Factors predicting early dropout from dialectical behaviour therapy in individuals with borderline personality disorder.

BACKGROUND: Dialectical behaviour therapy skills training (DBT-ST) has proven effective to treat individuals with borderline personality disorder (BPD). However, therapy still faces the problem of early dropout. The aim of the present study is to examine which factors are associated with early dropout from DBT-ST in a sample of subjects with BPD. METHOD: 118 subjects with BPD diagnosis were included in the study. Apart from socio-demographic and clinical variables, childhood trauma history, personality dimensions, and comorbidities with other psychiatric disorders were collected. Differences in regards to the aforementioned variables were compared between individuals who dropped out prematurely from therapy and those who finalized it. RESULTS: Significant differences between groups regarding socio-demographic and clinical variables, including childhood trauma history and comorbid personality disorders, were not found. Both groups differed significantly in regards to trait impulsiveness and in comorbidity with Eating Disorders (ED) and Cocaine Use Disorder (CUD). The regression analyses showed that ED and CUD significantly predicted drop-out (p=0.011 and p=0.031 respectively), while scores in trait impulsivity showed a tendency towards signification (p=0.063). CONCLUSIONS: Comorbidities between BPD and axis I disorders (i.e., ED and CUD) should be taken into account when referring patients to DBT-ST.

Evaluating Person-Centred Integrated Care to People with Complex Chronic Conditions: Early Implementation Results of the ProPCC Programme.

Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (-37.2%) and hospital stays (-38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of -46.3%.

Plasma ratio of clozapine to N-desmethylclozapine can predict cognitive performance in treatment-resistant psychotic patients.

Cognitive symptoms play a central role in schizophrenia and are strongly associated with social functioning. Treatment with clozapine presents controversial results regarding its effects on cognition. The opposite effects of clozapine and n-desmethylclozapine (NDMC) on cholinergic system have been suggested to underlie these inconclusive findings. The aim of this study is to determine whether clozapine/NDMC ratio can predict cognitive performance in patients with treatment-resistant psychosis. Nineteen clinically stable patients with schizophrenia or schizoaffective disorder treated with clozapine monotherapy completed demographic and clinical interviews. For the purpose of the study, patients were assessed with a neuropsychological battery and on the same day a blood sampling was obtained from each patient to measure plasma levels of clozapine and NDMC. Our results showed that clozapine/NDMC ratio, but not clozapine or NDMC plasma levels separately, was a predictive factor of cognitive performance, specifically of executive functioning. Our results showed that lower clozapine/NDMC ratios are associated with better executive functioning in clinically stable patients. These findings could be interpreted by the different pharmacodynamic properties on cholinergic, dopaminergic and serotonergic systems of NDMC compared to clozapine.

Factores predictores de abandono prematuro de terapia dialéctica conductual en pacientes con trastorno límite de la personalidad / Factors predicting early dropout from dialectical behaviour therapy in individuals with borderline personality disorder

Introducción. El entrenamiento en habilidades de la terapia dialectica conductual (TDC) ha mostrado eficacia para el tratamiento de individuos con trastorno limite de la personalidad (TLP). Sin embargo, una de sus principales dificultades es el abandono prematuro de la psicoterapia. El objetivo del presente estudio es evaluar factores asociados con el abandono prematuro de una terapia grupal de entrenamiento en habilidades de la TDC en sujetos con TLP. Método. Se incluyeron 118 sujetos con TLP. Ademas de factores sociodemograficos y clinicos, se evaluan otros factores como la presencia de antecedentes traumaticos en la infancia, rasgos dimensionales de personalidad y comorbilidad con otros trastornos psiquiatricos. Se analizan las diferencias entre aquellos sujetos que finalizan la terapia con los que abandonan prematuramente. Resultados. No se observan diferencias significativas en variables sociodemograficas, de gravedad clinica, la presencia de antecedentes traumaticos en la infancia ni otros trastornos de personalidad comorbidos. Si se encuentran diferencias significativas en la subescala de impulsividad asi como en la comorbilidad con Trastorno de la Conducta Alimentaria (TCA) y Trastorno por Consumo de Cocaina (TCC). En el analisis de regresion, las variables predictoras de abandono fueron la comorbilidad con TCA (p=0,011) y con TCC (p=0,031), las puntuaciones en impulsividad mostraron una tendencia a la significacion (p=0,063). Conclusiones. La comorbilidad con trastornos del Eje I y la impulsividad son factores que se deberian tener en cuenta para valorar a priori el riesgo de abandono prematuro de terapia y optimizar el tratamiento mas idoneo para cada paciente

Background. Dialectical behaviour therapy skills training (DBT-ST) has proven effective to treat individuals with borderline personality disorder (BPD). However, therapy still faces the problem of early dropout. The aim of the present study is to examine which factors are associated with early dropout from DBT-ST in a sample of subjects with BPD. Method. 118 subjects with BPD diagnosis were included in the study. Apart from socio-demographic and clinical variables, childhood trauma history, personality dimensions, and comorbidities with other psychiatric disorders were collected. Differences in regards to the aforementioned variables were compared between individuals who dropped out prematurely from therapy and those who finalized it. Results. Significant differences between groups regarding socio-demographic and clinical variables, including childhood trauma history and comorbid personality disorders, were not found. Both groups differed significantly in regards to trait impulsiveness and in comorbidity with Eating Disorders (ED) and Cocaine Use Disorder (CUD). The regression analyses showed that ED and CUD significantly predicted drop-out (p=0.011 and p=0.031 respectively), while scores in trait impulsivity showed a tendency towards signification (p=0.063). Conclusions. Comorbidities between BPD and axis I disorders (i.e., ED and CUD) should be taken into account when referring patients to DBT-ST

Calidad de vida relacionada con la salud en trabajadores del área medioambiental / Quality of life in workers in the environmental areas

Objetivo: El objetivo de este trabajo es describir la calidad de vida relacionada con la salud de una población de trabajadores en el contexto de la salud medioambiental. Material y Métodos: Estudio descriptivo transversal sobre una muestra de 401 trabajadores del área medioambiental de la provincia de Granada. Se aplicó un cuestionario con variables sociodemográficas, clínicas y de estilos de vida, junto con las láminas de Medición del Estado Funcional COOP-WONCA. Resultados: La puntuación media obtenida en COOP-WONCA fue de 14,34 (DT: 3,39). Las diferencias en las puntuaciones medias obtenidas en COOP-WONCA en relación a las variables sociodemográficas, clínicas y de estilos de vida no son relevantes, pero sí estadísticamente significativas en las siguientes variables: Lugar de Residencia (p=0,030); Tener una enfermedad común (p=0,017); Practicar algún deporte (p=0,041); Categoría profesional (p<0,001); Número de comidas al día (p=0,041), IMC (p=0,002); Nivel de Triglicéridos (p=0,022). Conclusiones: La percepción de la calidad de vida relacionada con la salud en la población de estudio es buena. Se observa una tendencia significativa en algunos factores que podemos considerar como protectores para una mejor percepción de la calidad de vida: residir en el ámbito urbano, no sufrir patología o enfermedad común, practicar algún deporte o afición, tener mayor cualificación profesional y estar en normopeso (AU)

Aim: To describe the quality of life related to health in a working population in the context of the environmental health. Methodology: A descriptive and transverse analysis was carried out within a sample of 401 workers in the environmental area of Granada. A survey was needed to collect information regarding sociodemographic, lifestyle and medical variables, together with the COOP-WONCA. Results: The average mark in COOP-WONCA was 14,34 (DT: 3,39). There were no relevant differences in the average obtained related to the sociodemographic, lifestyle and medical variables, but they were statistically meaningful as far as the following variables are concerned: place of living (p=0,030), to have a common disease (p=0,017); to practice some sport (p=0,041); professional category (p<0,001); number of meals per day (p=0,041); BMI (p=0,002), triglycerides level (p=0,022). Conclusions: Perceptions of the quality of life related to health in a population to investigate was satisfactory. A meaningful tendency could be observed in some factors that may be regarded as protectors for a better perception of the quality of life: to live in an urban area, not suffering from any pathology or common disease, to practice some sport or have a hobby, to have a good professional qualification and to have the appropriate weight (AU)