Mindfulness en el contexto clínico en psiquiatría de adultos: una revisión bibliográfica

En este trabajo final de graduación se pretende la integración de la información disponible hasta el momento sobre el mindfulness en las diferentes áreas que puedan ser de interés para la psiquiatría en el contexto de adultos. Se comienza por una descripción general sobre la práctica, que incluye contenidos como la definición, como se realiza la práctica de meditación basada en atención plena, mecanismos de acción, fundamentos, entre otros. Seguidamente, se detallan sobre los beneficios y los riesgos que se conocen de la práctica. Se especifican los diferentes tipos de intervenciones basadas en mindfulness y como pueden estos estar relacionados al ejercicio de la psiquiatría clínica. Parte importante del contenido en este trabajo es la evidencia científica de las diferentes áreas biológicas como los cambios en el cerebro (estructurales y funcionales), los efectos endocrinológicos e inmunológicos, entre otros. Posteriormente, se presenta la evidencia que existe sobre los diferentes tipos de intervenciones de atención plena en enfermedades específicas de la psiquiatría de adultos, como lo son la depresión, ansiedad, trastorno por consumo de sustancias, trastornos de personalidad, enfermedad bipolar, trastornos psicóticos, trastorno obsesivo compulsivo y trastorno de estrés post trauma. Finalmente, la conclusión pretende dar un resumen integrativo de la información y recomendaciones generales.In this final graduation work, the aim is to integrate the information available up to now on mindfulness in the different areas that may be of interest to psychiatry in the adult context. It begins with a general description of the practice, which includes contents such as the definition, how the practice of meditation based on mindfulness is carried out, mechanisms of action, fundamentals, among others. The benefits and risks that are known from the practice are detailed below. The different types of mindfulness-based interventions are specified and how they can be related to the practice of clinical psychiatry. An important part of the content in this work is the scientific evidence of the different biological areas such as changes in the brain (structural and functional), endocrinological and immunological effects, among others. Subsequently, the evidence that exists on the different types of mindfulness interventions in specific diseases of adult psychiatry is presented, such as depression, anxiety, substance use disorder, personality disorders, bipolar disease, psychotic disorders, obsessive compulsive disorder and post trauma stress disorder. Finally, the conclusion tries to give an integrative summary of the information and general recommendations.UCR::Vicerrectoría de Investigación::Sistema de Estudios de Posgrado::Salud::Especialidad en Psiquiatrí

Perceptual biases and metacognition and their association with anomalous self experiences in first episode psychosis

Anomalous self-experiences have been described as a prerequisite for anomalous perceptual experiences. Later, these anomalous perceptual experiences may then be metacognitively appraised as distressing, maintaining these experiences and later leading to anomalous (delusional) beliefs. This model of anomalous events may potentially be driven by perceptual biases and metacognitive deficits. This cross-sectional study explored the association between perceptual biases, metacognition and anomalous self- and perceptual experiences and delusional beliefs in First Episode Psychosis (FEP) and a matched healthy control sample. Fifty-eight individuals with FEP and seventy-two healthy controls were included in the main analysis. Increased auditory perceptual biases were significantly associated with increased state and trait anomalous self-experiences, in particular alienation from surroundings and emotional numbing. No significant associations were found between metacognitive efficiency and anomalous experiences. These findings may be consistent with the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly with the hyperreflexivity concept

Impact of the Enhanced Universal Support Offer to Care Homes during COVID-19 in the UK: evaluation using appreciative inquiry

There are over 2300 care homes in the North East and Yorkshire Region (NE&Y), with rising rates of COVID-19 infection in April 2020. The Enhanced Universal Support Offer (EUSO) planned to improve support to care homes, working collaboratively with local integrated community services. Implementation was organised at ‘place’, through clinical commissioning and it was focused on leadership, prevention, additional clinical support, and workforce planning. The aim of the evaluation research was to understand the impact of the EUSO. The evaluation was co-produced by a group of senior leaders with additional academic involvement. An appreciative inquiry approach informed the interviews and focus groups with representative stakeholders. A thematic analysis using NVivo enabled a validation process and the data was charted into a systems framework. Data analysis resulted in five high level themes: Communication, Working Relationships, Systemic Perceptions, COVID-19 Implementation, and Organisational Support. Best practices were associated with joint working between health, local authority and care homes including medication optimisation and technology use. Care homes valued access to a named GP and community nursing working as a part of a wider multidisciplinary team. Conversely an overly reactive response to care homes combined with ‘command and control’ limited the benefits that were achieved. The EUSO was delivered at pace and resulted in an increased appreciation of the policy and principles of care home residents and workforce. The evaluation reflected a need to appreciate the care homes’ knowledge and experience of resident wellbeing, and more fully involve them in the design of the support

CONCEPTUAL MODELLING: KNOWLEDGE ACQUISITION AND MODEL ABSTRACTION

Conceptual modelling has gained a lot of interest in recent years and simulation modellers are particularly interested in understanding the processes involved in arriving at a conceptual model. This paper contributes to this understanding by discussing the artifacts of conceptual modelling and two specific conceptual modelling processes: knowledge acquisition and model abstraction. Knowledge acquisition is the process of finding out about the problem situation and arriving at a system description. Model abstraction refers to the simplifications made in moving from a system description to a conceptual model. Soft Systems Methodology has tools that can help a modeller with knowledge acquisition and model abstraction. These tools are drawing rich pictures, undertaking analyses ‘one’, ‘two’, ‘three’, and constructing a root definition and the corresponding purposeful activity model. The use of these tools is discussed with respect to a case study in health care.

Bridging the digital divide in psychological therapies: observational study of engagement with the SlowMo mobile app for paranoia in psychosis

Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes

Comparison of Antiretroviral Therapies in Pregnant Women Living With Human Immunodeficiency Virus and Hepatitis B Virus

ObjectiveTo describe the anti-hepatitis B virus (HBV) efficacy, HBeAg serologic changes, HBV perinatal transmission, and safety in pregnant women who are living with human immunodeficiency virus (HIV) and HBV co-infection who were randomized to various antiretroviral therapy (ART) regimens.MethodsThe PROMISE (Promoting Maternal and Infant Survival Everywhere) trial was a multicenter randomized trial for ART-naive pregnant women with HIV infection. Women with HIV and HBV co-infection at 14 or more weeks of gestation were randomized to one of three ART arms: one without HBV treatment (group 1) and two HBV treatment arms with single (group 2) or dual anti-HBV activity (group 3). The primary HBV outcome was HBV viral load antepartum change from baseline (enrollment) to 8 weeks; safety assessments included alanine aminotransferase (ALT) level, aspartate aminotransferase (AST) level, and anemia (hemoglobin less than 10 g/dL). Primary comparison was for the HBV-active treatment arms. Pairwise comparisons applied t test and the Fisher exact tests.ResultsOf 3,543 women, 3.9% were HBsAg-positive; 42 were randomized to group 1, 48 to group 2, and 48 to group 3. Median gestational age at enrollment was 27 weeks. Among HBV-viremic women, mean antepartum HBV viral load change at week 8 was -0.26 log 10 international units/mL in group 1, -1.86 in group 2, and -1.89 in group 3. In those who were HBeAg-positive, HBeAg loss occurred in 44.4% at delivery. Two perinatal HBV transmissions occurred in group 2. During the antepartum period, one woman (2.4%) in group 1 had grade 3 or 4 ALT or AST elevations, two women (4.2%) in group 2, and three women (6.3%) in group 3.ConclusionOver a short period of time, HBV DNA suppression was not different with one or two HBV-active agents. HbeAg loss occurred in a substantial proportion of participants. Perinatal transmission of HBV infection was low. Hepatitis B virus-active ART was well-tolerated in pregnancy, with few grade 3 or 4 ALT or AST elevations.Clinical trial registrationClinicalTrials.gov , NCT01061151

Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies

Background: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers’ or caregivers’ experiences of stigma in Australian community pharmacies. Materials: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach. Discussion: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers’ community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma. Conclusions: Findings provide insight into the stigma of mental illness in community pharmacies

Telomeric expression sites are highly conserved in trypanosoma brucei

Subtelomeric regions are often under-represented in genome sequences of eukaryotes. One of the best known examples of the use of telomere proximity for adaptive purposes are the bloodstream expression sites (BESs) of the African trypanosome Trypanosoma brucei. To enhance our understanding of BES structure and function in host adaptation and immune evasion, the BES repertoire from the Lister 427 strain of T. brucei were independently tagged and sequenced. BESs are polymorphic in size and structure but reveal a surprisingly conserved architecture in the context of extensive recombination. Very small BESs do exist and many functioning BESs do not contain the full complement of expression site associated genes (ESAGs). The consequences of duplicated or missing ESAGs, including ESAG9, a newly named ESAG12, and additional variant surface glycoprotein genes (VSGs) were evaluated by functional assays after BESs were tagged with a drug-resistance gene. Phylogenetic analysis of constituent ESAG families suggests that BESs are sequence mosaics and that extensive recombination has shaped the evolution of the BES repertoire. This work opens important perspectives in understanding the molecular mechanisms of antigenic variation, a widely used strategy for immune evasion in pathogens, and telomere biology

Multi-drug resistant Acinetobacter infections in critically injured Canadian forces soldiers

<p>Abstract</p> <p>Background</p> <p>Military members, injured in Afghanistan or Iraq, have returned home with multi-drug resistant <it>Acinetobacter baumannii </it>infections. The source of these infections is unknown.</p> <p>Methods</p> <p>Retrospective study of all Canadian soldiers who were injured in Afghanistan and who required mechanical ventilation from January 1 2006 to September 1 2006. Patients who developed <it>A. baumannii </it>ventilator associated pneumonia (VAP) were identified. All <it>A. baumannii </it>isolates were retrieved for study patients and compared with <it>A. baumannii </it>isolates from environmental sources from the Kandahar military hospital using pulsed-field gel electrophoresis (PFGE).</p> <p>Results</p> <p>During the study period, six Canadian Forces (CF) soldiers were injured in Afghanistan, required mechanical ventilation and were repatriated to Canadian hospitals. Four of these patients developed <it>A. baumannii </it>VAP. <it>A. baumannii </it>was also isolated from one environmental source in Kandahar – a ventilator air intake filter. Patient isolates were genetically indistinguishable from each other and from the isolates cultured from the ventilator filter. These isolates were resistant to numerous classes of antimicrobials including the carbapenems.</p> <p>Conclusion</p> <p>These results suggest that the source of <it>A. baumannii </it>infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant <it>A. baumannii </it>infections in injured soldiers.</p