[Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year]. / Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal.

BACKGROUND: In recent years, there has been an increase of drugs poisoning cases seen in the Emergency Department. This study has aimed to evaluate the characteristics of these cases in the Ramón and Cajal Hospital in Madrid. MATERIALS AND METHODS: A descriptive analysis about the drug poisonings diagnosed in 2004 was performed, using a retrospective search in the database of the electronic clinical records. The studied variables were gender, age, intention, drugs, admission into the hospital and relapse. RESULTS: There were 566 drug poisoning (47%) with a cumulative incidence of 0.1%, in which women (62.3%) were found to predominate, and the average patient age was 42.46+/-19.97 years (range 14-100 years). In 64.31% of the cases (566), only one kind of drug was used, benzodiazepine being the most common. This appeared at least once in 62% of the cases. Furthermore, 83% were cases of voluntary poisoning. Of the involuntary poisonings, digoxin was the most common drug with a frequency of 58.4%. A total of 28.6% of the cases were admitted into hospital, while the total number of patients who suffered a relapse in this period was 10%. DISCUSSION: Voluntary drug intoxications are caused mostly by psychoactive drugs, likely due to a high prevalence of underlying psychiatric disease in these patients. However, unintentional intoxications are mainly found in patients under chronic treatment with drugs such as digoxin and antiepileptics. More studies should be carried out to analyze which kind of preventive actions could reduce or avoid the high number of relapses.

[Depressive syndromes in the immigrant population]. / Síndromes depresivos en la población inmigrante.

Migrations are currently one of the most important sociocultural and political phenomena. As a rule, immigrants are in good health, although the immigration is by itself a mental health risk factor. This population shows common specific problems as adaptation processes, depressive syndromes, or other psychiatric problems. "Ulises' syndrome", depression, and dysthymia are the most common mental health conditions among unlawful non-european community immigrants cared in specific facilities. Similarly to the spanish indigenous population, anxiety disorders and readjustment disorders are the most common diagnoses among legal immigrants cared by Mental Health Services (MHS). Given the impact of sociocultural aspects in the development and clinical manifestations of mental health problems, it is necessary to know the demands of the immigrant population and to adjust current facilities for their care.

[Addiction characteristics as prognostic factors in opiate dependence treated with naltrexone]. / Características de la adicción como factores pronósticos en el tratamiento con naltrexona de la dependencia de opiáceos.

INTRODUCTION: Addiction characteristics as prognostic factors in opiate dependence treatment were studied. Thus, several factors related to previous opiate consumption record were considered (current heroin route, amount of heroin, onset age of heroin consumption, time of heroin consumption, other drug consumption record). OBJECTIVE: To establish the prognostic value of addiction characteristics in a naltrexone program for opiate dependence. METHODS: To achieve this objective, an observational, retrospective study was designed with a design of a treatment group with no control group. 945 subjects diagnosed of opiate dependence who were consecutively hospitalized voluntarily in the naltrexone program of the Hospital Ramon y Cajal of Madrid during 1991-1995 form a part of the study population. Descriptive and survival techniques were used to analyze the data. RESULTS: Previous intravenous heroin route, chronic heroin consumption record, onset age of heroin use younger than 17 or older than 25, and other drug consumption especially benzodiazepine and also cocaine provide a prognostic value for a worse outcome. High quantities of heroin consumption also tend to be associated with a poorer evolution. CONCLUSIONS: Several addiction characteristics (current previous route, onset age of heroin consumption, quantity of heroin consumption, time of heroin consumption, other drug consumption) have a prognostic value for treatment evolution. Further studies are necessary to provide a more complete knowledge of addiction characteristics as prognosis factors in opiate dependence treatment.

[Antipsychotics use in drug abuse]. / Uso de antipsicóticos en drogodependientes.

A review was carried out into the literature of the last ten (Medline, IME, HealthSTAR, Cinahl) on the use of antipsychotic drugs in substance abusers. The use of these drugs is common in this population because of the high prevalence of psychotic pathologies among substance abusers and they are used in the treatment of situations derived from the consumption of certain substances and in secondary behavioural disorders following organic mental disorders or personality disorders. The special characteristics for the use of these drugs among addicts are reviewed as these patients tend to present adverse side-effects with greater frequency, for example, extrapyramidal symptoms and less compliance with treatment.

[Alcohol consumption in opioid-dependence patients in treatment with naltrexone]. / Consumo de alcohol en dependientes de opiáceos en tratamiento con naltrexona.

OBJECTIVES: Alcohol consumption in opiate dependence in naltrexone treatment was evaluated. MATERIAL AND METHODS: The alcohol consumption and their modifications were evaluated in two groups of heroin dependents in naltrexone treatment. A prospective study was made in two periods of time, evaluating 50 patients in the first one, and 82 in the second one. RESULTS: In both of them we found a significant increase of the amount of alcohol consumed, that was higher in the patients who had shown alcohol abuse before opiate dependence. CONCLUSIONS: The opiate dependent in naltrexone treatment increase of alcohol consumed.

[Alcohol dependence treatment with naltrexone: safety assessment. Observation study group of alcoholic dependence]. / Evaluación de la seguridad del tratamiento con naltrexona en la dependencia del alcohol. Grupo de Estudio Observacional de la Dependencia Alcohólica (GEODA).

OBJECTIVES: The security the naltrexone treatment in alcohol dependence was evaluated by clinic follow-up (tolerance and secondary effects) and analitic follow-up (transaminases and another biological assessment). MATERIAL AND METHODS: This is an one open study, not controlled, prospective and multicentric treatment of the alcoholism of Spain. 42 centres recruited alcoholic patients who were treated with 50 mg of naltrexone with pursuit of 6 months. RESULTS: 234 patient were selected, 173 concluded the study. The more frequent secondary effects were: astenia (16%), nausea (11.6%), sleepiness (8%), and insomnia (7%). The majority of patients tolerated well the treatment with naltrexone. Only 5 (3%) patients were dropped out of the study by intolerance to naltrexone. GOT, GPT, GGT levels decreased during the six months of treatment. CONCLUSIONS: The naltrexone treatment in alcoholic dependent is well tolerated. The secondary effects are infrequent and only in 3% of them the treatment were interrupted.

[Cocaine and psychiatric comorbidity]. / Cocaína y comorbilidad psiquiátrica.

A bibliographic review of psychiatric comorbidity in cocaine users was done in last ten years (Medline, IME, HealthSTAR, Cinahl). It was valued the prevalence of psychiatric disorders in cocaine users and that of consume of this substance in-patients with psychiatric disorders. Their relationship, influence over the evolution and consequences on the treatment were studied as well. Epidemiologic studies showed an increase of affective disorders, anxiety disorders and personality disorders in cocaine users and an increase of consume of this substance in those patients who are presented psychosis and anxiety disorders. The relationship of these disorders was analysed, as well as the influence oh the comorbidity in the evolution and repercussion on the treatment.

[Anxiety disorders and substance-related disorders]. / Los trastornos de ansiedad y la dependencia de alcohol o drogas.

Psychiatric comorbidity between anxiety disorders and substance-related disorders is studied. This relationship is complex due to the overlapping of symptoms (during the abstinence of alcohol and opiates as well as in the intoxication of cocaine) and also for the inaccurate definition of several disorders. Epidemiologic studies show an increase of prevalence of anxiety disorders, mainly agoraphobia and social phobia, in patients who are alcohol dependents and in heroine and cocaine users. Such studies also point out an augmentation of consume of substances (drugs and alcohol), with a prevalence of 24% in patients with several anxiety disorders. The relationship between these disorders is analysed. It is also studied the influence of such a comorbidity in the evolution and outcome of treatment.

[Naltrexone in the treatment of alcohol dependence]. / Naltrexona en el tratamiento de la dependencia del alcohol.

This paper reviews preclinical research which demonstrates the involvement of the opioid system in the reinforcing effects of alcohol, and the effects of naltrexone, a long-acting, nonselective opioid receptor antagonist to reduce alcohol intake. Naltrexone (50 mg/day) may prevent the return to drinking by blocking the pleasurable effects or "high" associated with alcohol drinking, and relapse rates were reduced. The most common adverse effects reported include nausea and vomiting and it does not appear to be hepatotoxic in dosages recommend. Thus, naltrexone appears to offer significant therapeutic benefits, when used with behavioural treatment for alcohol dependent patients.

[Detoxification treatment with naltrexone in opiate dependence]. / Tratamiento de deshabituación con naltrexona en la dependencia de opiáceos.

Outcome of a maintenance treatment with naltrexone (350 mg/week) are examined in a sample of 50 patients with opiate dependence disorder. Treatment was followed in an outpatient facility, in a setting similar to patient's own environment. The average attendance rate was of 6.4 months. Six months after the onset of the treatment, 46% of the patients still remained drug-free. Results of treatment was correlated with changes in life style of the addicts. A follow-up study found that, overall, the naltrexone treatment caused an increase in alcohol consumption whereas there was a noticeable decrease in cocaine use. Factors related to successful results were a good work adjustment, no use of other drugs and lack of psychopathology.

[Findings in HIV infected patients in a psychiatry unit]. / Hallazgos en pacientes con infección por HIV en psiquiatría de enlace.

A study has been made of 107 HIV infected patients by the C/C. Psychiatry unit in the department of infections diseases, during 1987-1988. In this group the psychiatrist studied the following factors: the AIDS risk group, HIV infection stages, the somatic disorders and the neuropsychiatric complications. Also are described the different aspects of the therapy. The results from the study show that 95% were drug abusers and the most common psychopathological diagnosis were delirium and adjustment disorders.

[Alcoholic hallucinosis: response to treatment]. / Alucinosis alcohólica: respuesta al tratamiento.

A clinical study of alcohol hallucinosis was made in 25 patients admitted in the hospital Psiquiátrico de Madrid since 1984 until 1990, taking into account the ICD-9. The 88% of the patients under control improved partially o completely in an average period of 18 days.

[Psychiatric complications related to AIDS infection: apropos of a case of hypomania]. / Complicaciones psiquiátricas relacionadas con infección por HIV: a propósito de un caso de hipomanía.

The psychiatric disorders related with HIV infection can take various and complex forms. One case of Hypomania in a drug abuser patient with HIV + is reported, and it is suggested that this virus may produce symptomatology indistinguishable from the functional disorders.