Mª Carmen Martín Gómez
@saludcastillayleon.es
Complejo Asistencial Universitario de Salamanca - Servicio de Psiquiatría
Psiquiatra
Scopus Publications
Scopus Publications
Pilar Andrés-Olivera, Judit García-Aparicio, María Teresa Lozano López, José Antonio Benito Sánchez, Carmen Martín, Ana Maciá-Casas, Armando González-Sánchez, Miguel Marcos, and Carlos Roncero
MDPI AG
The SARS-CoV-2 health emergency has led to a restructuring of health care systems and the reassignment of medical specialists from their usual duties to attend COVID-19 patients. The aim of this paper is to describe the levels of insomnia, anxiety, depression, and the impact on quality of life of doctors who were on the frontline of COVID-19 during the first two waves of the pandemic. Self-report surveys were conducted on said physicians during both waves, with 83 and 61 responses in the first and second waves, respectively. The reported presence of insomnia was frequent (71.8%), although it decreased in the second survey. Anxiety was moderate, decreasing from 57.1% to 43.1% between measurements. Overall, depression rates decreased between the two surveys. Substance use was found to have an indirect correlation with personal and professional satisfaction. In the light of the unforeseeable evolution of the pandemic and the medium- to long-term repercussions on professionals, we believe the adaptation of health resources is crucial to meet the new unpredictable mental health needs of this group.
Carmen Martin, Pilar Andrés, Alberto Bullón, José Luis Villegas, Javier Ignacio de la Iglesia-Larrad, Berta Bote, Nieves Prieto, and Carlos Roncero
SAGE Publications
Background: Homeless population has been severely affected by the COVID-19 pandemic. Their living conditions, comorbidity with different pathologies and a greater frequency of mental disorders, make this population vulnerable. Method: We implemented a program of serial visits in a hostel for confined homeless of the city council social services, for the monitoring and treatment of mental disorders and substance abuse problems. Accompanied by serial phone and email contacts. Results: A highly significant percentage (63%) had mental disorders or substance abuse, requiring pharmacological intervention, and 37% began follow-up in resources of the Mental Health and Addiction network of the Psychiatric Service at the end of the program. Hospital emergency service visits were drastically reduced. None of them were infected with COVID-19. An individualized Social plan was drawn up in order to reintegrate them with support in the community. Conclusions: The Results have been really positive, meeting all the objectives and opening up developing new programs in the future, in the pandemic outbreak and out of it.
Carlos Roncero, Llanyra García-Ullán, Javier I. de la Iglesia-Larrad, Carmen Martín, Pilar Andrés, Ana Ojeda, David González-Parra, Javier Pérez, Clara Fombellida, Ana Álvarez-Navares,et al.
Elsevier BV
Abstract
The COVID-19 pandemic reached world-wide causing a great impact on healthcare services. The aim of this work is to describe the response of the Mental Health Network of the Salamanca´ Area (Spain) to this crisis and the reorganization of its resources within the first 8 weeks after the state of alarm was declared. The Psychiatry Service applied a contingency plan which included the reorganization of the human resources, the closure of some of the units and the implementation of telemedicine programs along with two specific programs, namely a mental health assistance program in the context of the infection by coronavirus, and another program for homeless people. 9.038 phone interviews were carried out in the outpatients and community mental health programs. The activity in subacute and acute wards, as well as that of the day hospital programs was decreased to 50%.
Based on that this real-world response provided we concluded that the usage of telemedicine is promising in patients with any kind of disorder. Its implementation in daily practice will be considered in the future. Research must continue on COVID-19′s impact on patients with mental disorders and Psychiatry's necessary adaptations and new approaches to them.
Marta Hernández-García, Carmen Martín-Gómez, Marta Gómez-García, Javier Gomez-Pilar, Pablo Núñez-Novo, Antonio Arjona-Valladares, María Victoria Alejos-Herrera, Maria Teresa Lozano-López, Sinta Gamonal Limcaoco, Carlos Molina-Novoa,et al.
Elsevier BV
N. Casado-Espada, C. Martin, J. I. de la Iglesia-Larrad, R. de Alarcón, C. Fombellida, L. Fernández-Martín and C. Roncero
Opiate withdrawal-induced psychosis is an uncommon clinical manifestation. We present a 36-year-old male patient, with no prior personal or familiar psychiatric history, in treatment with several analgesic drugs (including oxycodone) for non-inflammatory chronic rachialgia. The patient is hospitalized after exhibiting psychotic symptomatology (delusions of harm and contamination, olfactory hallucinations, and aberrant behavior). This psychotic symptomatology first manifested after abruptly interrupting his prescribed oxycodone intake. It had a fluctuating course over time (alternating between lucid states and delusional ones) and eventually subsided after the prescription of antipsychotic drugs. In this case report, we describe the follow-up of the patient and discuss the influence and relevance of oxycodone withdrawal on the psychotic symptomatology.
Vanessa Suazo, Álvaro Díez, Carmen Martín, Alejandro Ballesteros, Pilar Casado, Manuel Martín-Loeches, and Vicente Molina
Elsevier BV
BACKGROUND
There is an increasing consideration for a disorganized cerebral activity in schizophrenia, perhaps relating to a synaptic inhibitory deficit in the illness. Noise power (scalp-recorded electroencephalographic activity unlocked to stimuli) may offer a non-invasive window to assess this possibility.
METHODS
29 minimally-treated patients with schizophrenia (of which 17 were first episodes) and 27 healthy controls underwent clinical and cognitive assessments and an electroencephalographic recording during a P300 paradigm to calculate signal-to-noise ratio and noise power magnitudes in the theta and gamma bands.
RESULTS
In comparison to controls, a significantly higher gamma noise power was common to minimally-treated and first episode patients over P3, P4, T5 and Fz electrode sites. Those high values were directly correlated to negative symptom severity and inversely correlated to verbal memory scores in the patients. There were no differences in signal-to-noise ratio magnitudes among the groups. Gamma noise power at Fz discriminated significantly between patients and controls. No significant differences were found in theta noise power or in gamma noise power over the other electrode sites between the groups of patients and controls.
LIMITATIONS
We have not assessed phase-locked and non-phase locked power changes, a complementary approach that may yield useful information.
CONCLUSIONS
Gamma noise power may represent a useful and non-invasive tool for studying brain dysfunction in psychotic illness. These results suggest an inefficient activation pattern in schizophrenia.
Vicente Molina, Carmen Martín, Alejandro Ballesteros, Alba G. Seco de Herrera, and Juan Antonio Hernández-Tamames
Springer Science and Business Media LLC
To date, few studies have addressed the relationship between brain structure alterations and responses to atypical antipsychotics in schizophrenia. To this end, in this study, magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) were used to assess the relationship between the brain volumes of gray (GM) and white (WM) matters and the clinical response to risperidone or olanzapine in 30 schizophrenia patients. In comparison with healthy controls, the patients in this study showed a bilateral decrease in the anteromedial cerebellar hemispheres, the rectal gyrus and the insula, together with bilateral increases in GM in the basal ganglia. Both patient groups had a significantly smaller volume of WM in a region encompassing the internal and external capsules as compared to the controls. We found an inverse association between striatal size and the degree of clinical improvement, and a direct association between the degree of insular volume deficit and its improvement. The non-responder patient group showed a significant decrease in their left rectal gyrus as compared with the responder group. This study reveals a pattern of structural alterations in schizophrenia associated with the response to risperidone or olanzapine.
V. Molina, D.E. López, R. Villa, J. Pérez, C. Martín, A. Ballesteros, A. Cardoso, and C. Sancho
Cambridge University Press (CUP)
AbstractPurposeTo study the short-term effect of treatment with quetiapine on prepulse inhibition (PPI) deficits of the startle reflex in schizophrenia patients.Subjects and methodsUsing PPI, we studied a group of 21 schizophrenia patients and 16 controls. Seventeen of the patients were re-tested with PPI after 21 days of treatment with quetiapine.ResultsAt baseline, an almost significant decrease in PPI was found in the patients as compared to the controls. PPI measurements did not change in the patients after 21 days of treatment with quetiapine, despite their clinical improvement.ConclusionOur results suggest that short-term quetiapine treatment may not modify PPI measures in schizophrenia patients.
Vicente Molina, Benjamín Cortés, Javier Pérez, Carmen Martín, Rocío Villa, Dolores E. López, and Consuelo Sancho
Springer Science and Business Media LLC
Sensorimotor gating deficits are relevant in schizophrenia and can be measured using prepulse inhibition (PPI) of the startle reflex. It is conceivable that such deficits may hinder the cognitive functions in schizophrenia patients. In this study, using PPI and a neuropsychological battery, we studied this possibility in a group of 23 acute, neuroleptic-free schizophrenia patients and 16 controls. A non-significant decrease in PPI was found in the patients as compared to the controls, as well as significant differences in the performance of Trail A and B in Wisconsin Card Sorting and Digit/Symbol Tests. No statistically significant correlations between PPI and neuropsychological performance were found after the correction for multiple comparisons in any group. Our results suggest that PPI deficits in schizophrenia patients may not contribute to the cognitive deficits typical of that illness, at least in patients with a non-significant PPI decrease.
Vicente Molina, Juan A. Hernández, Javier Sanz, Juan C. Paniagua, Ana I. Hernández, Carmen Martín, Juan Matías, Julia Calama, and Berta Bote
Elsevier BV
The long-term outcome of schizophrenia patients may differ depending on their brain structure. This would be reflected in significant structural differences between poor-outcome (i.e., Kraepelinian) and non-Kraepelinian patients. To assess this possibility, we have evaluated the degree of deviation in brain structure in Kraepelinian patients with respect to controls and non-Kraepelinian schizophrenia patients. We used voxel-brain morphometry (VBM) to assess the differences in gray matter volume across the brain in the Kraepelinian group with respect to the healthy controls and non-Kraepelinian patients. Twenty-six Kraepelinian and 18 non-Kraepelinian schizophrenia patients and 41 healthy controls were included. With respect to the healthy controls, the Kraepelinian patients showed a very significant decrease in gray matter in the frontal, occipital, and limbic cortices, and, at a subcortical level, bilaterally in the striatum and thalamus. In comparison with the non-Kraepelinian patients, the Kraepelinian individuals continued to show a similar subcortical decrease. Thus, Kraepelinian patients may be characterized by a distinct pattern of brain abnormalities, in particular, in subcortical regions.
V. Molina, P. Tamayo, C. Montes, A. De Luxán, C. Martin, N. Rivas, C. Sancho, and A. Domínguez-Gil
Elsevier BV
BACKGROUND
Previous reports show different cerebral activity patterns during treatment with clozapine and typical neuroleptics. However, to date no study has directly compared the brain activity patterns while subjects are undergoing treatment with clozapine and other atypical antipsychotics. This comparison is of interest, given the probably different mechanism of action of clozapine in comparison with other atypicals.
OBJECTIVE
To assess the effect of clozapine on perfusion deviations still evident during treatment with risperidone.
METHODS
Here we used hexamethylene-propylenaminoxime single photon emission computed tomography to compare the perfusion patterns observed during the performance of a Stroop test in 10 patients sequentially treated with risperidone and clozapine, owing to a lack of response to the former, and in 10 healthy controls.
RESULTS
Patients on risperidone showed decreased perfusion as compared to controls in the medial prefrontal, middle cingulate and insular regions, as well as increased activities in brain stem and the posterior hippocampus. After receiving clozapine, the same patients showed an even wider prefrontal perfusion deficit and the brain stem was still hyperactive, but the abnormalities in the cingulate cortex, insula and hippocampus had disappeared. Clinical improvement was directly related to an increase in thalamic perfusion.
CONCLUSION
Clozapine may alleviate hyperactivity in the limbic system in schizophrenia and may facilitate activation of the regions involved in cognitive tasks to a greater degree than risperidone, as well as eliciting greater inhibition of the PF region.
D. Gonzlez Parra, M.C. Martn Gmez, P. Franco Romo, and S. Snchez Iglesias
Elsevier BV
PUNTOS CLAVE
Antidepresivos en fase aguda
Inhibidores selectivos de la recaptacion de la serotonina (ISRS). Farmacos de primera linea en la eleccion.
ISRSNa. En la actualidad los de segunda linea.
Antidepresivos triciclicos y heterociclicos (ADT). Historicamente los mas eficaces, han sido relegados por sus importantes efectos adversos.
Moduladores de la liberacion de 5HT y noradrenalina. Buena eleccion terapeutica en asociacion con otro antidepresivo, mejoran el apetito y no provocan disfuncion sexual.
Moduladores de la liberacion de serotonina (5HT). En depresiones con alto componente de insomnio.
Inhibidores de la recaptacion de noradrenalina. Buena opcion en depresiones inhibidas, con sintomas atipicos y estacionales.
Falta de eficacia del tratamiento antidepresivo en la fase aguda. Estrategias de optimizacion de dosis, cambio o potenciacion de efecto antidepresivo con otros farmacos (litio, hormonas tiroideas, antipsicoticos, anticonvulsivantes).
Tratamiento farmacologico de la depresion en fase de continuacion. Tras tratamiento de la fase aguda, aspectos a valorar para continuar el tratamiento un total de 16-20 semanas. Conceptos de remision, recidiva y recurrencia de un episodio depresivo, claves para continuar un tratamiento.
Tratamiento farmacologico de la depresion en fase de mantenimiento. Criterios para mantener un tratamiento antidepresivo.
Suspension del tratamiento activo. En que momento es aconsejable suspender el tratamiento. Ventajas e inconvenientes.
Criterios racionales de jerarquizacion. Factores clinicos y no clinicos que hay que valorar al elegir un antidepresivo. Pauta general de actuacion ante un episodio depresivo.
V. Gonzlez de Mara, C. Leal Snchez, M.C. Martn Gmez, and S. Snchez Iglesias
Elsevier BV
M.C. Martn Gmez, D. Gonzlez Parra, P. Franco Romo, and S. Snchez Iglesias
Elsevier BV
P. Franco Romo, M.C. Martn Gmez, and S. Snchez Iglesias
Elsevier BV