Improvement of functional neurological disorder after administration of esketamine nasal spray: a case report

Esketamina; Trastorn neurològic funcional; Paràlisi mixtaEsketamina; Trastorno neurológico funcional; Parálisis mixtaEsketamine; Functional neurological disorder; Mixed paralysisFunctional neurological disorder (FND) is a complex neuropsychiatric condition characterized by the presence of neurological symptoms and signs (either motor or sensory) that cannot be explained by any known medical or mental disease. It is frequently presented with psychiatric comorbidities, such as major depression. Its prognosis is poor, with low improvement or recovery rates at 1 year after their onset, and no particular treatment has demonstrated significant efficacy in this regard. Here, we describe the management of a patient affected by treatment-resistant depression (TRD) and FND characterized by mixed paralysis (sensory and motor) in the left arm, and who was successfully treated with esketamine nasal spray, achieving remission in both disorders. The US Food and Drug Administration and the European Medicines Agency recently approved esketamine, the S-enantiomer of ketamine, for treatment of TRD. It is a fast-acting drug that provides a rapid-onset improvement of depressive symptoms. We have presented the first case, to our knowledge, of functional neurological symptoms being successfully treated with esketamine in a patient with comorbid TRD. While the novelty of this data implies a clear need for further research, it is suggested that esketamine might be a useful tool for the treatment of FND, acting through different theorized mechanisms that are in tune with recent advances in knowledge of the etiopathology of FND.The authors received no financial support for the research, authorship, and/or publication of this article

Incongruent Views of Functioning between Patients and Gastroenterologists : A Mixed Methods Study

Gastrointestinal patients, especially those diagnosed with functional digestive disorders (FGIDs), usually present a complex clinical picture that poses a challenge for their management in primary care. The main objective of the current research was to examine the relationship of the congruence of the perception of severity and quality of life between gastroenterologists and their patients with psychological distress and the helping attitude experienced by the latter attended in primary care centres. Additionally, we wanted to explore patients' and practitioners' perceptions. We performed a cross-sectional study with a total of 2261 patients (1562 analysed) that attended three primary care centres. Patients completed questionnaires that measured physical functioning, distress, and perception of helping attitude. Gastroenterologists registered the functional status of each participating patient. Patients were then invited to take part in the qualitative part of the study if they were considered to have incongruent views on their functioning with their gastroenterologist. In total, 52 patients took part in one of eight focus groups. Additionally, four individual interviews were carried out with three gastroenterologists and one consultation-liaison psychiatrist specialised in FGIDs. Both incongruence and functional diagnosis correlated with distress. However, incongruent views between patients and gastroenterologists explained more variance. Statistically significant differences in patients' helping attitude perception were detected between diagnostic but no incongruence groups. In the second stage of the study, a total of five themes were identified from the patient focus groups and the gastroenterologist interviews: illness-emotional and personal problems, disease-health system interaction, health system, intervention, and patients. The current research allowed us to confirm that incongruence in the perception of severity and quality of life between gastroenterologists and patients is related to psychological distress and that this occurs in a multifactorial context where the characteristics of the disorder interact with those of the health system

The Conners Continuous Performance Test CPT3™: Is it a reliable marker to predict neurocognitive dysfunction in Myalgic encephalomyelitis/chronic fatigue syndrome?

IntroductionThe main objective is to delimit the cognitive dysfunction associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in adult patients by applying the Continuous Performance Test (CPT3™). Additionally, provide empirical evidence on the usefulness of this computerized neuropsychological test to assess ME/CFS.MethodThe final sample (n = 225; 158 Patients/67 Healthy controls) were recruited in a Central Sensitization Syndromes (CSS) specialized unit in a tertiary hospital. All participants were administered this neuropsychological test.ResultsThere were significant differences between ME/CFS and healthy controls in all the main measures of CPT3™. Mainly, patients had a worse indicator of inattentiveness, sustained attention, vigilance, impulsivity, slow reaction time, and more atypical T-scores, which is associated with a likelihood of having a disorder characterized by attention deficits, such as Attention Deficit Hyperactivity Disorder (ADHD). In addition, relevant correlations were obtained between the CPT3™ variables in the patient’s group. The most discriminative indicators of ME/CFS patients were Variability and Hit Reaction Time, both measures of response speed.ConclusionThe CPT3™ is a helpful tool to discriminate neurocognitive impairments from attention and response speed in ME/CFS patients, and it could be used as a marker of ME/CFS severity for diagnosing or monitoring this disease

The Conners Continuous Performance Test CPT3™: Is it a reliable marker to predict neurocognitive dysfunction in Myalgic encephalomyelitis/chronic fatigue syndrome?

Chronic fatigue syndrome; Continuous performance test; Neurocognitive dysfunctionSíndrome de fatiga crónica; Prueba de rendimiento continuo; Disfunción neurocognitivaSíndrome de fatiga crònica; Prova de rendiment contínua; Disfunció neurocognitivaIntroduction: The main objective is to delimit the cognitive dysfunction associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in adult patients by applying the Continuous Performance Test (CPT3™). Additionally, provide empirical evidence on the usefulness of this computerized neuropsychological test to assess ME/CFS. Method: The final sample (n = 225; 158 Patients/67 Healthy controls) were recruited in a Central Sensitization Syndromes (CSS) specialized unit in a tertiary hospital. All participants were administered this neuropsychological test. Results: There were significant differences between ME/CFS and healthy controls in all the main measures of CPT3™. Mainly, patients had a worse indicator of inattentiveness, sustained attention, vigilance, impulsivity, slow reaction time, and more atypical T-scores, which is associated with a likelihood of having a disorder characterized by attention deficits, such as Attention Deficit Hyperactivity Disorder (ADHD). In addition, relevant correlations were obtained between the CPT3™ variables in the patient's group. The most discriminative indicators of ME/CFS patients were Variability and Hit Reaction Time, both measures of response speed. Conclusion: The CPT3™ is a helpful tool to discriminate neurocognitive impairments from attention and response speed in ME/CFS patients, and it could be used as a marker of ME/CFS severity for diagnosing or monitoring this disease

The Conners Continuous Performance Test CPT3 ™ : Is it a reliable marker to predict neurocognitive dysfunction in Myalgic encephalomyelitis/chronic fatigue syndrome?

The main objective is to delimit the cognitive dysfunction associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in adult patients by applying the Continuous Performance Test (CPT3 ™). Additionally, provide empirical evidence on the usefulness of this computerized neuropsychological test to assess ME/CFS. The final sample (n = 225; 158 Patients/67 Healthy controls) were recruited in a Central Sensitization Syndromes (CSS) specialized unit in a tertiary hospital. All participants were administered this neuropsychological test. There were significant differences between ME/CFS and healthy controls in all the main measures of CPT3 ™. Mainly, patients had a worse indicator of inattentiveness, sustained attention, vigilance, impulsivity, slow reaction time, and more atypical T-scores, which is associated with a likelihood of having a disorder characterized by attention deficits, such as Attention Deficit Hyperactivity Disorder (ADHD). In addition, relevant correlations were obtained between the CPT3 ™ variables in the patient's group. The most discriminative indicators of ME/CFS patients were Variability and Hit Reaction Time, both measures of response speed. The CPT3 ™ is a helpful tool to discriminate neurocognitive impairments from attention and response speed in ME/CFS patients, and it could be used as a marker of ME/CFS severity for diagnosing or monitoring this disease

Genome-wide multi-trait analysis of irritable bowel syndrome and related mental conditions identifies 38 new independent variants

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction frequently accompanied by mental conditions, including depression and anxiety. Despite showing substantial heritability and being partly determined by a genetic component, the genetic underpinnings explaining the high rates of comorbidity remain largely unclear and there are no conclusive data on the temporal relationship between them. Exploring the overlapping genetic architecture between IBS and mental conditions may help to identify novel genetic loci and biological mechanisms underlying IBS and causal relationships between them. We quantified the genetic overlap between IBS, neuroticism, depression and anxiety, conducted a multi-trait genome-wide association study (GWAS) considering these traits and investigated causal relationships between them by using the largest GWAS to date. IBS showed to be a highly polygenic disorder with extensive genetic sharing with mental conditions. Multi-trait analysis of IBS and neuroticism, depression and anxiety identified 42 genome-wide significant variants for IBS, of which 38 are novel. Fine-mapping risk loci highlighted 289 genes enriched in genes upregulated during early embryonic brain development and gene-sets related with psychiatric, digestive and autoimmune disorders. IBS-associated genes were enriched for target genes of anti-inflammatory and antirheumatic drugs, anesthetics and opioid dependence pharmacological treatment. Mendelian-randomization analysis accounting for correlated pleiotropy identified bidirectional causal effects between IBS and neuroticism and depression and causal effects of the genetic liability of IBS on anxiety. These findings provide evidence of the polygenic architecture of IBS, identify novel genome-wide significant variants for IBS and extend previous knowledge on the genetic overlap and relationship between gastrointestinal and mental disorders. The online version contains supplementary material available at 10.1186/s12967-023-04107-5

Mucosal Plasma Cell Activation and Proximity to Nerve Fibres Are Associated with Glycocalyx Reduction in Diarrhoea-Predominant Irritable Bowel Syndrome: Jejunal Barrier Alterations Underlying Clinical Manifestations

Intestinal barrier dysfunction; Intestinal glycocalyx; Mucosal nerve fibresDisfunción de la barrera intestinal; Glicocálix intestinal; Fibras nerviosas de la mucosaDisfunció de la barrera intestinal; Glicocàlix intestinal; Fibres nervioses de la mucosaIrritable bowel syndrome (IBS) is a disorder of brain-gut interaction characterised by abdominal pain and changes in bowel habits. In the diarrhoea subtype (IBS-D), altered epithelial barrier and mucosal immune activation are associated with clinical manifestations. We aimed to further evaluate plasma cells and epithelial integrity to gain understanding of IBS-D pathophysiology. One mucosal jejunal biopsy and one stool sample were obtained from healthy controls and IBS-D patients. Gastrointestinal symptoms, stress, and depression scores were recorded. In the jejunal mucosa, RNAseq and gene set enrichment analyses were performed. A morphometric analysis by electron microscopy quantified plasma cell activation and proximity to enteric nerves and glycocalyx thickness. Immunoglobulins concentration was assessed in the stool. IBS-D patients showed differential expression of humoral pathways compared to controls. Activation and proximity of plasma cells to nerves and IgG concentration were also higher in IBS-D. Glycocalyx thickness was lower in IBS-D compared to controls, and this reduction correlated with plasma cell activation, proximity to nerves, and clinical symptoms. These results support humoral activity and loss of epithelial integrity as important contributors to gut dysfunction and clinical manifestations in IBS-D. Additional studies are needed to identify the triggers of these alterations to better define IBS-D pathophysiology.This study was funded in part by Fondo Europeo de Desarrollo Regional (FEDER), Fondo de Investigación Sanitaria and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Subdirección General de Investigación Sanitaria, Ministerio de Economía y Competitividad: CP18/00116 (C.M.), PI19/01643 (B.L.); PI17/01443 (D.G.); PI15/00301 (C.A.-C.), PI17/0190 (J.S.), PI19/01643 & CPII16/00031, (M.V.); CIBEREHD CB06/04/0021 (F.A., C.A.-C., J.S., M.V.); Ministerio de Educación, Dirección General de Investigación: SAF 2016-76648-R (F.A.); Agència de Gestió d’Ajuts Universitaris i de Recerca, de la Generalitat de Catalunya: 2014 SGR 1285 (F.A.); Vall d’Hebron Institut de Recerca, Programa de becas predoctorales Amics de Vall d’Hebron: PRED-VHIR-2016-34 (C.P.-C.), PRED-VHIR-2014-018 (M.F.), the Swedish Research Council dnr 2019-00653 (J.-P.G.M.), and the European Union’s Horizon research and innovation programme 2020, grant no. 848228 (E.E., A.R.-U., B.L., C.A.-C., J.S.)

El rol de la incongruencia en la evaluación de pacientes hospitalizados con trastornos gastrointestinales

Introducción: Es conocida la elevada psicopatología asociada a los diferentes subtipos de pacientes con trastornos gastrointestinales funcionales (TGF) y la dificultad para el gastroenterólogo para detectarla y manejarla, pudiendo generar diagnósticos digestivos tardíos y en ocasiones erróneos. Los trastornos de la motilidad gastrointestinal (TMG) han sido menos estudiados desde ésta perspectiva. Tener en cuenta la experiencia subjetiva del paciente en relación a su enfermedad en comparación con la evaluación del gastroenterólogo y el nivel de incongruencia entre los dos puede ser de utilidad en el abordaje de estos pacientes. Objetivos: Estudiar la psicopatología, la calidad de vida y los rasgos de personalidad en una muestra de pacientes ingresados para estudio de la motilidad digestiva en una unidad hospitalaria altamente especializada. Por otro lado, se investigó la incongruencia de la funcionalidad evaluada por clínicos y pacientes y su relación con la psicopatología. Metodología: La presente investigación se describe como un estudio observacional, transversal, de pacientes que ingresan en la unidad de hospitalización digestiva para estudio de la motilidad gastrointestinal. Durante dos años, se incluyeron en este estudio todos los pacientes hospitalizados para la evaluación de la función motora gastrointestinal en una unidad de patología digestiva altamente especializada, de un centro de referencia terciario. Se incluyeron un total de 103 pacientes y fueron evaluados por el psiquiatra en las primeras 72 horas posteriores a la admisión al hospital. Se llevó a cabo una entrevista clínica y se administraron las siguientes escalas autoaplicadas: HADS, SCL-90-R, TAS-20, SF-36 y NEO-FFI-R. A nivel digestivo se realizaron las pruebas de motilidad oportunas así como la administración del Karnofsky Performance Status Scale (KPS) para evaluar la funcionalidad. Se definió la variable incongruencia como la diferencia entre KPS y las subescalas de funcionamiento físico del SF-36 (ambos en rango 0-100). Resultados: No se detectaron diferencias destacables entre los dos grupos en relación a datos sociodemográficos, rasgos de personalidad ni psicopatología. Sin embargo, la correlación de la funcionalidad medida por el clínico con el funcionamiento físico subjetivo fue alta y estadísticamente significativa sólo en el caso de los pacientes diagnosticados de TMG. La incongruencia entre la evaluación clínica y subjetiva de la funcionalidad correlacionó con todas las subescalas del SCL-90R. Cuando estratificamos por grupo de diagnóstico digestivo, en el grupo de TGF todas las subescalas del SCL-90R correlacionaron con la incongruencia mientras que en el grupo de TMG sólo fue significativa la correlación con somatización. Los análisis de covarianza no mostraron diferencias estadísticamente significativas en los niveles de psicopatología entre los grupos de diagnóstico digestivo al controlar por la incongruencia. En cambio, ésta última, mostró covariación estadísticamente significativa en todos los casos, por lo que la incongruencia mostró mayor capacidad predictiva de psicopatología que el diagnostico gastrointestinal per se. Usando modelos lineales generales, se encontró que la incongruencia era la variable con mayor relación con las variables psicopatológicas, incluso controlando por diagnóstico. Se encontraron interacciones entre la incongruencia y el diagnóstico digestivo (TMG vs. TGF), que refleja que los pacientes con TGF cuya evaluación subjetiva del funcionamiento es incongruente con la del clínico, tienen niveles más altos de psicopatología en comparación con pacientes afectos de TMG, en casi todos los casos independientemente de la incongruencia en estos últimos. Conclusiones: La psicopatología parece estar relacionada con las diferentes percepciones de la enfermedad que tienen clínicos y pacientes. La incongruencia del paciente y del clínico puede utilizarse como una herramienta simple de cribaje de psicopatología o distrés psicológico, especialmente entre los pacientes con trastornos gastrointestinales funcionales, facilitando los procesos de interconsulta psiquiátrica.Introduction: Psychopathology is highly associated with different subtypes of patients diagnosed of functional gastrointestinal disorders (FGDs). It is known by the gastroenterologist’ the difficulty to detect and manage psychopathology, generating late and sometimes erroneous digestive diagnoses. Gastrointestinal motility disorders (GMDs) have been less studied from this perspective. Taking into account the subjective experience of the patient in relation to their disease, compared to the evaluation of the gastroenterologist and the level of incongruence between the two may be useful in the approach of these patients. Objectives: To study psychopathology, quality of life and personality traits of patients admitted for specialized assessment in an inpatient tertiary Digestive Unit. On the other hand, the incongruence of the functionality evaluated by clinicians and patients and its relation with psychopathology was investigated. Methods: The present research is described as an observational, cross-sectional study. We included all patients hospitalized for evaluation of gastrointestinal motor function in a highly specialized Digestive Unit based at a tertiary referral center during two years. A total of 103 patients were included and evaluated by the psychiatrist within 72 hours of admission to the hospital. A clinical interview was conducted and the following self-administered scales were used: HAD, SCL-90-R, TAS-20, SF-36 and NEO-FFI-R. Digestive diagnostic tests were performed; to evaluate the functionality Karnofsky Performance Status Scale (KPS) was used. The incongruence variable was defined as the difference between KPS and the physical performance subscales of the SF-36 (both in the 0-100 range). Results: There were no remarkable differences between the two groups in relation to sociodemographic data, personality traits or psychopathology. However, the correlation of the functionality measured by the clinician with the subjective physical functioning was high and statistically significant only in the case of patients diagnosed with GMDs. Incongruence between the clinicians’ and patients’ evaluation of functionality correlated with all SCL-90-R subscales. When stratified by digestive diagnosis group, all SCL-90-R subscales correlated with incongruence in the FGDs group, whereas only the correlation with somatization was statistically significant among patients with GMDs. Covariance analyses did not show statistically significant differences in the levels of psychopathology among the digestive diagnosis groups when controlling for incongruence. In contraposition, this incongruence data showed statistically significant covariation in all cases, so the incongruence showed a greater predictive capacity for psychopathology than gastrointestinal diagnosis per se. Using general linear models, it was found that incongruence was the variable with stronger relationships with psychopathological variables, even when controlled by diagnosis. Interactions between incongruence and digestive diagnosis were found (GMDs vs. FGDs), demonstrating that patients with FGDs whose subjective performance evaluation is inconsistent with that of the clinician, have higher levels of psychopathology compared to patients with GMDs, in most cases regardless of incongruence in the latter. Conclusions: Psychopathology seems to be related to the different perceptions of the disease that the clinicians and the patients have. Patient and clinician incongruence can be used as a simple screening tool for psychopathology or psychological distress, especially among patients with functional gastrointestinal disorders, facilitating psychiatric liaison consultations

Interconsulta y psiquiatría de enlace: estudio descriptivo de las interconsultas a psicología clínica

Introducción: Entre las especialidades médicas es cada vez más reconocida la valoración por el equipo de interconsulta y psiquiatría de enlace de las repercusiones psicosociales de la enfermedad en el paciente hospitalizado. El objetivo de este estudio es analizar descriptivamente la intervención del psicólogo clínico en las interconsultas de un hospital general. Material y métodos: Se analizan retrospectivamente a un año, con medidas de tendencia central, las interconsultas recibidas en la unidad de interconsulta y psiquiatría de enlace dirigidas a psicología clínica. Resultados: Se registran un total de 131 interconsultas hospitalarias a psicología clínica. La mayoría desde la propia unidad de psiquiatría de enlace, por el psiquiatra referente interconsultor del caso (35,9 %). Con altas prevalencias de pacientes sin trastorno psiquiátrico (28 %) o con trastornos adaptativos (43 %). En la mayoría de casos se realizan entre 2 (26 %) y 3 (19 %) visitas durante el ingreso hospitalario. Al cierre de la interconsulta por psicología clínica, son altables a domicilio sin necesidad de soporte por salud mental el 40 % de los casos. Conclusiones: La figura del psicólogo clínico, con pocas intervenciones, valida recursos personales que favorecen la salud mental del paciente hospitalizado. Se requiere más investigación que pueda ayudar a planificar recursos y concretar el ámbito de intervención del psicólogo clínico en la interconsulta hospitalari