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INTRODUCTION: Psychotic-like experiences (PLEs), which include hallucinations and delusional experiences, are usually present in healthy populations, and their persistence, quality, and severity are associated with the development of psychiatric diseases, including schizophrenia and other poor psychosocial outcomes. Urbanicity, depression, and other psychosocial stressors have been associated with PLEs. However, evidence of PLEs in Latin American (LATAM) countries is still scarce, and there are no studies about PLEs in Chile. The main aim of this study is to describe the prevalence of PLEs in a nationally representative sample according to other social determinants of health. METHODS: The last results of the Chilean National Health Survey (ENS 2016-2017) were analyzed. PLEs were obtained from the Composite International Diagnostic Interview (CIDI) 3.0 and included in this survey. Other psychosocial variables (age, sex, educational level, financial stress, depressive symptoms, and urbanicity) were also included for further analysis. Exclusion criteria were (1) > = 65 and < 18 years old, and (2) previous diagnosis or treatment for schizophrenia or bipolar disorder. Descriptive statistics were used to describe data, and Poisson regression models were performed to weight variables and find psychosocial correlations with PLEs. RESULTS: 2095 subjects were considered for this study (women 62.9% and mean age = 42.5, SD = 13.5). The lifetime prevalence of the PLEs (> = 1 PLE) in Chile was 12.9%. Visual hallucinations were the most common PLE (9.6%), and ideas of reference were the least common (0.4%). The Poisson regression model showed a higher prevalence of PLEs in the Gran Concepción conurbation (OR = 2.56) and Gran Valparaíso conurbation (OR = 1.69) compared with non-big cities. On the other hand, the 18-24 year group had higher PLEs prevalence compared to other age groups. No correlations were found with educational status, financial stress, or depressive symptoms. CONCLUSIONS: A relatively high prevalence of PLEs was found in the Chilean general population, particularly in youth living in large urban areas (Gran Valparaíso and Gran Concepción), which is compatible with previous research. Considering that there were no correlations between low educational level and financial or depressive symptoms, it is necessary to have more studies that correlate other urban relevant variables, such as natural disasters, drug consumption, and domestic or neighborhood violence.
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Background: Cognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions. Methods: A total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT). Results: The mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points). Conclusions: The MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.
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Dentro de los desafíos de la investigación en psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los trabajos científicos presentados en la IV conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en octubre del 2022. Métodos: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. Resultados: Se seleccionaron 5 trabajos. El 100% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, la mayoría de los trabajos presentados provienen de la región metropolitana. El 80% de los trabajos realizan un diseño experimental con reclutamiento de pacientes y el 20% usaron una metodología cualitativa. Conclusión: Así como años anteriores, los trabajos seleccionados dan cuenta de la importancia por el mejoramiento en la prevención, diagnóstico e intervención temprana en Psicosis. Se debe potenciar en Chile y latinoamerica el desarrollo académico y clínico en el campo de los EMARS.
Among the challenges of research in psychosis in Chile and the world, is the development of academic hubs for research in at-risk mental states (ARMS). This article presents a descriptive analysis of the summaries of the scientific works presented at the IV international conference: Clinical and Therapeutic Challenges in Psychosis held in October 2022. Methods: A selection and award were made for the best work according to a scoring system developed by an ad-hoc scientific committee. Then the information was systematized in a summary table for its subsequent qualitative descriptive analysis. Results: 5 works were selected. 100% of the selected works address the issue of early detection and early intervention in psychosis, particularly in the ARMS. Most of the papers presented come from the metropolitan region. 80% of the works carried out an experimental design with patient recruitment and 20% used a qualitative methodology. Conclusion: As in previous years, the selected works show the importance of improving prevention, diagnosis, and early intervention in psychosis. Research and clinical work in Chile and Latinoamerica should be strengthened in the field of ARMS.
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Humanos , Transtornos Psicóticos/epidemiologia , Congressos como Assunto , Chile/epidemiologia , Epidemiologia DescritivaRESUMO
Automated language analysis of speech has been shown to distinguish healthy control (HC) vs chronic schizophrenia (SZ) groups, yet the predictive power on first-episode psychosis patients (FEP) and the generalization to non-English speakers remain unclear. We performed a cross-sectional and longitudinal (18 months) automated language analysis in 133 Spanish-speaking subjects from three groups: healthy control or HC (n = 49), FEP (n = 40), and chronic SZ (n = 44). Interviews were manually transcribed, and the analysis included 30 language features (4 verbal fluency; 20 verbal productivity; 6 semantic coherence). Our cross-sectional analysis showed that using the top ten ranked and decorrelated language features, an automated HC vs SZ classification achieved 85.9% accuracy. In our longitudinal analysis, 28 FEP patients were diagnosed with SZ at the end of the study. Here, combining demographics, PANSS, and language information, the prediction accuracy reached 77.5% mainly driven by semantic coherence information. Overall, we showed that language features from Spanish-speaking clinical interviews can distinguish HC vs chronic SZ, and predict SZ diagnosis in FEP patients.
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Brain Derived Neurotrophic Factor (BDNF) has been linked to cognitive symptoms of schizophrenia, which has been documented in previous reviews by several authors. However, a trend has recently emerged in this field moving from studying schizophrenia as a disease to studying psychosis as a group. This review article focuses on recent BDNF studies in relation to cognition in human subjects during different stages of the psychotic process, including subjects at high risk of developing psychosis, patients at their first episode of psychosis, and patients with chronic schizophrenia. We aim to provide an update of BDNF as a biomarker of cognitive function on human subjects with schizophrenia or earlier stages of psychosis, covering new trends, controversies, current research gaps, and suggest potential future developments in the field. We found that most of current research regarding BDNF and cognitive symptoms in psychosis is done around schizophrenia as a disease. Therefore, it is necessary to expand the study of the relationship between BDNF and cognitive symptoms to psychotic illnesses of different stages and origins.
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INTRODUCCIÓN: Dentro de los desafíos de la investigación en Psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los resúmenes de los trabajos científicos presentados en la II conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en Octubre del 2020. MÉTODOS: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. RESULTADOS: Se seleccionaron 12 trabajos. El 75% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, el 40% de los trabajos presentados provienen de regiones de la zona centro-sur de nuestro país. El 83% de los trabajos realizan un diseño experimental con reclutamiento de pacientes o discusión de casos clínicos complejos. CONCLUSIÓN: Los trabajos seleccionados dan cuenta del interés por el mejoramiento en el diagnóstico y terapéutica en este ámbito. Se debe potenciar el trabajo de investigación y asistencial en Chile en el ámbito de los EMARS.
INTRODUCTION: Within the challenges of research in Psychosis in Chile and the world is the development of academic research poles in mental states of risk (EMARS). This article makes a descriptive analysis of the summaries of the scientific papers presented at the II international conference: Clinical and therapeutic challenges in Psychosis held in October 2020. METHODS: The best work was selected and awarded according to a scoring system carried out by an ad-hoc scientific committee. The information was then systematized in a summary table for subsequent qualitative descriptive analysis. RESULTS: 12 papers were selected. 75% of the selected works address the issue of early detection and early intervention in psychosis, particularly the EMARS theme. Likewise, 40% of the papers presented come from regions of the south-central zone of our country. 83% of the works carry out an experimental design with recruitment of patients or discussion of complex clinical cases. CONCLUSION: The selected works show the interest in the improvement in diagnosis and therapy in this area. Research and assistance work in Chile should be promoted in the field of EMARS.
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Humanos , Transtornos Psicóticos , Congressos como Assunto , Pesquisa Biomédica , Chile , Pôsteres como AssuntoRESUMO
AIM: Early detection and intervention (EDI) is a main challenge in psychosis research. The Chilean schizophrenia (SZ) national program has universal support and treatment by law for all SZ patients, but this does not yet extend to earlier stages of illness. Therefore, we have piloted an ultra-high risk (UHR) program to demonstrate the utility and feasibility of this public health approach in Chile. METHODS: We introduce "The University of Chile High-risk Intervention Program," which is the first national EDI program for UHR youths. Longitudinal follow-up included clinical and cognitive assessments, and monitoring of physiological sensory and cognitive indices, through electroencephalographic techniques. RESULTS: We recruited 27 UHR youths over 2 years. About 92.6% met criteria for attenuated psychosis syndrome (APS). Mean Scale of Psychosis-Risk Symptoms (SOPS) ratings in the cohort were 6.9 (SD 4.6) for positive, 9.1 (SD 8.3) for negative, 5.4 (SD 5.3) for disorganized and 6.3 (SD 4.1) for general symptoms. About 14.8% met criteria for comorbid anxiety disorders and 44.4% for mood disorders. Most participants received cognitive behavioural therapy (62.9%) and were prescribed low dose antipsychotics (85.2%). The transition rate to psychosis was 22% within 2 years. CONCLUSIONS: We describe our experience in establishing the first EDI program for UHR subjects in Chile. Our cohort is similar in profile and risk to those identified in higher-income countries. We will extend our work to further optimize psychosocial and preventive interventions, to promote its inclusion in the Chilean SZ national program and to establish a South American collaboration network for SZ research.
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Pesquisa Biomédica , Diagnóstico Precoce , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Pesquisa Biomédica/tendências , Chile , Terapia Cognitivo-Comportamental , Estudos de Coortes , Comorbidade , Substituição de Medicamentos , Intervenção Médica Precoce , Feminino , Humanos , Masculino , Sintomas Prodrômicos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Adulto JovemRESUMO
Schizophrenia (SZ) is a disorder with a high heritability and a complex architecture. Several dozen genetic variants have been identified as risk factors through genome-wide association studies including large population-based samples. However, the bulk of the risk cannot be accounted for by the genes associated to date. Rare mutations have been historically seen as relevant only for some infrequent, Mendelian forms of psychosis. Recent findings, however, show that the subset of patients that present a mutation with major effect is larger than expected. We discuss some of the molecular findings of these studies. SZ is clinically and genetically heterogeneous. To identify the genetic variation underlying the disorder, research should be focused on features that are more likely a product of genetic heterogeneity. Based on the phenotypical correlations with rare variants, cognition emerges as a relevant domain to study. Cognitive disturbances could be useful in selecting cases that have a higher probability of carrying deleterious mutations, as well as on the correct ascertainment of sporadic cases for the identification of de novo variants.
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Marcadores Genéticos , Predisposição Genética para Doença , Variação Genética , Esquizofrenia/genética , Genótipo , Humanos , FenótipoRESUMO
Chronic exposure to organophosphate pesticides is a worldwide public health concern associated with several psychiatric disorders and dementia. Most existing studies on the effects of pesticides only evaluate agricultural workers. Therefore, this study sought to establish if individuals indirectly exposed to pesticides, such as residents in agricultural areas, also suffer cognitive impairments. Neuropsychological evaluations were carried out on three groups (n=102): agricultural workers directly exposed to pesticides (n=32), individuals living in agricultural areas indirectly (i.e. environmentally) exposed to pesticides (n=32), and an unexposed control group (n=38). The assessed cognitive processes included memory, executive functions, attention, language praxis, and visuoconstruction. The direct exposure group performed significantly lower in executive function, verbal fluency, and visual and auditory memory tests than the indirect exposure group, which, in turn, performed worse than the unexposed group. Even after adjusting for age, gender, and educational level, both exposure groups showed higher rates of cognitive deficit than control individuals. In conclusion, both direct and indirect chronic exposure to pesticides affects cognitive functioning in adults and, consequently, actions should be taken to protect the health of not only agricultural workers, but also of residents in agricultural areas.
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Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Disfunção Cognitiva/induzido quimicamente , Exposição Ambiental/efeitos adversos , Praguicidas/efeitos adversos , Adulto , Chile , Estudos Transversais , Fazendeiros/psicologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Exposição Ocupacional/efeitos adversosRESUMO
BACKGROUND: According to the projections of the World Health Organization, 15% of all disabilities will be associated with mental illnesses by 2020. One of the mental disorders with the largest social impacts due to high personal and family costs is psychosis. Among the most effective psychological approaches to treat schizophrenia and other psychotic disorders at the world level is cognitive behavioral therapy. Recently, cognitive behavioral therapy has introduced several tools and strategies that promote psychological processes based on acceptance and mindfulness. A large number of studies support the effectiveness of mindfulness in dealing with various mental health problems, including psychosis. This study is aimed at determining the efficiency of a mindfulness-based program in increasing cognitive function and psychological well-being in patients with a first episode of schizophrenia and a high risk mental state (those at risk of developing an episode of psychosis). METHODS AND DESIGN: This is an experimentally designed, multi-center randomized controlled trial, with a 3-month follow-up period. The study participants will be 48 patients diagnosed with schizophrenia (first episode) and 48 with a high-risk mental state, from Santiago, Chile, aged between 15 and 35 years. Participants will be submitted to a mindfulness-based intervention (MBI), which will involve taking part in eight mindfulness workshops adapted for people with psychosis. Workshops will last approximately 1.5 hours and take place once a week, over 8 weeks. The primary outcome will be the cognitive function through Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) and the secondary outcome will be psychological well-being measured by self-reporting questionnaires. DISCUSSION: The outcomes of this trial will add empirical evidence to the benefits and feasibility of MBIs for the psychotherapeutic treatment of patients with schizophrenia and high-risk mental states in reducing cognitive impairment in attention, working memory, and social cognition, as well as increasing the psychological well-being by empowering the patients' personal resources in the management of their own symptoms and psychotic experiences. TRIAL REGISTRATION: ISRCTN registration number ISRCTN24327446 . Registered on 12 September 2016.
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Cognição , Terapia Cognitivo-Comportamental/métodos , Intervenção Médica Precoce , Saúde Mental , Atenção Plena , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adolescente , Adulto , Atenção , Chile , Protocolos Clínicos , Feminino , Humanos , Masculino , Memória , Escalas de Graduação Psiquiátrica , Projetos de Pesquisa , Fatores de Risco , Esquizofrenia/diagnóstico , Autorrelato , Comportamento Social , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Metabolic syndrome (MS) is a prevalent and severe comorbidity observed in schizophrenia (SZ). The exact nature of this association is controversial and very often accredited to the effects of psychotropic medications and disease-induced life-style modifications, such as inactive lifestyle, poor dietary choices, and smoking. However, drug therapy and disease-induced lifestyle factors are likely not the only factors contributing to the observed converging nature of these conditions, since an increased prevalence of MS is also observed in first episode and drug-naïve psychosis populations. MS and SZ share common intrinsic susceptibility factors and etiopathogenic mechanisms, which may change the way we approach clinical management of SZ patients. Among the most relevant common pathogenic pathways of SZ and MS are alterations in the sphingolipids (SLs) metabolism and SLs homeostasis. SLs have important structural functions as they participate in the formation of membrane "lipid rafts." SLs also play physiological roles in cell differentiation, proliferation, and inflammatory processes, which might be part of MS/SZ common pathophysiological processes. In this article we review a plausible mechanism to explain the link between MS and SZ through a disruption in SL homeostasis. Additionally, we provide insights on how this hypothesis can lead to the developing of new diagnostic/therapeutic technologies for SZ patients.
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BACKGROUND: Working memory (WM) tasks usually elicit a P300 ERP component, whose amplitude decreases with increasing WM load. So far, this effect has not been studied in schizophrenics (SZs), a group that is considered to have an aberrant brain connectivity and impairments in WM capacity. The aim of this study was to determine the dependency of the P300 component on WM load in a sample of SZ subjects. METHODS: We recorded 26 subjects (13 SZ patients and their matched controls) with an 80-channel electroencephalogram. Subjects performed an N-back task, a WM paradigm that manipulates the number of items to be stored in memory. RESULTS: In healthy subjects, P300 amplitude was highest in the low WM load condition, and lowest in both the attentional control condition and the high WM load condition. In contrast, SZs evidenced low P300 amplitude in all conditions. A significant between group difference in P300 amplitude was evidenced only at the low WM load condition (1 -back), being smaller in SZs. CONCLUSIONS: SZ subjects display a lower than normal P300 amplitude, which does not vary as a function of memory load. These results are consistent with a general impairment in WM capacity in these patients.
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Córtex Cerebral/fisiopatologia , Potenciais Evocados P300/fisiologia , Memória de Curto Prazo/fisiologia , Esquizofrenia/fisiopatologia , Adulto , Análise de Variância , Eletroencefalografia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Índice de Gravidade de DoençaRESUMO
Early models for the etiology of schizophrenia focused on dopamine neurotransmission because of the powerful anti-psychotic action of dopamine antagonists. Nevertheless, recent evidence increasingly supports a primarily glutamatergic dysfunction in this condition, where dopaminergic disbalance is a secondary effect. A current model for the pathophysiology of schizophrenia involves a dysfunctional mechanism by which the NMDA receptor (NMDAR) hypofunction leads to a dysregulation of GABA fast- spiking interneurons, consequently disinhibiting pyramidal glutamatergic output and disturbing the signal-to-noise ratio. This mechanism might explain better than other models some cognitive deficits observed in this disease, as well as the dopaminergic alterations and therapeutic effect of anti-psychotics. Although the modulation of glutamate activity has, in principle, great therapeutic potential, a side effect of NMDAR overactivation is neurotoxicity, which accelerates neuropathological alterations in this illness. We propose that metabotropic glutamate receptors can have a modulatory effect over the NMDAR and regulate excitotoxity mechanisms. Therefore, in our view metabotropic glutamate receptors constitute a highly promising target for future drug treatment in this disease.
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Ácido Glutâmico/metabolismo , Receptores de N-Metil-D-Aspartato/fisiologia , Esquizofrenia/metabolismo , Esquizofrenia/fisiopatologia , Animais , Modelos Animais de Doenças , Humanos , Interneurônios/metabolismo , Modelos Neurológicos , Esquizofrenia/terapia , Transdução de Sinais/fisiologia , Ácido gama-Aminobutírico/metabolismoRESUMO
Se presenta un resumen de la tesis realizada para optar al grado de Doctor en Ciencias Médicas del programa de Postgrado de la Pontificia Universidad Católica de Chile. Desde el año 1995este programa ha permitido la formación de Médicos que sean capaces de originar investigación independiente en el área biomédica, de constituir un puente entre la investigación básica y la práctica clínica, y que contribuyan al mejoramiento de la docencia académica. El resumen de la tesis que se presenta a continuación fue realizado en el laboratorio de Neurociencias cognitivas del Dr. Francisco Aboitiz, perteneciente al departamento de Psiquiatría de la Pontificia Universidad Católica de Chile en estrecha colaboración con dos centros de investigación internacionales: El F.C. Donders Center para el estudio de neuroimágenes cognitivas, de la universidad de Radboud en Holanda, y el Laboratorio de imagen cerebral y neurociencia cognitiva (LENA ) en Francia.
This work corresponds to a summary of doctoral thesis performed to apply to the doctoral degree in medical science the Pontifical Catholic University of Chile. Since 1995, this program has allowed the training of medical doctors able to produce independent research in the biomedical sciences, bridging the gap between basic research and clinical practice and improving academic teaching. The following summary was made in the Cognitive Neuroscience Laboratory of the psychiatry department of the Pontifical Catholic University of Chile led by Dr. Francisco Aboitiz. This work was performed in close collaboration with two international research centers: The F.C. Donders Center for cognitive neuroimaging (Radboud University, Netherlands) and the cognitive neuroscience and brain-imaging laboratory (LENA, France).