Cognitive Effects of Combined Amisulpride and Quetiapine Treatment in Patients With Refractory Schizophrenia: A Naturalistic, Prospective Study.

BACKGROUND: Regarding the treatment of patients with resistant schizophrenia, different options exit, although they are supported by limited evidence. In this study, antipsychotic polypharmacy, comprising 1200 mg of amisulpride and 600 mg of quetiapine, was used. Clinical change evaluation was performed using neurocognitive evaluations. STUDY QUESTION: The use of amisulpride and quetiapine will imply a clinical improvement in patients affected by schizophrenia, which will be specially reflected in a cognitive improvement. STUDY DESIGN: Naturalistic and prospective study. Twenty-six patients were applied and assessed by a battery of neurocognitive evaluations since the pretreatment baseline until 6-month treatment. The patients had no biological response to medication, high social maladjustment, and a long clinical history of the disease. Kane and Brenner criteria for treatment-resistant schizophrenia were applied to choose the subjects. MEASURES AND OUTCOMES: The cognitive improvement will imply a significant betterment, from the pretreatment baseline until 6-month treatment, in the following cognitive tests: Stroop Test, WAIS Coding Subtest, and Comprehensive Trail Making Test (CTMT). An improvement in the Calgary Depression Scale, Simpson-Angus Scale, and Visual Analogue Scale (EVA) will also be observed. This scales were been used during the baseline, 3 months after, and then, 6 months. RESULTS: Subjects, after 6-month treatment with amisulpride and quetiapine, did show statistically significant differences in the assessed areas: WAIS Coding Subtest (P < 0.001), CTMT A and B (CTMT A P < 0.034; CTMT B P < 0.000), and Stroop Tests: Word (P < 0.001), Word-Color (P < 0.007), and Interference (P < 0.039). Furthermore, they showed a statistically significant difference in the Calgary Depression Scale (P < 0.002), Simpson-Angus Scale (P < 0.019), and EVA (P < 0.001). CONCLUSIONS: The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.

Psicopatología en el paciente con obesidad / Psycopathology in obese patients

Resumen: INTRODUCCIÓN: En las dos últimas décadas se han multiplicado las publicaciones científicas que cuestionan la definición médica tradicional de la obesidad por haberse centrado en el tejido adiposo (menos inerte y más interconectado con los demás tejidos de lo que se pensaba), y en un modelo patogénico heredado del siglo XIX que reducía el problema a un mero desequilibrio entre la incorporación y el gasto de energía, todo ello vagamente modulado por factores que se analizaban como variables secundarias: psicosociales y neuroendocrinas. OBJETIVO: Relacionar la psicopatología y la obesidad, dando prioridad a los puntos de vista emocional y de comportamiento como focos para descomponer al grupo de obesos en perfiles emocional-conductuales que requerirían tratamientos diferenciales. MÉTODO: Se presentan datos descriptivos de los 180 primeros pacientes incluidos del programa de Estudio de los Aspectos Emocionales del Sobrepeso y la Obesidad del Hospital Universitario Infanta Leonor en Madrid; se realizó una entrevista semi-estructurada y una batería de test psicométricos; se presentan datos descriptivos y un análisis de asociación entre Índice de Masa Corporal (IMC) y ansiedad o depresión. RESULTADOS: La mayoría de los pacientes tienen alta puntuación en psicopatología; el 80.9% tenía sintomatología depresiva importante, el 56.39% tenía elevada ansiedad-rasgo, el 48.26% tenía elevada ansiedad-estado, el 24.4% cumplía criterios de trastorno por atracones y el 11.9% de bulimia nerviosa (BN); un 17.3% tenía criterios de trastorno por estrés postraumático. DISCUSIÓN Y CONCLUSIÓN: Nuestros resultados apoyan la asociación esencial entre obesidad y psicopatología.

Abstract: INTRODUCTION: In the past two decades the traditional definition of obesity has been challenged because it emphasizes the centrality of adipose tissue (a less inert and more interconnected tissue than previously thought), and it preserves the 19th century model that reduces the problem into simple imbalance between energetic incomes and expenditures vaguely modulated by psychosocial and neuroendocrine factors considered as mere adjuvants. OBJECTIVE: To relate psychopathology and obesity prioritizing the emotional-behavioral origin of adiposity, and start the breakdown of the general obesity group into emotional and behavioral profiles that warrant differential treatments. METHOD: Descriptive data of 180 patients treated in the Overweight and Obesity Program of Infanta Leonor University Hospital (Madrid, Spain); a semi-structured interview and psychometric tests were performed. Association tests between affective (anxiety and depression) and Body Mass Index (BMI) variables are shown. RESULTS: Most patients showed high scores in psychopathology; 80.9% had major depressive symptomatology, 56.39% had high anxiety-trait, 48.26% had high anxiety-state, 24.4% met criteria for binge eating disorder and 11.9% of bulimia nervosa; 17.3% had criteria for posttraumatic stress disorder. DISCUSSION AND CONCLUSION: Our results support the association between obesity and psychopathology.

Review of the association between obesity and ADHD.

Excess weight and obesity are defined by the WHO (World Health Organization) as abnormal or excessive fat accumulation that is unhealthy.1 On the other hand, attention deficit hyperactivity disorder (ADHD) is defined by the presence of attention difficulties, poor motor regulation activity, and low impulse control.2 The association between obesity and ADHD has been systematically investigated for twelve years. In this review article, previous studies that were relevant in establishing this relation are examined. Neurobiological hypotheses about the relation between obesity and ADHD are reviewed, and an association with addictions is considered.