Alcohol use and risk factors for self-harm behavior in Spanish adolescents. / Consumo de alcohol y factores de riesgo de conductas autolesivas en adolescentes españoles.

Self-harm behaviors in children and adolescents constitute an important public health problem with prevalence figures in the clinical population between 40 and 80%. The objectives of the study were to analyze and compare the Spanish sub-samples of two studies, SEYLE and WE-STAY to determine prevalence, self-harm patterns and factors associated with self-harm behaviors, notably the use of alcohol or drugs. The questionnaires used in both studies were the Global School Health Survey (GSHS), the Beck Depression Inventory (BDI-II), the Strengths and Difficulties Questionnaire (SDQ). The self-harm behaviors were evaluated with a modified 6-item version of s the Deliberate Self-Harm Inventory (DSHI). The independence of the study's categorical variables was assessed using the Chi-square test. The change in the relative risk of self-harm between the SEYLE study and WE-STAY was evaluated through the odds ratio (OR) calculation. Two different logistic regression models were calculated in order to establish the factors associated with self-harm behaviors in each study. In the present study, the rates of DSH vary according to study and sex, ranging from 0.58% to 2.08%, and different patterns of self-harm are evidenced by sex, with males self-injuring more frequently by self-inflicted blows and burns, while young women more often cut themselves. The presence of depressive symptoms and alcohol use were the factors most strongly associated with an increased risk of DSH.

Las conductas autolesivas en niños y adolescentes constituyen un importante problema de salud pública con cifras de prevalencia en la población clínica entre el 40 y 80%. Los objetivos del estudio son analizar y comparar las submuestras españolas de dos trabajos, SEYLE y WE-STAY, para conocer la prevalencia, los patrones de autolesión y los factores asociados a las conductas autolesivas, en particular el consumo de alcohol o drogas. Los cuestionarios utilizados en ambos estudios fueron la Encuesta Global de Salud Escolar (GSHS), el Inventario de Depresión de Beck (BDI-II), el Cuestionario de Fortalezas y Dificultades (SDQ). Los comportamientos autolesivos fueron evaluados con una versión modificada de 6 ítems basada en el Inventario de Autolesiones Deliberadas (DSHI). La independencia de las variables categóricas del estudio se evaluó mediante la prueba Ji-Cuadrado. El cambio en el riesgo relativo de autolesión entre el estudio SEYLE y WE-STAY, se evaluó a través del cálculo de odds ratio (OR). Se calcularon dos modelos de regresión logística diferentes con el fin de establecer los factores asociados con comportamientos autolesivos en cada estudio. En el presente estudio las tasas de DSH varían en función del estudio y del sexo en un rango entre 0,58% y 2,08%, presentando patrones de autolesiones diferentes según el sexo, los hombres se autolesionaron más frecuentemente mediante golpes autoinfligidos y quemaduras, mientras que las mujeres se hicieron más frecuentemente cortes. La presencia de síntomas depresivos y el consumo de alcohol fueron los factores asociados de forma más robusta a un mayor riesgo de DSH.

Predictive factors of alcohol consumption in adolescents: data from 1-year follow-up prospective study. / Factores predictores del consumo de alcohol en adolescentes: datos de un estudio prospectivo de 1 año de seguimiento.

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (p<0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.

El uso/abuso de alcohol es un problema de salud en los adolescentes. La última Encuesta sobre uso de drogas en Enseñanzas Secundarias realizada en España (ESTUDES 2014-2015), pone de manifiesto que 76,8% de los adolescentes entre 14 y 18 años consumieron alcohol en el último año y 68,2% en el último mes. El principal objetivo es determinar los factores que se asocian con el consumo de alcohol a medio plazo en una muestra de adolescentes españoles. El estudio forma parte del proyecto Saving and Empowering Young Lives in Europe (SEYLE). La muestra final estuvo compuesta por 708 estudiantes, evaluados en dos momentos temporales [basal (T0) y al año (T1)] [varones: 51,98%, edad media basal (DE)=4,43 (0,67)]. Se realizaron análisis de regresión univariante y multivariante, con el fin de investigar las relaciones entre posibles variables predictoras descritas en el momento temporal T0 y el consumo de alcohol en el momento T1.En el momento basal (T0) la prevalencia de abuso de alcohol fue del 25,56%, mientras que la prevalencia al año fue del 49,72% (T1). Las variables que predicen de forma significativa el abuso de alcohol al cabo de un año son: abuso previo del alcohol en el momento T0 (p< 0,001), abuso previo de drogas (p=0,011), padres que asisten a sus competiciones deportivas (p=0,005), problemas de relación con compañeros (p=0,019) y ausencia de comportamiento prosocial (p=0,043). A la vista de nuestros resultados se puede concluir que, en adolescentes, los trastornos externalizantes parecen ser factores determinantes de consumo de alcohol a medio plazo.

Substance use or abuse, internet use, psychopathology and suicidal ideation in adolescents. / Uso y abuso de sustancias psicotrópicas e internet, psicopatología e ideación suicida en adolescentes.

Substance and Internet use or abuse, psychopathology and suicidal ideation appear to be related. The aim of this study is to investigate the association between use of psychotropic substances, inadequate Internet use, suicidal ideation and other psychopathological symptoms within the adolescent population. The present study was carried out as part of the Saving and Empowering Young Lives in Europe (SEYLE) project, funded by the European Union. The sample is composed of 1026 adolescents aged between 14 and 16 years from 12 state schools in Asturias (530 men and 496 women). This study adds to the possibility of knowing whether the SEYLE data is confirmed in a relatively isolated and recession hit province of Spain. In the present study the following consumption rates were obtained: a) alcohol 11.89% in males and 7.86% in females; b) tobacco: 4.15% and 5.44 % in males and females respectively; c) other drugs: 6.98% in males and 4.44% in females; d) maladaptive or pathological Internet use: 14.53% and 20.77% in males and females respectively. The variables that predict suicide ideation in the logistic regression model were: previous suicide attempts, depression, maladaptive or pathological Internet use, peer problems and alcohol consumption.

El uso o abuso de sustancias o internet, la psicopatología y la ideación suicida parecen estar relacionadas. El objetivo del presente estudio es investigar la asociación en población adolescente entre consumo de sustancias potencialmente adictivas, uso inadecuado de internet, psicopatología e ideación suicida. El estudio forma parte del proyecto europeo Saving and Empowering Young Lives in Europe (SEYLE). La muestra está compuesta por 1026 adolescentes con edades comprendidas entre 14 y 16 años procedentes de 12 centros escolares públicos del Principado de Asturias (530 varones y 496 mujeres). El presente trabajo aporta la posibilidad de conocer si los datos generales del proyecto SEYLE varían en una zona relativamente aislada y socioeconómicamente en recesión. Las tasas obtenidas de consumo de las distintas sustancias y de uso de internet fueron: a) alcohol: 11,89% en varones y 7,86% en mujeres; b) tabaco: 4,15% y 5,44% en varones y mujeres respectivamente; c) otras drogas: 6,98% en varones y un 4,44% en mujeres; d) uso de internet desadaptativo o patológico: 14,53% y 20,77% en varones y mujeres respectivamente. Se ha observado que las variables con capacidad predictiva sobre las conductas suicidas fueron: tentativas suicidas previas, síntomas depresivos, uso desadaptativo o patológico de internet, problemas con los compañeros y consumo de alcohol.

The state of psychiatry in Spain.

The 1986 General Health Act and the so-called 'psychiatric reform' were key issues in the development of the mental healthcare system (MHCS) in Spain. The World Health Organization Declaration and Action Plan on Mental Health in 2005 gave it a revitalizing impetus and resulted in the first National Health System (NHS) Mental Health Strategy in 2006. A literature search was performed using MEDLINE, Spanish journals, reference lists, national databases, and European and Spanish official documents to describe the current state of the MHCS in Spain. The main results were: (1) existence of great variability among the autonomous communities with respect to mental health resources and provision of care; (2) lack of national epidemiological information on mental disorders with the exception of substance use disorders and suicide, which comprise powerful longitudinal national data, (3) training in psychiatry is well established, although there is no specialism of child and adolescent psychiatry, and (4) a dramatic increase in scientific productivity in the last decade among research groups, in part due to the creation of the Spanish Mental Health Network, the Centro de Investigación Biomédica en Red en el Área de Salud Mental (CIBERSAM). Quantifiable and reliable indicators are needed to provide efficient monitoring and analysis of epidemiological events and subsequently to understand the status of the Spanish MHCS.

A cross-cultural comparison between Spain and the USA: temperament and character distribution by sex and age.

The Unified Biosocial Theory of Personality developed by Cloninger has been applied in different cultures. Distribution by age and sex of the Temperament and Character Inventory (TCI) dimensions were assessed cross-culturally for samples in Spain and the USA. Three non-clinical samples were included: i) 404 participants from Asturias (Spain); ii) 240 participants from Burgos (Spain); and iii) 300 adults from St. Louis (USA). Each participant was assessed by means of the TCI. A significant negative correlation between NS and both HA (r=-0.329; P<0.01) and P (r=-0.217; P<0.01) was found in the study sample, as well as significant effects of age in NS, HA, RD, and C for women and in NS and HA for men, and also of sex in HA and RD. Personality dimensions for the two Spanish samples appear to be similar (differences in HA4 and RD) compared to those for the US sample (differences in NS, HA, RD and P). Findings support Cloninger's theory about differences between men and women, but not regarding the intercorrelations between temperament dimensions.

Pharmacological treatment of obsessive compulsive disorder in adults: A clinical practice guideline based on the ADAPTE methodology. / Tratamiento farmacológico del trastorno obsesivo-compulsivo en adultos: una guía de práctica clínica basada en el método ADAPTE.

Despite the existence of effective evidence-based treatments for the management of obsessive-compulsive disorder (OCD), the therapeutic approach to this disease remains suboptimal. The availability of a therapeutic pharmacological guideline for OCD could help to improve the management of the disease in our setting and to reduce the burden of disease for the patient. With the sponsorship of the Spanish Society of Psychiatry, a group of experts has developed a guideline for the pharmacological treatment of OCD based on the recommendations of existing guidelines and following the methodology of the ADAPTE Collaboration. This article summarises the process of preparing this guideline and the recommendations adopted by consensus by a guideline panel grouped into five areas of interest: acute treatment, duration of treatment, predictors of response and special symptoms, partial response to lack of response to treatment, and special populations.

Association study between obsessive-compulsive disorder and serotonergic candidate genes.

BACKGROUND: To date, research examining the relationship between serotonergic genes and obsessive-compulsive disorder (OCD) has yielded conflicting results. The purpose of this study is to investigate the association between four serotonergic polymorphisms (STin2 VNTR and 5-HTTLPR of the SLC6A4 gene, and A-1438G (rs6311) and T102C (rs6313) of the HTR2A gene) and OCD. METHODS: 99 OCD patients, 456 non-OCD psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. RESULTS: All groups showed Hardy-Weinberg equilibrium for the analyzed genetic variability. A-1438G and T102C polymorphisms were in complete linkage disequilibrium. OCD patients showed an excess of STin2.12 carriers (12/12, 12/10, and 12/9 genotypes) compared with healthy controls (chi(2) (1)=7.21, corrected p=0.021; OR=3.38, 95% CI=1.32-8.62) and non-OCD psychiatric patients (chi(2) (1)=6.70, corrected p=0.030; OR=3.24, 95% CI=1.27-8.26). However, no differences were found between non-OCD patients and healthy controls (chi(2) (1)=0.05, corrected p>1; OR=1.04, 95% CI=0.72-1.51). No significant differences were found with respect to A-1438G and 5-HTTLPR polymorphisms. CONCLUSIONS: Our data provide supporting evidence of an association between the STin2 VNTR polymorphism of the SLC6A4 gene and OCD.

The Schizophrenia Outpatient Health Outcomes (SOHO) study: 3-year results of antipsychotic treatment discontinuation and related clinical factors in Spain.

INTRODUCTION: This article presents the long-term results in terms of antipsychotic medication maintenance and factors influencing it in a representative sample of patients with schizophrenia recruited in the SOHO study within Spain. METHODS: The SOHO was a prospective, 3-year observational study of the outcomes of schizophrenia treatment in outpatients who initiated therapy or changed to a new antipsychotic performed in 10 European countries with a focus on olanzapine. The Kaplan-Meier method was used to analyse the time to treatment discontinuation and the Cox proportional hazards model to investigate correlates of discontinuation. RESULTS AND CONCLUSIONS: In total, 1688 patients were included in the analyses. Medication maintenance at 3years varied with the antipsychotic prescribed, being highest with clozapine (57.6%, 95% CI 39.2-74.5), followed by olanzapine (48.3%, 95% CI 45.1-51.5); and lowest with quetiapine (19.0%, 95% CI 13.0-26.3). Treatment discontinuation was significantly less frequent with olanzapine than with risperidone (p=0.015), depot typical (p=0.001), oral typical antipsychotics (p<0.001) or quetiapine (p<0.001); but not than with clozapine (p=0.309). Longer maintenance was also associated with higher social abilities and better cognitive status at baseline; in contrast, a shorter time to discontinuation was associated with the need for mood stabilisers during follow-up. This study emphasises the different value of antipsychotics in day-to-day clinical practice, as some of them were associated with longer medication maintenance periods than others. This study has some limitations because of possible selection and information biases derived from the non-systematic, non-randomised allocation to treatments and the existence of unobserved covariates that may influence the outcome.

Lack of association between endothelial nitric oxide synthase (NOS3) gene polymorphisms and suicide attempts.

OBJECTIVE: The aim of this study is to investigate the association between two polymorphisms of endothelial nitric oxide synthase (NOS3) and suicide attempts. METHODS: We genotyped 186 suicide attempters and 420 unrelated healthy controls. The following polymorphisms were analysed: T-786C and 27-bp repeat in intron 4. RESULTS: No significant differences were found in genotype or in allelic distribution of the aforesaid polymorphisms. There were also no differences in the genotype distribution or allelic frequencies when separately assessing males and females or impulsive and non-impulsive attempters and normal controls. Estimated haplotype frequencies were similar in both groups. CONCLUSION: Our data do not support the hypothesis that genetically determined changes in the NOS3 gene confer increased susceptibility for suicidal behavior.

Association study of serotonin 2A receptor (5-HT2A) and serotonin transporter (5-HTT) gene polymorphisms with schizophrenia.

OBJECTIVE: To investigate (i) the association between four serotonergic polymorphisms (A-1438G and T102C of the 5-HT2A receptor gene, and 5-HTT VNTR and 5-HTTLPR of the 5-HT transporter gene) and schizophrenia and (ii) the potential interaction of those polymorphisms in the development of schizophrenia. SUBJECTS AND METHODS: 227 outpatients with schizophrenia (DSM-IV criteria) and 420 unrelated healthy controls from Asturias (Northern Spain) were genotyped using standard methods. RESULTS: Both groups showed Hardy-Weinberg equilibrium for the analyzed genetic variability. A-1438G and T102C polymorphisms are in complete linkage disequilibrium in our population. There was an apparent difference in the distribution of genotypes for the A-1438G (or T102C) polymorphisms (p=0.018, not significant after a Bonferroni correction). The 5-HT2A -1438A (or 102T) allele was significantly more frequent in patients than controls (0.53 and 0.45, respectively; corrected p=0.028, OR=1.39 (95% CI=1.11-1.75)). Genotype and allele distributions for 5-HTT polymorphisms were similar in both groups. However, assessment of the combined influence of 5-HT2A A-1438G and 5-HTTLPR polymorphisms demonstrated a significant effect (chi(2) (3)=11.51, p=0.009), whereby the combination of -1438A and 5-HTTLPR S alleles was associated with schizophrenia. CONCLUSIONS: Our findings support a possible synergistic effect of genetic factors influencing serotonergic neurotransmission on susceptibility to schizophrenia.

Effect of olanzapine or risperidone treatment on some cognitive functions in a one-year follow-up of schizophrenia outpatients with prominent negative symptoms.

AIMS: To compare olanzapine and risperidone outcome on some neurocognitive dimensions in chronic schizophrenia patients with prominent negative symptoms. METHOD: We randomised and followed for 1 year 235 chronic schizophrenia outpatients with a SANS global score > or =10 to open-label flexible-dose treatment with olanzapine or risperidone. Clinical, functional and cognitive assessments [including the COGLAB battery reaction time, vigilance-span of apprehension (VSA) and a card-sorting task] were done periodically. RESULTS: There were no significant differences between olanzapine (n=120) and risperidone (n=115) treatments in the neurocognitive dimensions tested. Mean+/-SD doses were 12.2+/-5.8 mg/day of olanzapine and 4.9+/-2.0 mg/day of risperidone. Patients in the olanzapine group showed a significant improvement in the VSA total score, but the within-group change was modest (effect size of 0.26); the difference with the risperidone group was not significant (p=0.207). Patients in both groups showed a significant improvement in a composite measure of executive efficiency based on the card-sorting task, with within-group effect size of 0.21 (risperidone) and 0.35 (olanzapine); the between-group difference was not significant (p=0.164). At baseline, better functional status correlated with VSA. Patients scoring lower on VSA or executive efficiency at baseline improved more on these respective measures. CONCLUSION: Modest pro-cognitive effects can also be found in chronic schizophrenia outpatients with prominent negative symptoms when treated with olanzapine or risperidone.

Quality of life in schizophrenic patients.

In the last decades, there has been increased interest in the field of quality of life in mental disorders in general, and particularly in schizophrenia. In addition, the appearance of the atypical antipsychotic drugs (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) with different therapeutic and side-effect profiles, has promoted a greater interest in assessing the quality of life of schizophrenic patients. In this paper we will briefly summarize the difficulties in assessing quality of life in schizophrenic patients, as well as the results concerning their quality of life and the influence of psychopathology, especially negative and depressive symptoms, on it. We will also review data from recent clinical trials showing the impact ofantipsychotic treatments and their side effects upon quality of life.

Improvement in social functioning in outpatients with schizophrenia with prominent negative symptoms treated with olanzapine or risperidone in a 1 year randomized, open-label trial.

UNLABELLED: GENERAL PURPOSE: To evaluate the social functioning of schizophrenic outpatients after switching to second-generation antipsychotics. METHODOLOGY: Multi-center, randomized, open-label, parallel, flexible-dose, 1-year study of schizophrenic outpatients with prominent negative symptoms (defined as a SANS Global score > or =10), previously treated with conventional antipsychotics. Patients were randomly assigned (1:1 ratio) to treatment with an initial dose of at least 10 mg/day olanzapine (N = 120) or at least 3 mg/day risperidone (N = 115). Dosage could be modified during the study according to clinical criteria. Social functioning was evaluated using the total and subscales scores of the Social Functioning Scale (SFS) (validated Spanish version). Other efficacy measures included the SANS, SAPS, and CGI-S scales. Response was defined in advance as a 30% improvement in the SANS Global score. RESULTS: The mean doses during the trial were 12.2 mg/day (S.D. = 5.8) of olanzapine and 4.9 mg/day (S.D. = 2) of risperidone. There were no significant baseline differences in SFS total scores or other relevant clinical variables. At 1 year, olanzapine-treated patients presented a mean improvement in SFS total scores (7.75) that were significantly higher (p = 0.0028) than for risperidone-treated patients (-0.92). Treatment with olanzapine resulted in a greater numerical improvement than risperidone in all SFS domains and reached statistical significance in such categories as social engagement or withdrawal (p = 0.01), independence (performance) (p = 0.0098), independence (competence) (p = 0.04), recreational activities (p = 0.0391), and occupation/employment (p = 0.0024) in which the greatest difference between the olanzapine and risperidone groups was found (0.86 vs. -3.06). Significantly more patients treated with olanzapine reached or surpassed the SFS typified total scores corresponding to a functional level that is representative of a sample of stabilized Spanish outpatients with schizophrenia without prominent negative symptoms (p = 0.0009). Associated factors were treatment with olanzapine and a 30% improvement or more in SANS global score or SAPS global score. CONCLUSIONS: Long-term treatment with olanzapine was associated with overall greater improvement in social functioning (as measured by SFS) compared to risperidone-treated patients.

Use of concomitant medication with antipsychotic treatment in outpatients with schizophrenia: results from the European Schizophrenia Outpatients Health Outcomes (SOHO) study.

Use of concomitant medications with antipsychotic agents in the treatment of schizophrenia is common but lacks a clear scientific rationale. We evaluated concomitant medication usage during the first 6 months of the prospective, observational, European Schizophrenia Outpatient Health Outcomes (SOHO) study, examining its frequency, variation according to type of antipsychotic drug used, and impact on treatment tolerability. We also determined factors that were associated with concomitant medication use. The use of concomitant medications differed greatly among the countries participating in the SOHO study. The presence of depressive symptoms and being female were associated with the use of concomitant antidepressants. Certain antipsychotics were associated with less use of concomitant medications: significantly fewer olanzapine-, quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics. Patients using concomitant medications had an increased incidence of sexually related side effects and extrapyramidal side effects (EPS) at 6 months follow-up compared with patients not using concomitant medications. The results should be interpreted conservatively due to the observational design of SOHO.

Validation of the Spanish Personal and Social Performance scale (PSP) in outpatients with stable and unstable schizophrenia.

INTRODUCTION: The main long-term therapeutic goals of schizophrenia should go beyond the symptoms and include the improvement of patients' psychosocial functioning and quality of life. The aim of this study was to validate the Personal and Social Performance (PSP) scale in Spanish outpatients with schizophrenia. MATERIALS AND METHODS: Naturalistic, 6-month follow-up, multicentre study. 244 patients and 76 controls were evaluated using the PSP, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Clinical Global Impression - Severity (CGI-S) and Change (CGI-C) scales. RESULTS: Internal reliability=0.87. Test-retest reliability=0.98. Construct validity=1 component that explained 73.2% of the variance. Convergent validity: Pearson correlation coefficient between PSP and SOFAS=0.95 (p<0.0001), between PSP and CGI-S=-0.88 (p<0.0001). Discriminant validity: the PSP discriminates between patients and controls [50.3 versus 91.9, p<0.0001] and among patients with mild, moderate, and severe schizophrenia according to CGI-S scores [73 versus 56.6 versus 37.5, p<0.0001]. Area under the curve=0.986. A cut-off point of 79 on the PSP scale provided good sensitivity (94.3%) and specificity (96.1%) for identifying patients and controls according to their level of functioning. At month 6 significant improvements (p<0.0001) were seen in PSP, SOFAS, and CGI-C scores. The PSP was sensitive to improvement; a score of very much improved in the CGI-C corresponds to a improvement of 34 points in the PSP. CONCLUSION: The Spanish PSP is a reliable, valid and sensitive instrument for measuring functioning in outpatients with schizophrenia. As a brief, clinician-rated instrument, the PSP scale seems to be appropriate for use in everyday clinical practice as a mean of identifying and monitoring changes in patient's functioning.

Role of serotonergic-related systems in suicidal behavior: Data from a case-control association study.

OBJECTIVE: To investigate whether functional polymorphisms directly (HTR2A and SLC6A4 genes) or indirectly (IL-1 gene complex, APOE and ACE genes) related with serotonergic neurotransmission were associated with suicidal behavior. SUBJECTS AND METHODS: 227 suicide attempters, 686 non-suicidal psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. RESULTS: There were no differences in genotype frequencies between the three groups. The -1438A/G [χ(2) (df)=9.80 (2), uncorrected p=0.007] and IL-1α -889C/T [χ(2) (df)=8.76 (2), uncorrected p=0.013] genotype frequencies between impulsive and planned suicide attempts trended toward being different (not significant after Bonferroni correction). Suicide attempts were more often impulsive in the presence of -1438G/G or IL-1α -889C/T or C/C genotypes. There was interaction between the polymorphism 5-HTTLPR and age [LRT (df)=6.84 (2), p=0.033] and between the polymorphisms APOE and IL-1RA (86bp)(n) [LRT (df)=12.21 (4), p=0.016] in relation to suicide attempt lethality. CONCLUSION: These findings further evidence the complexity of the association between genetics and suicidal behavior, the need to study homogenous forms of the behavior and the relevance of impulsive and aggressive traits as endophenotypes for suicidal behavior.

Genetic polymorphisms in the dopamine-2 receptor (DRD2), dopamine-3 receptor (DRD3), and dopamine transporter (SLC6A3) genes in schizophrenia: Data from an association study.

OBJECTIVE: To investigate the association between dopaminergic polymorphisms [DRD2 -141C Ins/Del, DRD3 Ser9Gly, and SLC6A3 VNTR] and schizophrenia. METHODS: Two hundred and eighty-eight outpatients with schizophrenia (DSM-IV criteria) [mean age (SD)=36.4 (12.4), 60.1% males] and 421 unrelated healthy controls [mean age (SD)=40.6 (11.3), 51.3% males] from a homogeneous Spanish Caucasian population were genotyped using standard methods. RESULTS: There was a significant difference in genotype distribution for the DRD2 -141C Ins/Del polymorphism [(chi(2) (2)=12.35, corrected p=0.012]. The -141C Del allele was more common in patients than in controls [0.19 vs. 0.13; chi(2) (1)=9.14, corrected p=0.018, OR (95% CI)=1.57 (1.17-2.10)]. Genotype and allele distributions for DRD3 Ser9Gly and SLC6A3 VNTR polymorphisms were similar in both groups. However, there was tentative evidence of an interaction effect between DRD3 Ser9Gly and SLC6A3 VNTR [Wald=9.56 (4), p=0.049]. Compared to the SLC6A3 10/10 genotype category, the risk of schizophrenia was halved among those with 9/10 [OR=0.51 (95% CI=0.30-0.89), p=0.017]. This protective effect was only present in combination with DRD3 Ser/Ser genotype because of the significant interaction between 9/10 and both Ser/Gly [OR=2.45 (95% CI=1.16-5.17), p=0.019] and Gly/Gly [OR=3.80 (95% CI=1.24-11.63), p=0.019]. CONCLUSIONS: This study provides evidence that a genetic variant in the DRD2 gene and possible interaction between DRD3 and SLC6A3 genes are associated with schizophrenia. These findings warrant examination in replication studies.

Cardiovascular risk in patients with bipolar disorder.

BACKGROUND: To date, little is known about cardiovascular risk (CVR) in terms of coronary heart disease (CHD) and cardiovascular mortality risk (CMR) in patients with bipolar disorder. This study provides data on the overall risk of any fatal or non-fatal coronary heart disease (CHD) and on the cardiovascular mortality risk (CMR) within 10 years in these patients. METHODS: Naturalistic, cross-sectional, multicenter study conducted in Spain. Patients were evaluated for cardiovascular risk using the Framinghan function (CHD) and the Systematic COronary Risk Evaluation (SCORE) function (CMR). RESULTS: The mean age was 46.6 years and 49% were male. Forty-six percent were in remission. Ten-year CHD risk was 7.6% (males 10.2% versus females 4.7%, p<0.001) and 10-year CMR was 1.8% (males 2.2% versus females 1.3%, p 0.161). Fifty-one percent smoked and 34% was obese. Metabolic syndrome was present in 22.4% of the sample (35.6% according to AHA and NHLBI criteria). Cardiovascular risk significantly increases with age, body mass index and presence of metabolic syndrome. LIMITATIONS: The cross-sectional design of the study. CONCLUSIONS: Cardiovascular risk is high in patients with bipolar disorder. It is associated with age, body mass index and metabolic syndrome. Psychiatrists should be aware of this issue and carefully monitor these patients for cardiovascular risk factors, including cigarette smoking, as part of the standard of care when treating them.