Trastorno Obsesivo-Compulsivo en tiempos de la COVID-19: una revisión sistemática

The pandemic caused by COVID-19 has physically and mentally affected people. A systematic review of the influence of COVID-19 on the exacerbation and incidence of Obsessive-Compulsive Disorder (OCD) symptoms in OCD patients and healthy population was carried out. Results obtained from 23 research articles and 1 case study are organized by population and geographic area and are discussed in comparison with previous pandemics. Some studies indicate that OCD symptomatology has been negatively affected by COVID-19, while others suggest that it remains unaffected and/or has improved. This topic should continue to be investigated.La pandemia por la COVID-19 ha afectado física y mentalmente a las personas. Se realizó una revisión sistemática sobre la influencia de la COVID-19 en la exacerbación e incidencia de los síntomas de Trastorno Obsesivo-Compulsivo (TOC), en pacientes y población general. Los resultados, a partir de 23 artículos de investigación y 1 estudio de caso, se ordenan según población diana y zona geográfica, y se discuten contrastándose con pandemias anteriores. Algunos indican que la COVID-19 ha impactado negativamente la sintomatología de TOC mientras otros apuntan a que no se ha visto afectada y/o ha mejorado. Este tema debería continuar investigándose

Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery

Background: Evidence from the context of local health ecosystems is highly relevant for research and policymaking to understand geographical variations in outcomes of health care delivery. In mental health systems, the analysis of context presents particular challenges related to their complexity and to methodological difficulties. Method guidelines and standard recommendations for conducting context analysis of local mental health care are urgently needed. This scoping study reviews current methods of context analysis in mental health systems to establish the parameters of research activity examining availability and capacity of care at the local level, and to identify any gaps in the literature. Methods: A scoping review based on a systematic search of key databases was conducted for the period 2005– 2016. A systems dynamics/complexity approach was adopted, using a modified version of Tansella and Thornicroft’s matrix model of mental health care as the conceptual framework for our analysis. Results: The lack of a specific terminology in the area meant that from 10,911 titles identified at the initial search, only 46 papers met inclusion criteria. Of these, 21 had serious methodological limitations. Fifteen papers did not use any kind of formal framework, and five of those did not describe their method. Units of analysis varied widely and across different levels of the system. Six instruments to describe service availability and capacity were identified, of which three had been psychometrically validated. A limitation was the exclusion of grey literature from the review. However, the imprecise nature of the terminology, and high number of initial results, makes the inclusion of grey literature not feasible. Conclusion: We identified that, in spite of its relevance, context studies in mental health services is a very limited research area. Few validated instruments are available. Methodological limitations in many papers mean that the particular challenges of mental health systems research such as system complexity, data availability and terminological variability are generally poorly addressed, presenting a barrier to valid system comparison. The modified Thornicroft and Tansella matrix and related ecological production of care model provide the main model for research within the area of health care ecosystems

Cognitive Treatment of Obsessive Compulsive Disorder in Online Format: A Case Report

Se presenta el caso de una estudiante que acude al Servicio de Atención Psicológica de la Universidad de Cádiz con diagnóstico de trastorno obsesivo compulsivo. Los contenidos de las obsesiones están relacionados principalmente con la duda. Las compulsiones más frecuentes son de limpieza, comprobación y orden. Las metas principales del tratamiento fueron reducir la aparición de obsesiones y compulsiones, modificando las creencias disfuncionales que las mantienen y disminuir el malestar asociado. La sintomatología obsesivo compulsiva se evalúa con los instrumentos YBOCS- Gravedad, OCI-R, ICO-R, INPIOS. Se planifica y se aplica una intervención de terapia cognitiva basada en el protocolo propuesto por Belloch et al. (2011) para el TOC de cuestionamiento de las creencias disfuncionales que mantienen las obsesiones de la paciente y las estrategias que utiliza para afrontarlas. Se han llevado a cabo18 sesiones semanales en formato online de 1 hora de duración. Para modificar las creencias obsesivas se utilizaron técnicas cognitivas (análisis de evidencias a favor y en contra, ventajas y desventajas, flecha descendente o estimación de probabilidades) y experimentos conductuales orientados al cuestionamiento de creencias. Se ha producido una disminución en la intensidad de las creencias disfuncionales, así como de la sintomatología obsesiva y del malestar.This is a case report of a student who comes to the Psychological Care Service of the University of Cadiz due to high anxiety and low mood related to the presence of obsessions and compulsions. The contents of the obsessions are mainly related to doubt. The most frequent compulsions were cleaning, checking and ordering. The main goals of the treatment were to reduce the occurrence of obsessions and compulsions, modifying the maintaining dysfunctional beliefs and reducing the associated distress. Obsessivecompulsive symptomatology was assessed with the Y-BOCS-Gravity, OCI-R, ICO-R, INPIOS and OC-TCDQ instruments. The diagnosis of obsessive-compulsive disorder (OCD) is established. A cognitive therapy intervention is planned and applied based on the protocol proposed by Belloch et al. (2011) for OCD of questioning the dysfunctional beliefs that maintain the patient’s obsessions and the strategies she uses to cope with them. 18 weekly sessions have been delivered in online format, each lasting 1 hour. Cognitive techniques (analysis of evidence for and against, pros and cons, advantages and disadvantages, downward arrow or probability estimation) and behavioural experiments aimed at questioning beliefs were used to modify obsessive beliefs. There has been a decrease in the intensity of dysfunctional beliefs and a considerable decrease in obsessive symptomatology and distress

Integrated mapping of local mental health systems in Central Chile

Objective. To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods. MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDELTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 (“DESDE-Chile”) designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity. Results. The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions. This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning

Standardised description of health and social care:A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

Background: Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. Method: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997–2018). Results: Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. Conclusions: The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed plannin

A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study

Background: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. Objective: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. Methods: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). Results: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. Conclusions: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care

Association of prolactin, oxytocin, and homocysteine with the clinical and cognitive features of a first episode of psychosis over a 1-year follow-up

Background: The clinical debut of schizophrenia is frequently a first episode of psychosis (FEP). As such, there is considerable interest in identifying associations between biological markers and clinical or cognitive characteristics that help predict the progression and outcome of FEP patients. Previous studies showed that high prolactin, low oxytocin, and high homocysteine are factors associated with FEP 6 months after diagnosis, at which point plasma levels were correlated with some clinical and cognitive characteristics. Methods: We reexamined 75 patients at 12 months after diagnosis to measure the evolution of these molecules and assess their association with clinical features. Results: At follow-up, FEP patients had lower prolactin levels than at baseline, and patients treated with risperidone or paliperidone had higher prolactin levels than patients who received other antipsychotic agents. By contrast, no changes in oxytocin and homocysteine plasma levels were observed between the baseline and follow-up. In terms of clinical features, we found that plasma prolactin and homocysteine levels were correlated with the severity of the psychotic symptoms in male FEP patients, suggesting that they might be factors associated with psychotic symptomatology but only in men. Together with oxytocin, these molecules may also be related to sustained attention, verbal ability, and working memory cognitive domains in FEP patients. Conclusion: This study suggests that focusing on prolactin, oxytocin, and homocysteine at a FEP may help select adequate pharmacological treatments and develop new tools to improve the outcome of these patients, where sex should also be borne in mind

Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020

Objetivo: Este artículo revisa y evalúa el uso de los Atlas Integrales de Salud Mental como herramientas de apoyo a la planificación de servicios dentro del modelo de investigación de ecosistemas de atención de salud. Método: Se describen los tipos de atlas y el procedimiento para su elaboración. Se presentan los realizados en España y se evalúa su impacto en la planificación de servicios de salud mental. Los atlas agregan información sobre las características locales del sistema de atención, la disponibilidad geográfica de recursos recogida mediante el instrumento DESDE-LTC, y su uso. Utilizan un sistema de información geográfica y otras herramientas visuales. Siguen una metodología de abajo arriba con colaboración de personas decisoras de agencias de planificación para su elaboración y validación externa. Resultados: Desde 2005 se han realizado Atlas Integrales de Salud Mental en nueve comunidades autónomas que comprenden alrededor del 65% de la población de España. Los atlas han tenido un impacto desigual en la planificación de servicios, con un mayor impacto en Cataluña, Vizcaya y Guipúzcoa, y Andalucía, donde responsables sociales han participado activamente en su codise ˜no y su aplicación a la planificación de servicios sociosanitarios. Conclusiones: Los atlas permiten detectar carencias o duplicidades en la atención, monitorizar cambios a lo largo del tiempo, realizar comparaciones nacionales e internacionales, modelar la eficiencia y hacer análisis benchmark. Este conocimiento puede incorporarse a los sistemas de apoyo a la decisión para una más eficaz planificación de los servicios de salud mental basada en evidencia informada.Objective: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. Method: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. Results: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. Conclusions: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy

The influence of oxytocin and prolactin during a first-episode of psychosis: the implication of sex differences, clinical features and cognitive performance

Background: Approximately 3% of the population suffers a first episode of psychosis (FEP), and a high percentage of these patients subsequently relapse. Because the clinical course following a FEP is hard to predict, it is of interest to identify cognitive and biological markers that will help improve the diagnosis, treatment, and outcome of such events and to define new therapeutic targets. Here we analyzed the plasma oxytocin and prolactin levels during an FEP, assessing their correlation with clinical and cognitive features. Methods: The oxytocin and prolactin in plasma was measured in 120 FEP patients and 106 healthy controls, all of whom were subjected to a clinical and neuropsychological assessment. Most patients were under antipsychotics. Statistical analyses aimed to identify factors associated with the FEP and to search for associations between the variables. This study is preliminary and exploratory because the P-values were not corrected for multiple comparisons. Results: FEP patients had less oxytocin, more prolactin, and a poor premorbid IQ, and they performed worse in sustained attention. Male patients with higher prolactin levels experienced more severe psychotic symptoms and required higher doses of antipsychotics. Low oxytocin was associated with poor sustained attention in women, whereas low oxytocin and high prolactin in men correlated with better performance in sustained attention. Conclusion: Low oxytocin, high prolactin, and poor premorbid IQ and sustained attention are factors associated with an FEP, representing potential therapeutic targets in these patients. These biological factors and cognitive domains might play an important role during a FEP, which could help us to develop new strategies that improve the outcomes of this disorder and that should perhaps be gender specific

The Influence of Oxytocin and Prolactin During a First Episode of Psychosis: The Implication of Sex Differences, Clinical Features, and Cognitive Performance

Background Approximately 3% of the population suffers a first episode of psychosis (FEP), and a high percentage of these patients subsequently relapse. Because the clinical course following a FEP is hard to predict, it is of interest to identify cognitive and biological markers that will help improve the diagnosis, treatment, and outcome of such events and to define new therapeutic targets. Here we analyzed the plasma oxytocin and prolactin levels during an FEP, assessing their correlation with clinical and cognitive features. Methods The oxytocin and prolactin in plasma was measured in 120 FEP patients and 106 healthy controls, all of whom were subjected to a clinical and neuropsychological assessment. Most patients were under antipsychotics. Statistical analyses aimed to identify factors associated with the FEP and to search for associations between the variables. This study is preliminary and exploratory because the P-values were not corrected for multiple comparisons. Results FEP patients had less oxytocin, more prolactin, and a poor premorbid IQ, and they performed worse in sustained attention. Male patients with higher prolactin levels experienced more severe psychotic symptoms and required higher doses of antipsychotics. Low oxytocin was associated with poor sustained attention in women, whereas low oxytocin and high prolactin in men correlated with better performance in sustained attention. Conclusion Low oxytocin, high prolactin, and poor premorbid IQ and sustained attention are factors associated with an FEP, representing potential therapeutic targets in these patients. These biological factors and cognitive domains might play an important role during a FEP, which could help us to develop new strategies that improve the outcomes of this disorder and that should perhaps be gender specific