P50 sensory gating deficit is a common marker of vulnerability to bipolar disorder and schizophrenia.

OBJECTIVE: P50 gating in schizophrenia has contributed much to our understanding of the pathophysiology of the illness. We examined euthymic bipolar patients to determine if they also have a P50 gating deficit. METHOD: P50 gating was measured in 81 euthymic bipolar patients (50 with a lifetime history of psychotic symptoms), 92 stable schizophrenic patients, and 67 control subjects. RESULTS: P50 gating was significantly lower in control subjects than in bipolar patients with a lifetime history of psychosis (P = 0.001) and schizophrenic patients (P = 0.0001). In all patient groups, the percentage of patients with P50 gating was higher than in the control group (chi(2) = 30.596; P < 0.0001). There was no statistically significant correlation between P50 gating and other clinical variables. CONCLUSION: Our data suggest that P50 gating deficit is a neurobiological marker that is present in stable schizophrenic patients and euthymic bipolar patients.

Depression in primary care: effectiveness of venlafaxine extended-release in elderly patients; Observational study.

Depression in the elderly is frequent but is often not recognized or treated as such. Few studies have assessed the effectiveness and tolerability of venlafaxine extended-release in patients over 60 years in primary care. This study aims to demonstrate the effectiveness and safety of venlafaxine extended-release in depressive disorders in this kind of population. Observational, multicenter and prospective study in an outpatient population over 60 years with depressive symptoms that needs pharmacological treatment and with a minimum score of 14 on the 17-items Hamilton rating scale for depression (HAM-D17). Effectiveness was assessed by HAM-D17. Physician's assessment of the patient's global status was also used and all the possible adverse effects were recorded. Venlafaxine extended-release was administered for 6 months at 75 mg per day dose, with the possibility of going up to 150 mg per day according to clinical criterion. Data of 1214 patients were obtained, with remission rates (HAM-D17

[Response and remission in depressive patients with anxiety symptoms treated with venlafaxine extended release in primary care]. / Respuesta y remisión en pacientes depresivos con síntomas de ansiedad tratados con venlafaxina retard en atención primaria.

INTRODUCTION: The aim of this observational study was to evaluate the long term effect of treatment with venlafaxine extended release on response and remission in patients with depressive syndrome and associated anxiety symptoms, in primary health care. METHODS: Observational, naturalistic and prospective, open-label study. Inclusion criteria were as follows: age over 18 years, diagnosis of depressive syndrome with anxiety symptoms and minimum scores of 17 and 10 on Hamilton Depression Rating (HAM-D17) and Anxiety Rating (HAM-A) scales, respectively. Daily doses of 75-150 mg of venlafaxine extended release were administered for 24 weeks. Effectiveness on the depressive-anxious symptoms was assessed using the HAM-D17 and HAM-A scales. Response and remission criteria were considered. RESULTS: 6,719 patients were evaluable for effectiveness and safety - intention to treat population. Venlafaxine extended release treatment was associated with significant decreases in the scores in the HAM-D17 and HAM-A scales, as well as with significant increases in response and remission rates. At week 24, remission rates were: 74.62% (HAM-D17

[Cost-effectiveness of venlafaxine for the treatment of depression and anxiety. Bibliographic review]. / Coste-efectividad de venlafaxina en el tratamiento de la depresión y de la ansiedad. Revisión bibliográfica.

OBJECTIVE: To compare the efficiency of the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) with venlafaxine in comparison with tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI). METHODS: A bibliographic systematic review of the published pharmacoeconomic studies in which one of the treatments was venlafaxine (immediate or extended-release) was conducted for MDD or GAD indications. RESULTS: Nine studies for immediate-release venlafaxine and seven with extended-release in MDD were published, two with Spanish data. In the more extended Spanish model (1 year treatment), in depressive disorder, 106, 97 and 99 depression symptom free days (SFD) were achieved by venlafaxine, TCA and SSRI respectively, with annual costs of 6,791, 7,116 and 7,029 euros. Similar results were obtained in the second Spanish 6 month study. Regarding GAD, after the treatment of elderly patients during 8 weeks, 17 and 5 SFD were obtained with venlafaxine and placebo, with a cost per SFD of 22.94 and 65.40 euros, respectively. CONCLUSIONS: According to the available studies, venlafaxine generates lower total costs (due to the reduction of treatment failure costs) than SSRI and TCA for the treatment of MDD. Venlafaxine is cost-effective in comparison with no treatment for GAD.

[Diagnostic process and management of schizophrenia in Spain: the ACEE project]. / Diagnóstico y manejo de la esquizofrenia en España: el proyecto ACEE.

INTRODUCTION: Although schizophrenia has a great impact on the health care, social and family levels, there is little epidemiological information on patients with schizophrenia, its diagnosis and treatment in Spain. The ACEE (Abordaje Clínico de la Esquizofrenia en España; Clinical Approach to Schizophrenia in Spain) study was designed with the primary objective of defining the management of schizophrenia in Spain from the perspective of current clinical practice. METHOD: ACEE is a descriptive cross-sectional multicenter observational study with data collected in the setting of current clinical practice by means of a specifically designed questionnaire. RESULTS: A total of 1,937 patients have been studied (83% pertaining to the public sector and 17% to private one). Most subjects had paranoid schizophrenia in the stabilization phase, and did not work because of their illness. Most (96%) were receiving antipsychotic treatment and 55% also received some non-drug treatment. Negative symptoms were more frequent than positive symptoms (88% versus 63%). Significant differences were observed for type of patients and diagnostic procedures involved between the public and private health care sectors. CONCLUSIONS: The ACEE study shows that schizophrenic patients attending Spanish psychiatric centers are mainly single, non-working males who are living in their family setting. Treatment basically consists of antipsychotics combined with other drugs, and few complementary examinations are performed.

[Quality of life, in depressed patients in Primary Health Care setting. Effectiveness and safety of venlafaxine extended release]. / Calidad de vida en pacientes con depresión tratados en Atención Primaria. Efectividad y seguridad de la venlafaxina retard.

INTRODUCTION: The aim of this observational study was to evaluate effectiveness, tolerability and impact on quality of life of treatment with venlafaxine extended release at a dose of 75 to 150 mg/day, in depressed outpatients treated in Primary Health Care. METHODS: Observational, prospective, open-labeled study, carried out by 882 Primary Health Care physicians. Outpatients, between 18 and 70 years of age with depressive symptomatology susceptible of treatment, with a Hamilton Depression Scale (HAM-D17) score 14 were included. Daily doses of 75 or 150 mg of venlafaxine extended release were administered orally for 24 weeks. Antidepressant effectiveness was assessed using the HAM-D17 scale and quality of life with the Quality of Life in Depression Scale (QLDS), Spanish version. RESULTS: 4,747 patients were recruited, of which 4,320 were included in a intention to treat effectiveness analysis and 4,557 patients in a safety analysis. HAM-D17 and QLDS mean score significantly decreased from week 4 to the end of study. 86,2% of the patients were responders and 73.8% achieved remission of the symptoms. Likewise, 95% reported absence or mild somatic and psychic anxiety on the final visit. Tolerability was considered good or excellent for 98.7% subjects. 191 patients (4.2%) reported adverse events. CONCLUSIONS: Venlafaxine extended release is a safe and effective drug that reduces depressive symptoms of Primary Health Care patients and improves their quality of life.

[Limitations of the diagnosis of bipolar disorder]. / Los límites del diagnóstico del trastorno bipolar.

INTRODUCTION: It has been studied the possible confusion in the diagnosis of bipolar disorder when there are no clear mania symptoms and other psychiatric disorders, due to his clinic similarity. The diagnosis received from a group of patients admitted in a Psychiatric Unit of a General Hospital by manic episode were studied. METHODS AND MATERIAL: 84 admitted patients have been followed up along an average of 32 months. By means logistic regression, there were found the factors that explained the change in the diagnosis along the evolution. RESULTS: 87% of the patients after the follow up kept the diagnosis of bipolar disorder. However, 63.1% had received other diagnosis. Two factors predicted to receive other diagnosis: depressive clinic and not having stable couple. CONCLUSION: Bipolar disorder presents a proper stability once diagnosis have been made. It may be confused with psychotic sight, unipolar depression and B cluster personality disorders. It is checked that patients which start with manic psychosis phases are the ones that present biggest diagnosis stability.

[Assessment of needs in schizophrenia patients]. / Evaluación de necesidades de personas con enfermedad esquizofrénica (CAN).

BACKGROUND: To optimise appropriate planning of services, the care needs in patients with chronic mental illness, the organisms or individuals that cover these needs, and the relationships between specific needs and sociodemographic variables should be identified. This study was designed to assess needs in a population of persons with mental illness. METHODS: The Camberwell Assessment of Need (CAN) questionnaire was used to obtain and report quantitative information on needs. A total of 246 patients diagnosed as having schizophrenic disorder and 246 staff members of public mental health services, all living and working in the province of Granada (southern Spain, n = 187) or the city of Madrid (central Spain, n = 56), completed the questionnaire. Regression analysis was used to identify correlations between needs and sociodemographic variables. RESULTS: Mean needs score was 6.5; the most frequent needs were those related with daytime activities, company, psychotic symptoms, psychological distress, basic education and money management. The sociodemographic variables most closely associated with these needs were: not living with a life partner, low educational level, and receiving state benefits. The type of help these patients received was mainly from the family (informal help); public services (formal help) covered mainly clinical needs. CONCLUSIONS: The needs of persons with schizophrenic disorder do not differ from those of members of the more marginalised groups in Spanish society. Care provided by family members often represents a considerable burden on relatives.

[Prevalence of psychiatric disorders in primary care using the PRIME-MD questionnaire]. / Prevalencia de los trastornos psiquiátricos en atención primaria usando el cuestionario PRIME-MD.

OBJECTIVE: To quantify the frequency of psychiatric disorders detected by primary care doctors, using the PRIME-MD questionnaire, and by psychiatrists using a structured clinical interview. DESIGN: An observational, descriptive, crossover study, using a questionnaire. One of each two patients was selected until reaching the total number of patients. SETTING: The study was conducted in five primary care centres in Madrid. PATIENTS: To be included in the study, patients had to consent verbally, be able to understand the questions asked and have been previously diagnosed as psychotic or demented. 395 patients were recruited, of which 312 completed the study. INTERVENTIONS: The primary care doctor administered the PRIME-MD questionnaire to each patient, and then a psychiatrist conducted the SCAN interview. RESULTS: The time spent by the doctor on the PRIME-MD questionnaire was usually 10 minutes. The doctor had previously detected psychiatric pathology in 18.5% of his/her patients; with the PRIME-MD questionnaire he/she detected it in 53.5%. The psychiatrist with the SCAN detected psychiatric pathology in 41.3% of patients. CONCLUSIONS: The high frequency of psychiatric disorders in primary care patients and primary care doctors' lack of ability in detecting these disorders was confirmed by this study. The PRIME-MD questionnaire, an instrument for rapid detection of the most commonly found psychiatric disorders within primary care, may considerably improve this situation.

Diferencias de género en el perfil clínico, respuesta y remisión de pacientes depresivos tratados con venlafaxina retard / Gender differences in clinical profile, response and remission of depressive patients treated with venlafaxine extended release

Introducción. El objetivo principal de este estudio es evaluar las diferencias específicas de género en el perfil clínico de pacientes depresivos tratados en atención primaria, así como en la respuesta y remisión clínica a venlafaxina retard. Métodos. Se ha analizado una muestra de 6.719 pacientes ambulatorios adultos (1.713 hombres y 4.925 mujeres)con diagnóstico de síndrome depresivo con síntomas asociados de ansiedad incluidos en un estudio observacional, abierto, prospectivo y multicéntrico. Se administró venlafaxina de liberación retardada durante 24 semanas a dosis de 75-225 mg/día. Resultados. No se han encontrado en este estudio diferencias globales en cuanto a la gravedad basal del episodio depresivo, según las evaluaciones de la HAM-D17 y escala de Impresión Clínica Global de Severidad (ICG-S). No obstante, las mujeres presentaron puntuaciones más altas en ítems de las escalas HAM-D17 y HAM-A relacionados con quejas somáticas y de ansiedad en las visitas basal y final. El porcentaje de remisión en la escala HAM-D17 fue del 75,4 % en hombres y 74,3 % en mujeres (p= 0,4339) en la semana 24. En el caso de la HAM-A fue 84,1 frente a 80,6% (hombres frente a mujeres, p=0,004).Conclusiones. No se observaron diferencias basales en la puntuación media de la HAM-D17 ni en las tasas de remisión entre hombres y mujeres (HAM-D17) en la visita final. Las mujeres presentaron tasas de remisión de ansiedad más bajas (HAM-A) y conservaron más quejas somáticas y de ansiedad a lo largo del estudio (AU)

Introduction. The primary objectives of this study are to evaluate gender-specific differences in the clinical profile of primary care depressive patients as well as in the clinical response and remission to venlafaxine extended release. Methods. We have analyzed a sample of 6,719 adult outpatients (1,713 men and 4,925 women) with diagnosis of depressive syndrome with associated anxiety symptoms included in an observational, prospective, multicenter and open study. Venlafaxine extended release was administered for 24 weeks at a dosage of 75-225 mg/day. Results. In this study, we have not found overall differences regarding the baseline severity of the depressive episode, as assessed by means of the HAM-D17 and Clinical Global Impression Scale of Severity (CGI-S). However, women showed higher scores on items of the HAMD17 and HAM-A scales related with anxious and somatic complaints at baseline and endpoint. The percentage of remission on the HAM-D17 scale reached 75.4 % for men and 74.3 % for women (p = 0.4339) at week 24. In the case of HAM-A: 84.1 % vs. 80.6 % (men vs. women, p=0.004).Conclusions. We did not observe baseline differences in the mean score of the HAM-D17 nor the remission rates between women and men (HAM-D17) at the final visit. Women showed lower anxiety remission rates (HAM-A) and maintained more anxious and somatic complaints throughout the study (AU)

Introducción. Grupo de trabajo para el tratamiento a largo plazo de la depresión / Introduction. Task force on long-term treatment of depression

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Conceptos prácticos para la clasificación y el manejo de la depresión largo plazo / Long-term depression: practical concepts of classification and management

En el manejo de la depresión a largo plazo es necesario tener en cuenta algunos conceptos clave: características evolutivas de los episodios depresivos, instauración del primer episodio clínico, número de episodios, duración, intervalos y ciclos, patrones de curso, etc. El tratamiento a largo plazo es un concepto amplio que incluiría el tratamiento o la estrategia terapéutica realizada tras finalizar el tratamiento agudo. Se ha dividido en tratamiento de continuación o consolidación y tratamiento de mantenimiento o profiláctico. Desde un punto de vista conceptual otros términos y definiciones son relevantes: la remisión parcial supone que el paciente presenta clínica depresiva sin cumplir ya criterios de episodio o síndrome completo. La respuesta puede considerarse en el momento que se inicia la remisión parcial. La remisión parcial puede ser espontánea, aunque se tiende a asumir que es secundaria a la efectividad del tratamiento ensayado. La ausencia de evolución de la remisión parcial a la remisión total plantea la necesidad de ensayar nuevas estrategias terapéuticas. Los síntomas residuales indican el primer escalón de otros más graves como la recidiva episódica y la cronicidad. En la literatura se relaciona la «sintomatología residual» con una mayor frecuencia de recidivas episódicas. La remisión completa se refiere a la ausencia de síntomas significativos de depresión durante un tiempo determinado (al menos 2 meses). La recuperación se sitúa en un continuum entre estar libre de síntomas depresivos hasta sufrir síntomas leves o moderados. Se define recaída como un episodio clínico separado del previo por menos de 6 meses y recurrencia por más de 6 meses (AU)

In the long-term management of depression is necessary to take into account some key concepts: evolutive characteristics of depressive episodes, first clinical episode onset, number of episodes, duration, intervals and cycles, course of illness, etc. Long-term treatment is a broad term that would include the treatment or therapeutic strategy used once the acute treatment is over. It has been divided into continuation or consolidation treatment and maintenance or prophylactic treatment. Conceptually, other terms and definitions are relevant: partial remission implies a depressive symptomatology without criteria for a complete episode or syndrome. Response may be considered once partial remission has begun. Partial remission may be spontaneous, though there is a trend to assume that is secondary to the study drug’s effectiveness. The absence of evolution of partial to total remission creates the need to test new therapeutic strategies. Residual symptoms are the first step to more severe ones such as episodic relapse and chronicity. «Residual symptomatology» is associated in literature with a higher rate of relapses. Full remission implies lack of significant depressive symptoms for a determined period of time (at least 2 months). Recovery is a continuum between absence of depressive symptoms and mild or moderate symptoms. Relapse is defined by a clinical episode at least 6 months after the previous one and recurrence over 6 months (AU)

Factores de riesgo y predictores de evolución en la depresión a largo plazo / Risk factors and outcome predictors in the long-term depression

Los estudios evolutivos señalan diversas variables basales sociodemográficas como predictores en mayor o menor medida de la evolución crónica de los trastornos depresivos: sexo, edad de comienzo y presencia de antecedentes familiares, aunque pueden citarse otros muchos más controvertidos. Los estudios de neuroimagen han mostrado por lo general asociaciones positivas entre la presencia de alteraciones estructurales y un pronóstico adverso de la depresión, tanto una evolución hacia la cronicidad como hacia la aparición de un síndrome demencial. Se revisan otros grandes tipos de factores. Un grupo relacionado con el curso de la enfermedad: número de episodios y persistencia de los síntomas. Otro grupo de factores reúne los que tienen que ver con las características clínicas propiamente dichas: presencia o ausencia de determinados síntomas o conjuntos de síntomas. Finalmente, un tercer factor clínico de gran importancia es la comorbilidad, tanto somática como psiquiátrica. Los problemas de reconocimiento y diagnóstico de la depresión y el empleo de herramientas terapéuticas inadecuadas o insuficientes son todavía demasiado frecuentes. Por otra parte, la mala adherencia al tratamiento sigue constituyendo un problema crucial en el tratamiento a largo plazo de la depresión (AU)

Outcome studies indicate that some baseline sociodemographic variables are predictors of the chronic evolution of depressive disorders: gender, onset and existence of family psychiatric history, among others, much more controversial. Neuroimage studies have generally shown positive associations between the existence of structural changes and an adverse prognosis of depression, towards an evolution to chronicity or onset of a demential syndrome. Other major types of factors have been revised as well. One group related with the course of the disease: number of episodes and persistence of symptoms. Another group of factors gathers those related with clinical characteristics: presence or absence of determined symptoms or groups of symptoms. Finally, a third clinical factor of great relevance is comorbidity, both somatic and psychiatric. Problems in the recognition and diagnosis of depression and the use of unsuitable or inadequate therapeutic tools are still too frequent. Besides, treatment noncompliance is still a crucial problem for the long-term treatment of depression (AU)