The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units.

Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021.

A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients’ comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care.

End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.

Diminished diet quality in the Caribbean and other island settings may be related to a dietary transition from local foods towards imported products. The current study aimed to characterise the association between intentionally purchasing local foods (IPLF) and diet quality in Puerto Rico (PR).

Cross-sectional study.

Primary care clinics in the PR metropolitan area.

Data were obtained from adult participants (30–75 years; n 243) of the Puerto Rico Assessment of Diet, Lifestyle, and Diseases. IPLF was probed by asking: ‘How often do you purposely purchase foods from PR (like fruits, vegetables, meat and other products that are produced on the island rather than being imported)?’ Dietary intake was measured using a FFQ, and diet quality was assessed by the Alternate Healthy Eating Index (range 0–110; higher scores indicating higher diet quality). Multivariate-adjusted generalised linear models tested the association between IPLF and Alternate Healthy Eating Index 2010 (AHEI) and its component scores.

A third (33·9 %) of participants reported seldom, 33·5 % reported often and 30·6 % reported always IPLF. Compared with seldom IPLF, fully adjusted mean AHEI scores were 3·6 (P = 0·038) points higher among those often IPLF and 9·3 (P < 0·0001) points higher among those always IPLF. Compared with seldom IPLF, those who always IPLF had significantly higher fully adjusted mean component scores for vegetables, fruits, whole grains, nuts and legumes, trans fat and n-3 fats.

Adults in PR who intentionally purchase local foods had higher diet quality, especially for intake of plant-based foods and healthy fats, highlighting potential dietary benefits associated with improved local food availability in PR.

An increase of suicide rates have been associated with periods of economic crisis. Suicide rates in Spain are the first cause of nonnatural death, having surpassed traffic crash rates.

To study if the economic crisis affected the suicide rates and antidepressant consumption.

Suicide rates were extracted from the Spanish Statistic National Institute. Data about antidepressant consumption were extracted from the web page of the Spanish Department of National Health. Mean rate of suicide and mean rate of antidepressant consumption prior (2005–2007) and during the economic crisis (2008–2010) were compared. Data on antidepressant consumption are presented as antidepressant units per 100 people/year. Suicide rates are presented as rate per 100.000 people/year. Data are presented as mean ± standard deviation.

Unemployment mean rate was 9.2 ± 1.4 before the economic crisis, while it was 17.7 ± 20.5 during the economic crisis (p = 0.03). Mean rate of suicide before the economic crisis was 7.7 ± 0.19 while during the crisis was 7.2 ± 0.14 (p = 0.15). Antidepressant consumption increased significantly (p = 0.02) before the crisis (48.5 ± 11.9) compared to the crisis period (59.7 ± 16.7).

Our data show that during the Spanish economic crisis there was not an increase in the suicide rate but the antidepressant consumption increased significantly. Our results point to the fact that the Spanish population in time of economic crisis tend to take antidepressants instead of committing suicide.

Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).

Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.

Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.

Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances.

To analyse the relationship between a maniac episode and tapentadol.

Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic.

Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol.

– Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids.

– Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.

S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.

Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).

At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.

At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.

FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.

It is well known the relationship of manic episode with the consumption of different drugs organic diseases, and psychiatric drugs, such as mood stabilizers and antidepressants. There are several commonly used substances, mainly psychostimulant, potentially inducing psychiatric pathology.

To study other possible causes of substance-induced manic episode.

We report a case of manic episode with psychotic symptoms without previous psychiatric background, after consumption of Korean Ginseng.

It is necessary to scrutinize other possible substances, not usually described in the literature related to the onset of psychiatric illness, being necessary to ask about this use during the clinical interview.

Parkinson's disease (PD) is classified primarily as a movement disorder. Psychiatric complications, however, are common during the progression of the disease. Psychosis is rare in untreated patients with PD, but the prevalence rises to 40% during dopaminergic treatment.

We report the clinical course of a ropinirole induced psychosis in a 57-year-old female with PD.

The patient was treated with different antiparkinsonians (rasagiline, ropinirole and levodopa), and after a dosage increase of ropinirole, psychotic symptoms appeared (auditory hallucinations and paranoid delusion). Antipsychotic treatment started with quetiapine and a gradual dose reduction of antiparkisonians. Nevertheless, psychotic symptoms required a hospital admission.

Rasagiline was suspended at admission, the dose of ropinirole was decreased until withdrawal, and the dose of levodopa was reduced. The dose of quetiapine was increased to control psychotic symptoms.

The pathogenesis of psychosis in PD is poorly understood. It has been related with the presence of dementia and concomitant treatment with dopaminergic agonists (DA). According to the literature, pergolide is associated with a significantly increased risk for the development of psychosis, followed by ropinirole, pramipexole and cabergoline, whereas levodopa has the lowest associated risk. Treatment includes, in the first place, suspending anticholinergics and selegiline, and then, amantadine, DA, and entacapone. Finally, levodopa may also be reduced. These patients frequently require antipsychotic treatment that may worsen extrapyramidal symptoms.

Psychosis should be considered in PD, especially in patients treated with DA. Treatment begins with reducing antiparkinsonians and then adding antipsychotics. Clozapine and quetiapine are a good choice.