Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness.

Traumatic experiences and posttraumatic stress disorder (PTSD) are more frequent in patients with serious mental illness than in the general population. This study included 102 patients with schizophrenia, bipolar disorder, and schizoaffective disorder, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Epidemiological and clinical data were collected using the Brief Psychiatric Rating Scale and Traumatic Life Events and Distressing Event questionnaires. We found a high number of traumatic experiences, and 15.1% of the patients met all criteria for PTSD. We found no differences based on diagnosis or sex, although there was a nonsignificant trend toward greater PTSD comorbidity in women. Among patients with serious mental illness and PTSD, 64.3% had made some attempt at suicide at some point in life, compared with 37.4% of patients without PTSD.

Prevalence and clinical impact of childhood trauma in patients with severe mental disorders.

A high prevalence of childhood abuse has been reported in patients with severe mental illness. We conducted a cross-sectional study of 102 patients with schizophrenia, bipolar disorder, or schizoaffective disorder. Social, demographic, and clinical data were obtained. Patients were evaluated using Brief Psychotic Relative Scale, and Traumatic Life Events and Distressing Event questionnaires. Almost half (47.5%) of these patients had suffered some kind of child abuse, and our results confirmed a relationship between a history of childhood abuse and more severe psychosis. Diagnosis of schizophrenia was determined 4.1 years earlier in victims of childhood abuse. Hospital admissions were twice as high in victims of psychological abuse. Patients with a history of sexual abuse were more than twice as likely to attempt suicide (68% vs. 28.9%).

Usefulness of optic fundus examination with retinography in initial evaluation of hypertensive patients.

BACKGROUND: Although international guidelines for management of hypertension recommend optic fundus examination in the initial evaluation of hypertensive patients, there have been no studies to evaluate the usefulness of retinography in this application. METHODS: Two hundred and fifty consecutive new patients with hypertension but without known cardiovascular disease were studied. The average age was 57.2 years (s.d. 12.9) and 56% were men. The study was conducted in 14 primary care centers. Measurements included target organ damage (TOD) evaluation (electrocardiography, retinography, microalbuminuria, and serum creatinine) and blood pressure (BP) measurements. Outcome measurements were made to risk stratification according to 2003 World Health Organization and International Society of Hypertension (WHO-ISH) and 2007 European Society of Hypertension and European Society of Cardiology (ESH-ESC) guidelines, analyzed first without incorporating the retinography results and then reclassified using the retinography data. RESULTS: Advanced retinopathy was detected in 10.8%. The risk stratification arrived at as per the WHO-ISH guidelines, and without the retinography data was: 11.4% low risk, 62.4% moderate risk, and 26.2% high risk. When retinography results were taken into account, 8% from the moderate-risk group were reclassified to the high-risk group (11.4, 54.4, and 34.2%, respectively; P < 0.001). Using ESH-ESC guidelines, the risk stratification without the retinography data was 0.9% reference, 11.3% low, 58.8% moderate, 21.7% high, and 7.3% very high risk. With retinography, 10% were reclassified from a lower to a higher risk group (0.9, 10.4, 51.1, 20.4, and 17.2%, respectively; P < 0.001). CONCLUSIONS: As an alternative to optic fundus examination, retinography enables a more accurate cardiovascular risk stratification in the first evaluation after diagnosis of hypertension. When retinography is included in the assessment of cardiovascular risk, approximately 10% of patients are reclassified to a higher risk group.

Hypertension confirmation and blood pressure control rates in epidemiological surveys.

BACKGROUND: Scarce knowledge about hypertension confirmation and control after a single blood pressure (BP) measurement is available. The objective of this study was to evaluate hypertension confirmation and control rates after 6-year follow-up in a population-based cohort. METHODS: A cohort of 1748 participants representative of a Spanish population received standardized BP measurements. Systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg was found in 617 participants. Three hundred and thirty-four of them had no history of hypertension and the remaining 283 had been previously diagnosed or received antihypertensive treatment. All were advised to consult their physicians. We discarded for follow-up 109 participants with already well-controlled hypertension (27.8% of all hypertensive participants). We followed 583 participants (94.5% of the cohort) for 6 years (14 died and 20 were lost to follow-up). RESULTS: The diagnosis of hypertension was confirmed during follow-up in 139 (44.4%) of those with no previously known hypertension, making the overall prevalence for the cohort equal to 30.4% (n=531). The hypertension control rate at the end of follow-up was 50.1%, whereas it was 27.9% at baseline. Diabetes was the only factor to be independently associated with good control of hypertension. CONCLUSION: Six years after a single-occasion blood pressure measurement, hypertension was confirmed in almost half of the participants with systolic BP>or=140 mmHg or diastolic BP>or=90 mmHg and no history of hypertension. Hypertension control achieved with this screening procedure is almost double that observed in the baseline examination, and is highest among diabetic participants.

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