RESUMEN
Previous works have studied structural brain characteristics in first-episode psychosis (FEP), but few have focused on the relation between brain differences and illness trajectories. The aim of this study is to analyze gray and white matter changes in FEP patients and their relation with one-year clinical outcomes. A sample of 41 FEP patients and 41 healthy controls (HC), matched by age and educational level was scanned with a 3T MRI during the first month of illness onset. One year later, patients were assigned to two illness trajectories (schizophrenia and non-schizophrenia). Voxel-based morphometry (VBM) was used for gray matter and Tract-based spatial statistics (TBSS) was used for white matter data analysis. VBM revealed significant and widespread bilateral gray matter density differences between FEP and HC groups in areas that included the right insular Cortex, the inferior frontal gyrus and orbito-frontal cortices, and segments of the occipital cortex. TBSS showed a significant lower fractional anisotropy (FA) in 8 clusters that included segments of the anterior thalamic radiation, the left body and forceps minor of corpus callosum, the right anterior segment of the inferior fronto-occipital fasciculus and the anterior segments of the cingulum. The sub-groups comparison revealed significant lower FA in the schizophrenia sub-group in two clusters: the anterior thalamic radiation and the anterior segment of left cingulum. These findings are coherent with previous morphology studies. The results suggest that gray and white matter abnormalities are present at early stages of the disease, and white matter differences may distinguish different illness prognosis.
Asunto(s)
Imagen de Difusión Tensora , Sustancia Gris/diagnóstico por imagen , Trastornos Psicóticos/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto , Anisotropía , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
The introduction of long-acting injectable atypical antipsychotics has ensured adherence to treatment in patients with low awareness of the disorder, with an acceptable rate of side effects. In the case of long acting olanzapine injection in particular, has particular relevance the existence of a special side-effect called post-injection syndrome. This rare side effect consisting in the presence of symptoms of olanzapine overdose after intramuscular administration of medication has led to restrictions on the use of the drug and the need for patient observation for three hours after each injection. We report a case of postinjection syndrome, to our knowledge, the first in Spain since the commercialization of Zypadhera. As in most cases described in the literature have symptoms of overdosage of olanzapine (dysarthria, sedation, fatigue, etc.) that are selflimiting without any therapeutic measure and are accompanied by supratherapeutic plasma levels of olanzapine.
Asunto(s)
Antipsicóticos/efectos adversos , Benzodiazepinas/efectos adversos , Antipsicóticos/administración & dosificación , Benzodiazepinas/administración & dosificación , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Olanzapina , SíndromeRESUMEN
La introducción de los antipsicóticos atípicos de liberación retardada ha permitido asegurar la adherencia al tratamiento en aquellos pacientes con baja conciencia de trastorno, con una tasa aceptable de efectos secundarios. En el caso de la olanzapina de liberación retardada en concreto, tiene especial relevancia la existencia del llamado Síndrome post-inyección. Este efecto secundario poco común consistente en la presencia de síntomas de sobredosis de olanzapina tras la administración intramuscular de la medicación ha supuesto restricción del uso del medicamento y la necesidad de observación del paciente durante tres horas después de cada inyección. Se presenta un caso de Síndrome post-inyección, a nuestro conocimiento, el primero en España desde la comercialización de Zypadhera. Al igual que en la mayoría de casos descritos en la bibliografía el paciente presenta síntomas de sobredosificación de olanzapina (disartria, sedación, astenia, etc.) que se auto limitan sin medida terapéutica alguna y se acompañan de niveles plasmáticos supraterapéuticos de olanzapina(AU)
The introduction of long-acting injectable atypical antipsychotics has ensured adherence to treatment in patients with low awareness of the disorder, with an acceptable rate of side effects. In the case of long acting olanzapine injection in particular, has particular relevance the existence of a special side-effect called post-injection syndrome. This rare side effect consisting in the presence of symptoms of olanzapine overdose after intramuscular administration of medication has led to restrictions on the use of the drug and the need for patient observation for three hours after each injection. We report a case of postinjection syndrome, to our knowledge, the first in Spain since the commercialization of Zypadhera. As in most cases described in the literature have symptoms of over dosage of olanzapine (dysarthria, sedation, fatigue, etc.) that are selflimiting without any therapeutic measure and are accompanied by supra therapeutic plasma levels of olanzapine(AU)