[Consensus on physical health of patients with schizophrenia from the Spanish Societies of Psychiatry and Biological Psychiatry]. / Consenso sobre la salud física del paciente conesquizofrenia de las Sociedades Españolasde Psiquiatría y de Psiquiatría Biológica.

INTRODUCTION: Schizophrenia has traditionally been associated with higher rates of physical comorbidity and excess mortality. OBJECTIVE: To develop a Spanish consensus document concerning the physical health of patients with schizophrenia and the interventions required to reduce the over-morbidity and over-mortality of these patients. Method. The process consisted of: a) systematic review of the literature in the Medline database up to January 2006 and manual review of the bibliographical references of the papers obtained; b) reviews of national and international guides by the coordinating committee and medical specialist acting as expert advisors; c) multidisciplinary consensus meetings, and d) editing of the final consensus document. RESULTS: Compared to the general population, patients with schizophrenia present higher rates of infection (HBV, HCV, HIV), endocrine/metabolic disorders, cardiac and respiratory diseases (over-morbidity) and higher global death risk, as well as death from natural causes--basically respiratory, cardiovascular and oncological diseases (over-mortality). As a guide, therefore, this document proposes a series of interventions to be performed by psychiatrists to reduce the current rates. CONCLUSIONS: Given the over-morbidity and overmortality of patients with schizophrenia, awareness of these aspects should be increased among primary healthcare providers and specialists, including psychiatrists, and physical health problems should be incorporated into psycho-educational programs, and treatment compliance and severe mental disorder treatment units.

Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study.

INTRODUCTION: Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies. METHOD: In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy. Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels. RESULTS: In these patients, adding topiramate leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values. Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions. CONCLUSIONS: Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in craving-priming and dependence intensity scales, number of drinking days per month reported and transaminase levels. Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment.

[Depression in the elderly living in a rural area and other related factors]. / La depresión en el anciano en una zona rural y su interacción con otros factores.

INTRODUCTION: We want to determine the prevalence of depression in a rural population (65 years and over) free from cognitive impairment and to evaluate related factors of late life depression. PATIENTS AND METHOD: A total of 265 persons (mean age [SD]: 76.2 [6.7] years; 60.4 % females) residing in the towns of Proaza, Quiros and Santo Adriano (Asturias) were interviewed. The evaluation included sociodemographical and clinical aspects as well as the Mini-Mental State Examination Spanish version (MMSE), the Geriatric Depression Scale (GDS), the Oviedo Sleep Questionnaire (OSQ), the CAGE Questionnaire, the Goldberg General Health Questionnaire (GHQ-28), and the World Health Organization Quality of Life Instrument (WHOQOL-BREF). RESULTS: A total of 23 subjects out of the total sample were excluded from the study due to scoring less than 18 points on the MMSE. The final sample included 242 subjects (mean age [SD]: 75.59 (6.2) years; 60.3 % females). Prevalence of probable depression was 23.1 % [30.1 % females vs 12.5 % males; p = 0.002]. Depression was statistically associated with a higher number of physical diseases (p = 0.012), higher psychiatric comorbidity (p = 0.031), less cognitive impairment measured by MMSE (p = 0.019), higher prevalence of sleep disorders (p < or = 0.050), higher score in the GHQ-28 (p = 0.000), and worse quality of life evaluated by the WHOQOL-BREF (p = 0.000). CONCLUSIONS: Depression is moderately prevalent in this population. Depression is more frequent in females, those living alone, without studies, working in agricultural sector, with physical or psychiatric comorbidity, with higher cognitive impairment, and with a worse health status and quality of life perception.

[Dimensions of personality disorders and neurophysiological correlates]. / Dimensiones de los trastornos de la personalidad y correlatos neurofisiológicos.

INTRODUCTION: To objective is to identify the factorial structure underlying personality disorders, using clinical and personality measures, and to check whether the resulting structure is valid and theoretically comprehensible, using neurocognitive and psychophysiological measures for establishing possible differences between the factors. METHOD: From the data obtained with the scales MCMI-II and BFQ administered to a sample of 87 subjects diagnosed as a case of any clinical category of DSM-IV personality disorders, and 17 normal controls, we carried out first-order and second-order factor analyses. RESULTS: Five first-order factors (designated as aggressive personality, personality with social deficit, non-pathological personality, obsessive personality and non-assertive personality) and three second-order factors (non-pathological/obsessive personality) were found. CONCLUSIONS: On studying the second-order factors in relation to neurocognitive and psychophysiological measures, it was found that socially-inhibited and non-assertive personalities (factor 1) are characterized by specific neuropsychological deficits in sustained attention; that aggressive personalities (factor 2) are characterized by impulsiveness and deficit in concepts formation; and that in non-pathological personalities with obsessive traits (factor 3), as obsessiveness increases, subjects present less efficacy in sustained attention tasks and greater psychogalvanic response to stress.

[Polipharmacy in the antipsychotic prescribing in practices psychiatric out-patient clinic]. / Polifarmacia en la prescripción de antipsicóticos en consultas de psiquiatría.

INTRODUCTION: Due to the lack of scientific studies in the psychopharmacological treatment of psychosis, the references advise against the use of antipsychotic polypharmacy (AP). This study investigates the situation of this matter and its relationship with the introduction of atypical antipsychotics (AA) in our daily out-patient practice. METHODS: The study group included 160 patients, with ICD-10 diagnosis of non-affective psychosis and illness evolution of at least two years, whose ages ranged from 18 to 65 years, without mental retardation, who came to the out patient clinic at least once during the first semester of 2002 and, in order to make a comparison, at least one other time 9 to 12 months before. The retrospective study was done using the clinical records. RESULTS: In both moments studied, more than 50 % of the patients (65 % and 63.4 % respectively) had AA as their only treatment. AP was 25.6 % and 26.9 % respectively, 19.4 % of all patients were always in AP. At the end of the study, patients on AP were being prescribed a higher dose of chlorpromazine equivalents per day (p < 0.001) and more anticholinergics (p < 0.001). CONCLUSIONS: Our results show that in out patient settings AA have been consolidated as the first treatment option and that AP is a very common and stable phenomenon.

[Influence of psychiatric disorders in the effectiveness of a long-term methadone maintenance treatment]. / Influencia de los trastornos psiquiátricos en la efectividad de un programa de mantenimiento prolongado con metadona.

OBJECTIVES: To obtain knowledge of the psychiatric disorders of a heroin dependent population undergoing MMT and the influence of such on the outcomes of treatment for dependence. METHODS: 132 opiate dependents undergoing MMT in Drug Addiction Treatment Unit, Avilés (Spain) were followed-up over 6 years of treatment. At the beginning and after 6 years of treatment an Ad hoc protocol (sociodemographic and clinical variables) was administered. Analyses of HIV and urine (opiates, cocaine and benzodiacepines) were made throughout treatment. The Goldeberg Anxiety and Depression Scale (GADS) and the International Personality Disorder Examination (IPDE) were also administered. RESULTS: The effectiveness of MMT was high, with evident social and clinical improvement. The following disorders were diagnosed: affective 29.7%, anxiety 19.1%, psychotic 11.8% and personality 51.1%. Anxiety and affective disorders were related with heroin and benzodiacepine use and with being HIV+. Personality disorders were more prevalent in older addicts, those unemployed and patients with court cases pending, and in those with cocaine and benzodiacepine use. Dose of methadone was not related with psychiatric disorders. CONCLUSIONS: Psychiatric disorders (affective, anxiety and personality disorders) were frequent and linked to worse treatment outcomes (drug use, criminal activities). In some patients, there was a HIV-depression-drug use relationship, and these patients clearly need a specific psychosocial intervention. In order for MMT programmes to be more effective greater attention needs to be paid to mental health problems in these patients.

[Attempted suicide versus suicidal intention: a study of differential characteristics]. / Tentativa suicida versus intención suicida: un estudio de las características diferenciales.

INTRODUCTION: Suicidal behaviours are internationally considered as a serious health problem and, consequently, considerable efforts are being made in the search for factors related with this behaviour. OBJECTIVES: To determine if there are any differences between those who attempted suicide and those with suicidal ideation. PATIENTS AND METHOD: During 1997-98, we interviewed a total of 134 patients hospitalised due to attempted suicide (n = 49), suicidal ideation (n = 38), and a control group made up of other psychiatric patients (n = 47) in the Psychiatric Unit of the Hospital de Jove (Gijón). All patients completed the "Protocol for Investigation of Suicidal Behaviour" which contains different sociodemographic and clinical variables, and the Scale for Suicide Ideation, Hopelessness Scale, Hamilton Depression Rating Scale, and Eysenck Personality Questionnaire-Adult form. RESULTS: No significant differences were found in sociodemographic or clinical variables between the suicidal ideation and attempted suicide groups. Only the intensity of hopelessness as measured on the Beck scale (greater in the suicidal ideation group) and emotional instability in females (also greater in the suicidal ideation group) are the variables which differentiate those who present suicidal ideation and those who attempt suicide.

[Prevalence of eating disorders in secondary level students: A preliminary study]. / Prevalencia de trastornos de conducta alimentaria en jóvenes de enseñanza secundaria: un estudio preliminar.

OBJECTIVES: To determine the prevalence of eating disorders in secondary level students, as well as to determine the relationship between eating behaviour and personality traits. SUBJECTS AND METHOD: During the 1997-98 school year, 816 secondary level students from Langreo (Asturias) were evaluated. EVALUATION: Eating Disorder Inventory (EDI) and Eysenck Personality Questionnaire Adult Form (EPQ-A). RESULTS: The sample was made up of 415 males and 401 females [mean age (SD): 15.91 (1.37)]. Seventy-two <> of eating disorders were detected, 87.5% of which were females (p= 0.0000). The <> scored higher (p< 0.05) than their <> counterparts on all EDI subscales, except perfectionism. The <> females scored higher (p< 0.05) than the <> males on the drive for thinness and dissatisfaction with one's body subscales, whereas the <> males scored higher than the females on the perfectionism and maturity fears subscales. In both sexes, clinical features of neuroticism, introversion, and psychoticism were associated with higher scores (p< 0,05) on various EDI subscales. CONCLUSIONS: Greater prevalence of <> eating disorders in females. The <> subjects present a different eating behaviour profile based on sex. In both sexes, neuroticism, introversion, and psychoticism features favour a possible distortion of eating behaviour.

[Epidemiologic differences in delinquents relative to their psychiatric records]. / Diferencias epidemiólogicas en delincuentes con relación a sus antecedentes psiquiátricos.

We report the results of a survey carried out by us in the penitentiary from 1989 to 1992. The aim of it was to determine a possible relationship between criminal behaviour and previous psychiatric pathology. A total of 121 individuals imprisoned from February to april 1989 were studied. Only those convicts who had been free taken into account. Individuals who had been imprisoned before in other prisons were not included in our study. A questionnaire was elaborated by us to carry out this survey. The convicts were tested as soon ad they came into the Oviedo penitentiary. The convicts were classified within two groups. In the first group only those who had previous psychiatric pathology were included. The rest of them, including drug addicts were part of the second group of our study. Our results show that criminal behaviour is much common between those who do not have suffered previously from psychiatric pathology. Furthermore, relationship between psychiatric pathology of the convict and his mother's criminal behaviour was proven. It aslo was shown between psychiatric pathology and suicide or own-inflected injuries.

[Epidemiologic aspects of suicide in Asturias in relation to the climate, the seasons and other factors]. / Aspectos epidemiológicos del suicidio en Asturias en relación con la climatología, lo estacional y otros factores.

Based on epidemiologic methodology different factors related to suicide committed in Asturias (Spain) during 1983-1987 were analysed. The following factors were studied: age, sex, procedure of suicide, climate variables (atmospheric pressure, frequency of south-winds), seasons of the year and Moon phases in which suicides were committed. The incidence was 11.13/100,000. In respect to several factors significant differences were found (X2 test): age, sex and suicide procedure depending on sex. In relation to other factors, although some differences were observed in relation to sex, no significant differences were present.

[Sleep, organic deterioration and general health in the aging population. Study in a basic health zone of Oviedo]. / Sueño, deterioro orgánico y salud general en población involutiva. Estudio en una zona básica de salud de Oviedo.

An epidemiologic approach to the involutive general population was made to detect patients and risk group of insomnia. The survey was carried out in one health area of Oviedo, during the winter of 1990. A total of 329 elderly persons were interviewed, and three questionnaires were used: the G.H.Q., MMSE and a questionnaire "ad hoc". In the study, sleep disorders were correlated with level of general health (Golberg) and cognitive impairment (MMSE).

[Thematic Apperception Test: psychodiagnosis in heroin-dependent patients]. / T.A.T.: psicodiagnóstico en pacientes heroinómanos.

The aim of our work is the search of some differential psychopathologic features or categories in the personality of the heroin addict, through the application of Murray TAT. Which, we try to contrast with another contributions carried out until the present time. On the other hand, other parameters of sociolaboral and demographic character have been valued. We do not detect a structure of uniform personality, through we observe clear differences with respect to people who are not dependent on drugs. According to the results we have found, there are a larger number of psychopathologic elements in the whole of the heroin addict personality, as a greater low self-esteem, a suicidal inclination, a problematic with authority models, an evasión of aggressiveness, feelings of anxiety and quiltiness, without being a universal pattern.

[Psychopathologic traits of patients addicted to heroin]. / Rasgos psicopatológicos en pacientes heroinómanos.

The aim of our work is the search for some differential psychopathologic features in the heroin addict personality, through the 16 PF of Cattell (A form), which we try to contrast with other contributions from studies carried out up to the present. Moreover, other parameters of demographic and socioeconomic interest have been evaluated. Through the results we have gotten, it seems that there is a larger number of psychopathologic elements in the personality of the heroin addict, such as greater introversion, frustration, culpability, radicalism, self-sufficiency, anxiety, over-excitement, actions influenced by their feelings, and a minor acceptance of the rules of the group, though these features do not constitute a standard structure of personality.

Extent and patterns of drug use by students at a Spanish university.

A drug-use survey of 1,010 randomly chosen students at the University of Oviedo in Spain was carried out in 1986. The survey instrument used was a self-administered questionnaire. During the 12 months before the survey, 91 per cent of the students had used alcohol, 57 per cent tobacco, 17 per cent cannabis, 9 per cent tranquillizers, 5 per cent amphetamines, 2 per cent cocaine, 2 per cent hallucinogens, 1 per cent opiates and 0.6 per cent volatile solvents. At some time in their lives, 96 per cent of the students had used alcohol, 70 per cent tobacco, 31 per cent cannabis, 19 per cent tranquillizers, 15 per cent amphetamines, 5.5 per cent hallucinogens, 5 per cent cocaine, 3 per cent opiates and 3 per cent volatile solvents. Both male and female students had begun using volatile solvents early in life. The age of first cannabis use for the majority of users was between 16 and 18. The users of other illicit drugs covered by the study had not begun using them until they were 18 or older.

Drug use among adolescents in Asturias (Spain).

A survey of drug use, based on a sample of 2,537 school students in the 15-17 year age group selected from 11 schools in central Asturias (Spain), showed that 697 respondents, or 29.1 per cent, were drug users. Cannabis was the most widely abused drug: 500 respondents, or 20.8 per cent of the total sample, became involved with this drug at some time in their lives. The percentages of the total sample show that the use of cannabis at any time ("ever" use) was followed by use of: tranquillizers (10.3 per cent), amphetamines and amphetamine-like substances (7.9 per cent), inhalants (2.3 per cent), hallucinogens (2.0 per cent), sedatives (1.7 per cent), opiates (1.4 per cent) and cocaine (1.2 per cent). Males were generally more involved with drugs than females were. The average age at first drug use was 15.4 for males and 15.5 for females.