - Giovanni Amodeo
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Mario Cenci
- Department of Mental Health, Fabriano, Italy
| | - Michele Di Lella
- Department of Mental Health, National Health Service, Alessandria, Italy
| | | | | | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Madrid, Spain
| | - Natale Loparco
- Department of Mental Health, National Health Service, Taranto, Italy
| | - Luis Gutierrez-Rojas
- Departamento de Psiquiatría, Hospital Clínico, Granada - Complejo Hospitalario Granada, Granada, Spain
| | | | | | - Gianluca Pillai
- Department of Mental Health, National Health Service, Oristano, Italy
| | - Felicia Russo
- Servizio Psichiatrico di Diagnosi e Cura, Ospedale F. Fallacara, Triggiano and Department of Mental Health, National Health Service, Bari, Italy
| | - Vanessa Sanchez-Gistau
- Early Intervention Psychosis Service, Hospital Universitari Insitut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Franco Spinogatti
- Department of Mental Health, National Health Service, Cremona, Italy
| | - Marco Toscano
- Department of Mental Health, ASST Rhodense, Garbagnate M.se, Italy
| | - Vincenzo Villari
- Department of Mental Health, National Health Service, Torino, Italy
| | - Sergio De Filippis
- Casa di Cura Neuropsichiatrica e Comunità Terapeutica-Genzano, University of Rome and Villa Von Siebenthal, Rome, Italy
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