The effect of early life events on glucose levels in first-episode psychosis.

First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.

Evolution of metabolic risk factors over a two-year period in a cohort of first episodes of psychosis.

Patients with a first episode of psychosis (FEP) display a broad range of metabolic risk factors related to the development of diverse medical comorbidities. Initial stages of these disorders are essential in understanding the increased vulnerability of developing cardiometabolic disturbances, associated with a reduced life expectancy. This study aimed to evaluate the metabolic profile of a cohort of patients with a FEP and its evolution during a two year follow-up, as well as the factors that influence the changes in their metabolic status. 16 participating centers from the PEPs Project recruited 335 subjects with a FEP and 253 matched healthy controls, aged 9-35years. We investigated a set of anthropometric measures, vital signs and laboratory data obtained from each participant over two years in a prospective, naturalistic study. From the beginning of the study the FEP group showed differences in the metabolic profile compared to the control group, together with a progressive worsening in the major part of the analyzed variables during the follow-up period, with higher rates of obesity and metabolic syndrome. Certain risk factors were related to determinate clinical variables such as male gender, the presence of affective symptoms or an early onset or to treatment variables such as the use of antipsychotic polypharmacy, antidepressants or mood stabilizers. Our results highlight the extremely high risk of patients at early phases of schizophrenia and other psychotic disorders of developing cardiovascular comorbidity and the fast worsening of the metabolic profile during the first two years.

La formación del médico psiquiatra en España: de los estudios de pregrado a la formación especializada / The formation of the psychiatrist in Spain: from the undergraduate studies to the specialized training

En el presente trabajo se revisa el proceso de formación del médico especialista en psiquiatría en España. A puntode partida de la reforma educativa universitaria luego de la creación del Espacio Europeo de Educación Superior yel llamado Acuerdo de Bolonia, se introdujeron importantes reformas curriculares, metodológicas y tecnológicasen las Facultades de Medicina del país. Este proceso histórico llevó a la promulgación del Real Decreto de 2008,a través del cual se regula el nuevo programa de formación de la especialidad de Psiquiatría. Se comentan tambiénpropuestas del esperado “proyecto de troncalidad” que permita que la Psiquiatría sea una disciplina-eje, conPsiquiatría Infantil y del Adolescente como su rama específica.

This article reviews the training process of psychiatry’s specialist physician in Spain. With the university educationreform following the creation of the European Space of Superior Education and the Bologna Accord as points ofdeparture, important curricular, methodological and technological changes were introduced in Spanish medicalschools. This historical process led to the promulgation of the 2008 Royal Decree through which the new specialtytraining in Psychiatry was regulated. Proposals on the expected “troncality process” which will allow Psychiatryto become a unitary, axis-like discipline with Child and Adolescent fields as a specific branch are also commentedupon.

Switching to ziprasidone in the clinical practice setting: an open-label study.

OBJECTIVE: This observational study evaluates the long-term outcome of switching to ziprasidone in patients with schizophrenia in the clinical practice setting. METHODS: Patients (208) with schizophrenia who had been switched to ziprasidone monotherapy due to partial response or tolerability problems were followed for 1 year. Efficacy was assessed at baseline and months 1, 3, and 12 with Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression-severity (CGI-S), and CGI-improvement. Quality of life, functionality, and safety measures, including metabolic parameters, were also assessed; 195 subjects comprised the per protocol analysis population. RESULTS: A reduction > or = 30% in BPRS total score was observed in 42.5% of the subjects. Mean scores of the BPRS (global and positive and negative clusters), CGI-S and CGI-I significantly decreased at endpoint (p < 0.001). Ziprasidone treatment was also associated with statistically significant improvements in the GAF, WHO-DAS-II, and SF-12. After 1-year follow-up, a mean weight decrease of -1.6 kg (p < 0.05) was observed. Mean levels of LDL cholesterol and triglycerides also decreased (p < 0.01) while HDL cholesterol levels increased (p < 0.05) at endpoint. No significant changes in mean glucose levels at study end were detected. CONCLUSION: These findings suggest that switching to ziprasidone is effective and well tolerated in patients with schizophrenia requiring a change in antipsychotic medication.

[Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme]. / Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP.

INTRODUCTION: Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease. PATIENTS AND METHODS: Seventy-six patients were recruited and randomly assigned to either an experimental REHACOP group or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Both groups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions. RESULTS: The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions. Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. CONCLUSIONS: The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree of impairment and the stage of progress of the disease.

[REHACOP: a cognitive rehabilitation programme in psychosis]. / REHACOP: programa de rehabilitacion cognitiva en psicosis.

INTRODUCTION: In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. MATERIALS AND METHODS: The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. RESULTS AND CONCLUSIONS: This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies.

An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms.

INTRODUCTION: Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. METHODS: We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. RESULTS: Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. CONCLUSIONS: Our findings suggest that PS and negative symptoms predict QoL in schizophrenia.

[Mental disorders in psychiatric outpatients in Spain]. / Trastornos mentales en pacientes de atención especializada en el ámbito extrahospitalario español.

OBJECTIVES: The aim of data presented is to increase knowledge about the morbidity and impact of mental disorders in Spanish psychiatry. The objective is to describe, based on real practice conditions, the most prevalent mental disorders in a sample of Spanish patients treated in outpatient Psychiatry centers. MATERIAL AND METHOD: Epidemiological, naturalistic, prospective, cross-sectional study, carried out in the outpatient psychiatry setting in Spain in 2006. Mental disorders were assessed using the International Neuropsychiatric Interview (MINI). RESULTS: A total of 1,436 patients, 72% of whom were women, mean age of 49.2 ± 13.3 years, were included. According to the MINI assessment, 90.3 % of the patients were diagnosed of at least one mental disorder. The most prevalent mental disorders were: recurrent major depressive episode (27.2%, 353 patients); only current major depressive episode (2 weeks) (25.9%, 336 patients); current dysthymic disorder (last 2 years) (25.9%, 336 patients); current major depressive episode with melancholy symptoms (18.7%, 243 patients); current generalized anxiety disorder (16.6 %, 215 patients). CONCLUSIONS: The study results show the prevalence of mental disorders in a sample representative of the Spanish population, treated in outpatient specialized Psychiatry centers. Mood and generalized anxiety disorders were the most prevalent disorders.

The opinion of psychiatric residents on the training they receive.

The results of a survey carried out by the Spanish National Board for Psychiatric Training among psychiatric trainees in their third and fourth year of training are presented and discussed. The aim of the survey was to know the resident's opinion and level of satisfaction on the training they had received. The results indicate that the majority of residents had complied with the National Program for Psychiatric Training requirements and that their level of satisfaction was fair. However a small but substantial percentage did not comply adequately with the program, particularly in relation with the training in psychotherapy, research methodology, old age psychiatry, neurology and general medicine. Based on these results the National Board puts forward some recommendations meant for those involved in the training of psychiatrists in Spain.

Nimodipine in opiate detoxification: a controlled trial.

OBJECTIVE: To evaluate the use of L-type calcium channel blockers (CaCB) in out-patient opiate detoxification. DESIGN: Controlled trial with sequential allocation of patients to groups. METHODS: Three groups of individuals subject to opiate detoxification were involved: (1) the experimental group (n=30) received a course of nimodipine and dextropropoxiphen; (2) one control group (n=20) was detoxified with a course of dextropropoxiphen and benzodiazepine; and (3) a second control group (n=30) was treated with a standard course of alpha-2-adrenergic agents and naltrexone. In all cases, the detoxification course was scheduled to last 7 days. RESULTS: All the groups showed a significant opiate withdrawal syndrome (OWS) during detoxification (follow-up effect: Lambda=0.04; F6.52=201.89; P < 0.001), but from the first day the group treated with CaCB manifested fewer symptoms than the control groups (treatment effect: F2.57=97.99; P < 0.001). From the start, the intensity of the OWS was reduced by half in the CaCB group (M=6.67) compared with that manifested by the two other groups (M approximately 13). The clinical impression of the evolution of the detoxification was that it was comfortable and free of complications (significant side-effects were not observed). CONCLUSIONS: The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.

Factores asociados a la utilización de preservativos en una población de adictos a drogas por vía parenteral / Factors associated of non-condom use among a population of parenteral drug abusers

Se ha estudiado la utilización de preservativos en una muestra de 139 adictos a drogas por vía parenteral. Las categorías asociadas significativamente a la no utilización de preservativos son: el sexo femenino (OR=5.1;IC95%=2.0-13.2) y una historia de adicción de cinco o másaños (OR=3.0; IC95%=1.3-6.9). Menos del 25% de las mujeres incluidas en el estudio utilizan preservativos en sus relaciones sexuales. Por el contrario, un nivel educativo superior protege frente a la no utilización de preservativos (OR=0.3; IC95%=0.1-8.8) El modelo más parsimonioso ajustado a los datos incluye las variables sexo, nivel educativo, tipo y frecuencia de relaciones sexuales, y años de adicción. No son necesarias el tipo de convivencia, situación laboral, edad, ni antecedentes de enfermedades de transmisión sexual. Se sugiere la necesidad de implementar acciones con el fin de modificar las conductas de riesgo en las relaciones secuales establecidas por adictos a drogas por vía parenteral sin olvidar que la principal vía de transmisión del virus de la inmunodeficiencia humana en este colectivo se produce al compartir agujas y jeringuillas contamiandas