Concordance in psychopharmacological treatment before and after first mental health consultation.

PURPOSE: To analyse concordance between treatment prescribed before and after the first mental health consultation. We understand concordance in two different senses: first, as a similar amount of equivalent doses and drug type; second, as a similar treatment for each patient. METHOD: This is an analytical, descriptive, retrospective study on psychopharmacological treatment before and after first mental health consultation of 1236 patients. Drugs were classified into four groups and the equivalent dose respect to reference medication was considered in each group in order to make a comparison between primary and mental health. RESULTS: Moderate concordance was found in prescribed treatments before and after first mental health consultation (except antidepressants). The average number of benzodiazepines decreased, as did average doses prescribed at mental health consultation respect to previously prescribed treatment; average doses of antidepressants, however, increased. From the patient's perspective, dose increase was more frequent than decrease. Nevertheless, a high percentage of polymedicated patients were found, although this percentage decreased after the first mental health consultation. CONCLUSION: There exists a moderate concordance between the pharmacological treatment prescribed before and after the first mental health consultation. However, the use of benzodiazepines diminished significantly after the first consultation, mainly due to a decrease in the percentage of polymedicated patients.

Analysis of Consultation Demand in a Mental Health Centre during the Recent Economic Recession.

The economic recession that recently affected most European countries has led to a worsening of the mental health situation in the general population and an associated rise in outpatient psychiatric care. The aim of this study was to analyse the socio-demographic, clinical and assistential features of the demand for specialist mental health attention. A descriptive and analytical study was conducted in the period 2011-2015 (N = 1252). The principal relations among variables were analysed by an χ2 test, followed by a Z test with Bonferroni's correction. For a global perspective a Multiple Correspondence Analysis was performed. 2 The most frequent disorders were adjustment, anxiety and mood disorders, and in addition there were a large number of patients without diagnosis. The percentage of unemployed or inactive patients was high, as it was for those with a low academic level. The younger patients were more prone to have adjustment disorders, especially among the unemployed ones, while anxiety disorders were more frequent in the patients with jobs. A close association seems to exist between unemployment, low academic level and mental health problems. The high demand for mental health attention reveals a clear need to optimize the utilization of specialized care in mental health.

[Myasthenia gravis induced by inmuno checkpoints inhibitors: first case report secondary to avelumab therapy and review of published cases]. / Miastenia grave inducida por tratamiento con inhibidores del punto de control inmunologico: primer caso secundario a avelumab y revision de casos previamente publicados.

INTRODUCTION: The inmuno checkpoints inhibitors are new revolutionary treatment for many neoplastic diseases in advanced stadium. There are described several types of neurological complications induced by nivolumab: polyneuropathy, seizures, radiculitis and myasthenia gravis disease. CASE REPORT: A 65 years old man with metastatic lung adenocarcinoma who presented myasthenia gravis disease induced by avelumab therapy with good response to treatment with pyridostigmine and withdrawal of avelumab. CONCLUSIONS: The exact mechanism by which this drug induces myasthenia gravis is still unknown and there is probably a different pathophysiological process to idiopathic myasthenia gravis. An important fact is the variability in the time of onset of myasthenia gravis after initiating treatment with inmuno checkpoints inhibitors. From the clinical point of view, most of the reported cases appeared with a generalized form of myasthenia gravis with bulbar involvement and later developed ophthalmoparesis and fluctuating palpebral ptosis. Our case as well as the review of the previous literature can be useful to alert the clinical neurologist about the possibility of the development of immune-mediated cases of this nature induced by the treatment with avelumab in clinical practice as well as to guide its clinical, prognostic and clinical characteristics.

TITLE: Miastenia grave inducida por tratamiento con inhibidores del punto de control inmunologico: primer caso secundario a avelumab y revision de casos previamente publicados.Introduccion. Los farmacos inhibidores del punto de control inmunologico han supuesto una revolucion en el tratamiento de varios procesos neoplasicos en estadio avanzado. Sin embargo, se han descrito numerosas complicaciones neurologicas, entre las que se encuentran polineuropatias, crisis epilepticas, radiculitis y miastenia grave. Caso clinico. Varon de 65 años con adenocarcinoma de pulmon en estadio IV en tratamiento con avelumab que desarrolla una miastenia grave ocular seropositiva, con buena respuesta a la piridostigmina y retirada de la medicacion. Conclusiones. El mecanismo exacto por el cual el avelumab induce una miastenia grave aun se desconoce, y probablemente existe un proceso fisiopatologico diferente al de la miastenia grave idiopatica. Un dato importante es la variabilidad en cuanto al tiempo de aparicion de la miastenia grave despues de iniciar el tratamiento con inhibidores del punto de control inmunologico. Desde el punto de vista clinico, la mayoria de los casos descritos comenzo con una forma de miastenia grave generalizada con afectacion bulbar que posteriormente desarrollo oftalmoparesia y ptosis palpebral fluctuante. Este caso, asi como la revision de la bibliografia, puede ser util para alertar al neurologo clinico sobre la posibilidad del desarrollo de cuadros inmunomediados de esta naturaleza inducidos por el tratamiento con avelumab en la practica clinica y para orientar sus caracteristicas clinicas, pronosticas y de tratamiento.

Hostility and helper T-cells in patients with bulimia nervosa.

OBJECTIVE: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN). METHOD: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment. RESULTS: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items. CONCLUSIONS: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Valoración de la expresividad emocional en familias de pacientes con trastornos alimentarios: aplicación de la Camberwell Family Interview en una muestra española / Assessment of expressed emotion in families of patients with eating disorders: using the Camberwell Family Interview on a Spanish sample

Introducción. La expresividad emocional (EE) familiar ha sido relacionada con diversos factores clínicos y evolutivos en pacientes con trastornos alimentarios. El objetivo del presente trabajo fue estudiar la EE en familiares de pacientes con trastornos alimentarios utilizando la Camberwell Family Interview (CFI) con la intención de comparar los resultados con los detectados en otras patologías o en otros estudios sobre trastornos alimentarios desarrollados fuera de España. Métodos. Setenta y un progenitores de 43 pacientes con un trastorno alimentario fueron evaluados utilizando la CFI. Resultados. El 46,5 % de las familias evaluadas presentaron una alta EE. No se encontraron diferencias significativas entre las madres y los padres con respecto a la EE global, pero sí se observó una mayor tendencia en las madres a la sobreimplicación emocional. Conclusiones. El número de familias que presentan una alta EE en la población estudiada es inferior a la encontrada en los trabajos sobre EE en esquizofrenia y ligeramente superior a la encontrada en otros estudios realizados en trastornos alimentarios. Existe una tendencia a que las madres presenten una mayor EE que los padres

Introduction. The level of expressed emotion (EE) in the family members has been related to several clinical and outcome related factors in patients with eating disorders. This study aimed to study the levels of EE in families of patients with eating disorders using the Camberwell Family Interview (CFI) in order to determine whether they were similar to those reported in other studies developed outside Spain. Methods. Seventy-one parents of 43 eating disorders patients were evaluated using a Spanish version of the CFI. Results. In our sample, 46.5 % of the families had EE high levels. There were no significant differences between mothers and fathers in global scores, but mothers tended to have higher emotional overinvolvement with the patient. Conclusions. The percentage of families that had high EE in our sample was lower than that reported for families with a member with schizophrenia and slightly higher than that detected in other studies on eating disorders. Mothers tended to have higher EE levels than fathers

Assessment of expressed emotion in families of patients with eating disorders: using the Camberwell Family Interview on a Spanish sample.

INTRODUCTION: The level of expressed emotion (EE) in the family members has been related to several clinical and outcome related factors in patients with eating disorders. This study aimed to study the levels of EE in families of patients with eating disorders using the Camberwell Family Interview (CFI) in order to determine whether they were similar to those reported in other studies developed outside Spain. METHODS: Seventy-one parents of 43 eating disorders patients were evaluated using a Spanish version of the CFI. RESULTS: In our sample, 46.5 % of the families had EE high levels. There were no significant differences between mothers and fathers in global scores, but mothers tended to have higher emotional overinvolvement with the patient. CONCLUSIONS: The percentage of families that had high EE in our sample was lower than that reported for families with a member with schizophrenia and slightly higher than that detected in other studies on eating disorders. Mothers tended to have higher EE levels than fathers.