Long-Acting Injectable Second-Generation Antipsychotics in Seriously Ill Patients with Schizophrenia: Doses, Plasma Levels, and Treatment Outcomes.

This research studies the dose-plasma level (PL) relationship of second-generation antipsychotics, together with the treatment outcomes achieved, in seriously ill people with schizophrenia. An observational, prospective, one-year follow-up study was carried out with patients (N = 68) with severe schizophrenia treated with paliperidone three-month (PP3M) or aripiprazole one-month (ARIM). Participants were divided into standard-dose or high-dose groups. PLs were divided into "standard PL" and "high PL" (above the therapeutic reference range, TRR) groups. The dose/PL relationship, and severity, hospitalizations, tolerability, compliance, and their relationship with doses and PLs were evaluated. There was no clear linear relationship between ARIM or PP3M doses and the PLs achieved. In half of the subjects, standard doses reached PLs above the TRR. The improvements in clinical outcomes (decrease in clinical severity and relapses) were related to high PLs, without worse treatment tolerability or adherence. All participants remained in the study, regardless of dose or PL. Clinical severity and hospitalizations decreased significantly more in those patients with high PLs. Considering the non-linear dose-PL relationship of ARIM and PP3M in people with severe schizophrenia, PLs above the TRR are linked to better treatment outcomes, without worse tolerability. The need in a notable number of cases for high doses to reach those effective PLs is highlighted.

Concurrencia de trastorno por consumo de sustancias y de otro trastorno mental en personas en tratamiento por alguno de ellos en España / Co-occurrence of substance use disorders and other mental disorders in people undergoing specific treatment for any of them in Spain

La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM. Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones. (AU)

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed. The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain. (AU)

Plasmatic Levels and Response to Variable Doses of Monthly Aripiprazole and Three-Month Paliperidone in Patients with Severe Schizophrenia. Treatment Adherence, Effectiveness, Tolerability, and Safety.

Introduction: There is a need when optimizing antipsychotic treatment to know the plasmatic levels (PLs) achieved with the different doses and their relationship with effectiveness and toxicity, especially in patients with poor clinical progress. This study investigates the dose-PL-response relationship of monthly aripiprazole (AOM) and three-month paliperidone (PP3M). Methods: Observational, 52-week prospective study of patients with severe schizophrenia (CGI-S ≥ 5) treated with PP3M or AOM for at least one year before their inclusion in the study (N=68). Dose-PL relationship was determined. Subjects were included in standard-dose and high-dose (above labeled) and standard/therapeutic range-PLs and high-PLs (above range) groups. Treatment adherence, effectiveness (hospitalizations, severity), tolerability and safety were assessed. PLs and clinical response were evaluated. Results: No clear linear relationship was found between doses and PLs. In a considerable number of cases, standard doses achieved PLs above the therapeutic range. A significant clinical improvement was related to high PLs, without less safety, tolerability, or treatment compliance being involved. Clinical severity decreased more frequently in patients who received high doses and reached high PLs. Hospital admissions decreased significantly in those patients with high PLs. Conclusion: Taking into account the absence of a linear relationship between doses and PLs, the effectiveness in people with severe schizophrenia of AOM and PP3M depends on reaching high PLs, achieved with high doses, but also with standard doses in some cases, without leading to worse treatment tolerability, safety, or adherence.

Effectiveness of More Personalized, Case-Managed, and Multicomponent Treatment for Patients with Severe Schizophrenia Compared to the Standard Treatment: A Ten-Year Follow-Up.

Case management is a model of personalized intervention in people with severe mental illness. To explore the treatment adherence and effectiveness of patients with severe schizophrenia (Clinical Global Impression Severity, CGI-S ≥ 5) undergoing treatment in a community-based, case-managed program (CMP) with an integrated pharmacological and psychosocial approach compared with the standard treatment, an observational, ten-year follow-up study was conducted on patients treated in mental health units (MHUs) or a CMP (n = 688). Treatment discontinuation, hospitalizations, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S. Adherence to the CMP was higher than adherence to standard treatment (p < 0.001). There were fewer hospitalizations and suicide attempts in the CMP (p < 0.001). The clinical severity decreased more in the CMP (p < 0.005). Long-acting injectable (LAI) antipsychotic medication was more closely related to these outcomes than oral antipsychotics (APs) were (p < 0.001). Patients with severe schizophrenia in an integrated CMP recorded higher treatment compliance and better outcomes compared with standard care. Treatment with LAI APs was linked to these outcomes. A personalized combination of case management and LAI AP medication was more effective in these patients than standard treatment and oral APs.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme.

OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHODS: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (N = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (P < .0001), as well the involuntary admissions (P < .001). Being on long-acting injectable antipsychotic medication was related with these results (P < .0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Estudio en imagen en espejo (10 años de seguimiento y 10 de pretratamiento estándar) de ingresos hospitalarios de personas con esquizofrenia grave en un programa comunitario con gestión de casos / Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

Objetivos:Conocer los ingresos en una unidad hospitalaria de psiquiatría de pacientes con esquizofrenia grave antes (tratamiento estándar en CSM) y después de su incorporación a un programa comunitario, integral y con gestión de casos. También la influencia de la medicación antipsicótica (oral o inyectable de larga duración) en ello.Método:Estudio observacional, en espejo, de 10 años de seguimiento y 10 retrospectivos («pretratamiento»: estándar) de pacientes con esquizofrenia grave en un programa comunitario, de tratamiento farmacológico y psicosocial integrado y con gestión de casos intensiva (n=344). Se registraron los motivos de alta en el programa y los ingresos hospitalarios (y si eran involuntarios) 10 años antes y durante el tratamiento. También los antipsicóticos utilizados.Resultados:La retención conseguida en el programa fue elevada: a los 10 años solo el 12,2% de los pacientes fueron altas voluntarias, frente a al 84,3% que lo habían sido en algún momento en el tratamiento estándar previo. El porcentaje de pacientes con ingresos hospitalarios y su número disminuyeron drásticamente tras la incorporación al programa (p<0,0001), así como su involuntariedad (p<0,0001). El hecho de estar con medicación antipsicótica inyectable de larga duración se relacionó estos resultados (p<0,0001).Conclusiones:La incorporación de pacientes con esquizofrenia grave a un programa integral, de base comunitaria y con gestión de casos intensiva consiguió una elevada retención en el tratamiento, y fue efectivo para disminuir drásticamente las hospitalizaciones por recaídas, comparado con el tratamiento estándar previo en CSM. El tratamiento con antipsicóticos inyectables de larga duración se relacionó con estos resultados. (AU)

Objectives:To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).Method:Observational, mirror image study of ten years of follow-up and ten retrospectives (‘pre-treatment’: standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.Results:The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001).Conclusions:Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes. (AU)

The mental health nurse as case manager of a patient with severe schizophrenia.

Community-based programmes for people with severe mental illness (SMI), with a case management methodology, have shown high treatment adherence and a decrease in psychiatric hospitalizations. There is a need for continuity of care through a good therapeutic relationship, maintained throughout the care process until reaching clinical stabilization. The proposed case shows the treatment of a woman with a diagnosis of schizophrenia who began treatment in a mental health centre and was later referred to a case managed SMI programme. A nursing assessment was carried out from the beginning and a care plan was made based on the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Interventions Classification) taxonomy. The outcomes over the years are remarkable, achieving among other objectives not only clinical stabilization but also a normal life.

La enfermera especialista en salud mental en la gestión del caso de una paciente con esquizofrenia grave / The mental health nurse as case manager of a patient with severe schizophrenia

Los programas comunitarios para personas con trastorno mental grave (TMG) con metodología basada en la gestión de casos han mostrado conseguir una elevada adherencia al tratamiento, y una disminución de los ingresos hospitalarios debido a reagudizaciones de los procesos. Es necesaria la continuidad de cuidados a través de una buena relación terapéutica a lo largo de todo el proceso asistencial hasta llegar a la estabilización clínica. El presente caso trata de una mujer con diagnóstico de esquizofrenia con tratamiento inicial en un centro de salud mental y posteriormente en un programa para personas con TMG con gestión de casos. Se realizó inicialmente una valoración enfermera y se elaboró un plan de cuidados en base a la taxonomía North American Nursing Diagnosis Association (NANDA), Nursing Outcomes Classification (NOC) y Nursing Interventions Classification (NIC). Los resultados obtenidos a lo largo de los años han sido muy positivos, consiguiendo, entre otros objetivos, la estabilización clínica y una vida normalizada.

Community-based programmes for people with severe mental illness (SMI), with a case management methodology, have shown high treatment adherence and a decrease in psychiatric hospitalizations. There is a need for continuity of care through a good therapeutic relationship, maintained throughout the care process until reaching clinical stabilization. The proposed case shows the treatment of a woman with a diagnosis of schizophrenia who began treatment in a mental health centre and was later referred to a case managed SMI programme. A nursing assessment was carried out from the beginning and a care plan was made based on the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Interventions Classification) taxonomy. The outcomes over the years are remarkable, achieving among other objectives not only clinical stabilization but also a normal life.

The Use of Second-Generation Antipsychotics in Patients with Severe Schizophrenia in the Real World: The Role of the Route of Administration and Dosage-A 5-Year Follow-Up.

To assess the impact of the route of administration and doses of second-generation antipsychotics (SGAs) on treatment adherence, hospital admissions, and suicidal behaviour in patients with severe schizophrenia (Clinical Global Impression−Severity−CGI-S ≥ 5), we implemented an observational 5-year follow-up study. A total of 37.5% of the patients on oral antipsychotics (Aps) and 11.5% of those on long-acting injectables (LAIs) abandoned the treatment (p < 0.001). There were no differences in treatment discontinuation between the LAI-AP standard and high-dose groups. A total of 28.1% of the patients on oral Aps had at least one hospitalisation, as well as 13.1% of patients on LAIs (p < 0.001). There were fewer hospitalisations of patients on LAIs in the high-dose group (p < 0.05). Suicide attempts were recorded for 18% of patients on oral Aps but only for 4.6% of patients on LAIs (p < 0.001). No differences were found between the dosage groups on LAIs. Tolerability was good for all Aps and somewhat better for LAIs than oral Aps in terms of side effects (p < 0.05). There were no differences between the standard and high-dose groups. More patients discontinued treatment due to side effects in the oral AP group (p < 0.01). LAI SGA treatment was more effective than oral AP in terms of adherence and treatment outcomes for managing people with severe schizophrenia. Moreover, significant improvements were found that favour high-dose LAI SGA treatment for some of these patients. This study highlights the need to consider LAI antipsychotics and high-dose strategies for patients with severe schizophrenia.

Co-occurrence of substance use disorders and other mental disorders in people undergoing specific treatment for any of them in Spain. / Concurrencia de trastorno por consumo de sustancias y de otro trastorno mental en personas en tratamiento por alguno de ellos en España.

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed.The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain.

La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM.Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones.

Psychosocial and Pharmacological Approaches for Improving Treatment Adherence and Outcomes in People With Severe Schizophrenia: A 10-Year Follow-up.

The objective of this study was to understand the psychosocial and pharmacological approaches linked to better treatment adherence and outcomes (psychiatric hospitalizations, clinical severity, and suicide attempts) among patients with schizophrenia receiving the standard treatment in mental health units (MHUs) compared with patients in a community-based, case-managed program (CMP). An observational, prospective (10 y) study was conducted involving patients with severe schizophrenia (N=688). The treatment adherence of patients in the CMP was higher than among those in the MHUs (12.2% vs. 84.3% abandoning treatment; P<0.0001). Hospital admissions and suicide attempts were significantly lower among those treated in the CMP than among those receiving standard care in the MHUs (P<0.001). Scores on the clinical severity scale decreased significantly more in the group in the CMP than in the group in the MHUs (P<0.005). Treatment with long-acting injectable antipsychotic medication was closely linked with higher treatment retention (P<0.001) and fewer hospital admissions and suicide attempts compared with treatment with oral antipsychotics in both patient groups, with the effect greater in the group in the CMP (P<0.001). We highlight how patients with severe schizophrenia treated in a CMP with integrated treatment showed a higher retention rate, fewer psychiatric hospital admissions and suicide attempts, and less clinical severity compared with those receiving standard treatment in MHUs. Treatment with long-acting antipsychotics was also clearly related to these outcomes. A combination of intensive case-managed integrated treatment and treatment with long-acting antipsychotic medication facilitated the achievement of clinical and rehabilitation goals in patients with schizophrenia with severe symptoms and impairment compared with standard care and treatment with oral antipsychotics.

Adherence, Tolerability and Effective Doses of Aripiprazole Once-monthly in the Long-term Treatment of Patients with Severe Schizophrenia.

BACKGROUND: The evaluation of long-term effectiveness and tolerability of aripiprazole once-monthly (AOM) is yet scarce, and severely ill patients have not been specifically studied. OBJECTIVE: The aim of the study was to explore the long-term adherence, effectiveness and tolerability of AOM in the treatment of patients with severe (Clinical Global Impression-Severity, CGI-S ≥ 5) schizophrenia, and whether high-dose therapy may benefit patients inadequately controlled on standard doses. METHODS: Six-year mirror-image study, with a 36-month prospective follow-up, was conducted on patients with severe schizophrenia who underwent treatment with AOM (n = 60). The assessment included the CGI-S, the WHO Disability Assessment Schedule (WHO- DAS), the Medication Adherence Report Scale (MARS), the laboratory tests, the assessment of weight and adverse effects reported. Reasons for treatment discontinuation, hospital admissions and psychiatric medications in the previous three years and during the follow-up were recorded. RESULTS: The average dose was found to be 780 (120) mg/28 days. Tolerability was good, with fewer side effects or biological parameters alterations reported. There were three discharges due to adverse effects, two due to lack of effectiveness and one treatment abandoning. Weight and prolactin levels were decreased. CGI-S and WHO-DAS were decreased (p < 0.001), and MARS increased (p < 0.001). There were less treatment abandoning, hospital admissions (p < 0.0001) and concomitant medication (p < 0.01) observed than during the previous 36 months. CONCLUSION: Treatment adherence and tolerability of AOM were found to be remarkable, even in those patients on high doses. AOM showed effectiveness in patients with severe schizophrenia, who recorded less hospitalizations and clinical severity and disability, although a considerable percentage of them required higher doses than labeled.

Paliperidone Palmitate Every Three Months (PP3M) 2-Year Treatment Compliance, Effectiveness and Satisfaction Compared with Paliperidone Palmitate-Monthly (PP1M) in People with Severe Schizophrenia.

Paliperidone palmitate every three months (PP3M) is expected to facilitate patient's treatment compliance and satisfaction. The objective here was to compare PP3M treatment compliance and satisfaction, effectiveness and tolerability, with paliperidone palmitate-monthly (PP1M) in patients with severe schizophrenia. A 24-month prospective, open-label study of patients with severe schizophrenia treated with PP3M after at least 2 years of stabilization with PP1M (n = 84) was carried out. Treatment satisfaction was assessed with the Treatment Satisfaction Questionnaire for Medication (TSQM) and with a Visual Analogue Scale (VAS). Effectiveness was measured with psychiatric hospital admissions and the Clinical Global Impression-Severity (CGI-S) scale. Tolerability assessments included laboratory tests, weight and adverse effects. Reasons for treatment discontinuation were recorded. CGI-S significantly improved after 24 months. Three patients changed back to PP1M due to adverse effects, and four were hospitalized. There were neither abandoning nor significant changes in weight or biological parameters, and lower incidence of side effects, with PP3M treatment. TSQM and VAS scales increased. No differences were found related to doses. Apart from somewhat improvement in treatment adherence, effectiveness, and tolerability, patients with severe schizophrenia lengthy treated with PP1M showed more satisfaction with PP3M, even those who needed high doses to get clinical stabilization.

Oral Versus Long-Acting Injectable Antipsychotic Treatment for People With Severe Schizophrenia: A 5-Year Follow-up of Effectiveness.

ABSTRACT: The objective here is to compare the effectiveness of long-acting injectable antipsychotics (LAI-APs) and oral ones (OAPs) in patients with severe (Global Clinical Impression-Severity ≥ 5) schizophrenia (N = 688). A 5-year follow-up study has been conducted in patients undergoing standard treatment in mental health units (MHUs) or on a severe mental illness program (SMIP). A total of 8.7% of the patients on the SMIP discontinued treatment, whereas 43.6% did so in MHUs (p < 0.0001). In both cases, treatment retention was significantly higher in patients on LAI-APs (p < 0.001). Also, hospital admissions were in both cases fewer among those on LAI-APs (p < 0.001). There was a significant link between suicide attempts and OAP treatment (p < 0.01). Given the relationship between the use of LAI-APs versus oral treatments in achieving higher adherence and less relapses and suicide attempts, the use of second-generation antipsychotics LAIs should be considered more suitable for people with severe schizophrenia.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme. / Estudio en imagen en espejo (10 años de seguimiento y 10 de pretratamiento estándar) de ingresos hospitalarios de personas con esquizofrenia grave en un programa comunitario con gestión de casos.

OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHOD: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Tolerability of effective high doses of paliperidone palmitate in patients with severe resistant schizophrenia.

The aim of the study was to evaluate the effectiveness and tolerability of doses of paliperidone palmitate (PP) of 175 mgEq and over/28 days in patients with severe schizophrenia [Clinical Global Impression-Severity scale (CGI-S)≥5] and their retention in treatment. A 36-month prospective, observational study was carried out of patients with severe schizophrenia who were treated with 175 mg and over every 28 days of PP to achieve clinical stabilization (N=30). Assessment included CGI-S, WHO Disability Assessment Schedule, Camberwell Assessment of Need, and Medication Adherence Report Scale. Laboratory tests, weight, side effects, reasons for discharge, and hospital admissions were measured. The average dose of PP was 228.7 (11.9) mgEq/28 days. There was one discharge because of side effects. Weight and prolactin levels decreased. After 3 years, CGI-S (P<0.01), Camberwell Assessment of Need (P<0.01), and WHO Disability Assessment Schedule in the four areas (P<0.05) decreased. The Medication Adherence Report Scale increased (P<0.001). There were fewer hospital admissions (P<0.001). Retention in treatment after 36 months was 90%. Tolerability of 175 mgEq/28 days and over of PP was very good, being useful in improving treatment adherence in severely ill patients and helping in this way to achieve clinical stabilization and better social functioning. These patients were clozapine candidates; thus, high doses of PP could be an alternative for them.

Predicción de corioamnionitis histológica por determinación de la proteína C reactiva en gestantes con rotura prematura de membranas. Hospital Daniel Alcides Carrión. 2012 - 2013 / Prediction of histologic chorioamnionitis by determining the C-reactive protein in pregnant women with premature rupture of membranes. Hospital Daniel Alcides Carrion. 2012 - 2013

OBJETIVO: Determinar la utilidad del valor de la proteína C-reactiva para predecir corioamnionitis histológica en gestantes con rotura prematura de membranas en el Hospital Nacional Daniel Alcides Carrión durante el período 2012-2013. METODOLOGIA: Estudio observacional de tipo analítico-comparativo, retrospectivo de corte transversal, realizado en el Hospital Daniel Alcides Carrión, en el periodo 2012-2013. La muestra fue no probabilística, donde se revisaron 220 historias de gestantes con rotura prematura de membranas con diagnóstico clínico o sospecha de corioamnionitis. Para el análisis descriptivo se empleó medidas de tendencia central, de dispersión, frecuencias absolutas y relativas. Para el análisis bivariado se empleó la prueba del Chi cuadrado para demostrar la asociación entre el valor de PCR y el corioamnionitis; para el análisis comparativo se utilizó la prueba t de student con un nivel significancia del 95 por ciento. RESULTADOS: Se observó que la edad promedio de las pacientes fue de 26.6±6.8 años, donde la mayoría tenía entre 20 a 30 años con un riesgo social medio y principalmente nulíparas. A su vez, no hubo relación entre la edad de la paciente, el riesgo social y la paridad con el diagnóstico de corioamnionitis histológica (p>0.05), observándose que los pacientes con y sin corioamnionitis tenían una distribución similar entre estas características. Existe diferencia significativa de los valores promedios del PCR y la edad media gestacional entre las pacientes con y sin corioamnionitis histológica (p2 mg/dl, para predecir corioamnionitis histológica en gestantes con rotura prematura de membranas. Se comprobó que existe relación entre el valor del PCR aumentado (>2 mg/dl) y la corioamnionitis histológica (p=0.032). Además, la sensibilidad no fue...

OBJECTIVE: To determine the usefulness of the value of C-reactive protein for predicting histological chorioamnionitis in pregnant women with premature rupture of membranes in the National Hospital Daniel Alcides Carrion during the period 2010-2013. METHODOLOGY: Observational, analytical-comparative, retrospective cross-sectional study, held at the Hospital Daniel Alcides Carrion, in the period September 2013 to February 2014. The sample was not random, 220 pregnant histories with premature rupture of membranes with clinical diagnosis or suspicion of chorioamnionitis were reviewed. For bivariate analysis, the chi square test was used in order to demonstrate the association between CRP and chorioamnionitis; for comparative analysis, the student t test with a significance level of 95 per cent was used. RESULTS: It was observed that the average age of the patients was 26.6±6.8 years, where most were between 20 to 30 years, with an average social risk and mainly nulliparous. In turn, there was no relationship between the age of the patient, the social risk and parity with the diagnosis of histological chorioamnionitis (p>0.05), patients with and without chorioamnionitis had a similar distribution between these characteristics. There is significant difference in the mean values of CRP and the mean gestational age between patients with and without histological chorioamnionitis (p2 mg/dl to predict histologic chorioamnionitis in pregnant women with premature rupture of membranes. It was found that there was relationship between the value of increased CRP (>2 mg/dl) and histological chorioamnionitis (p=0.032). In addition, the sensitivity was not high, 46 per cent of patients with chorioamnionitis had increased CRP value, however it was observed a high value for...

Effect of Game Management on Wild Red-Legged Partridge Abundance.

The reduction of game and fish populations has increased investment in management practices. Hunting and fishing managers use several tools to maximize harvest. Managers need to know the impact their management has on wild populations. This issue is especially important to improve management efficacy and biodiversity conservation. We used questionnaires and field bird surveys in 48 hunting estates to assess whether red-legged partridge Alectoris rufa young/adult ratio and summer abundance were related to the intensity of management (provision of supplementary food and water, predator control and releases of farm-bred partridges), harvest intensity or habitat in Central Spain. We hypothesized that partridge abundance would be higher where management practices were applied more intensively. Variation in young/adult ratio among estates was best explained by habitat, year and some management practices. Density of feeders and water points had a positive relationship with this ratio, while the density of partridges released and magpies controlled were negatively related to it. The variables with greatest relative importance were feeders, releases and year. Variations in post-breeding red-legged partridge abundance among estates were best explained by habitat, year, the same management variables that influenced young/adult ratio, and harvest intensity. Harvest intensity was negatively related to partridge abundance. The other management variables had the same type of relationship with abundance as with young/adult ratio, except magpie control. Variables with greatest relative importance were habitat, feeders, water points, releases and harvest intensity. Our study suggests that management had an overall important effect on post-breeding partridge abundance. However, this effect varied among tools, as some had the desired effect (increase in partridge abundance), whereas others did not or even had a negative relationship (such as release of farm-reared birds) and can be thus considered inefficient or even detrimental. We advise reconsidering their use from both ecological and economical points of view.

Harvest of Red-Legged Partridge in Central Spain.

A basic rule to attain sustainable use of harvested resources is to adjust take to availability. Populations of red-legged partridges in Spain have decreased in recent decades, and releases of farm-bred partridges to improve short-term availability are increasingly common. We used questionnaires and bird surveys to assess whether harvest was related to availability of wild partridges or intensity of farm-bred partridge releases. We studied 50 hunting estates, including 6 administratively labeled as intensive (with few numerical and temporal restrictions to releases). In addition, we considered hunting pressure (number of hunters × hunting days/km(2)) and habitat as explanatory variables in the analyses. In intensive estates, annual harvest was exclusively related to release intensity, indicating that in these estates hunting is detached from natural resources and approaches an industrial activity based on external inputs. In non-intensive estates, harvest was affected by wild stock availability, walked-up shooting pressure, and habitat (greater harvest in estates with more Mediterranean shrubland). In these estates, releases did not increase annual harvest, and can be considered an inefficient practice. Additionally, the relationship between abundance estimates and harvest disappeared in estates with low partridge abundance estimates, suggesting possibilities for overharvesting in a large proportion of estates. Increasing the abundance of wild red-legged partridge through techniques like habitat management, and improving the adjustment of harvest to availability, may be a good strategy to increase long-term harvest in non-intensive estates. Additionally, Government and managers must create ways to segregate and label the estates where only wild red-legged partridges are managed from those where releases are used, to reduce ecological costs of management decisions. © 2012 The Wildlife Society.