ABSTRACT
Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%), and such comorbidity complicates treatment and worsens prognosis (including higher suicide risk). There are not many research works on the specific pharmacologic treatment of dual comorbid anxiety disorders. Most authors recommend a simultaneous approach of both, anxiety and substance use, disorders. Research data on pharmacotherapy suggest that psychotropics used in the treatment of anxiety disorders are also effective in dual diagnosis. SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiacepines should be avoided. New generation antiepileptic have shown efficacy in case series and open label studies in the latest years, thus being a promising treatment option for dual comorbid anxiety disorders, specially pregabalin in generalized anxiety disorder.
Subject(s)
Anxiety Disorders/drug therapy , Substance-Related Disorders/drug therapy , Algorithms , Anxiety Disorders/diagnosis , Anxiety Disorders/etiology , Diagnosis, Dual (Psychiatry) , Humans , Practice Guidelines as TopicABSTRACT
Introducción: La crisis económica produce efectos negativos en la salud física y mental de la población. El objetivo del presente trabajo es estudiar la asociación existente entre la situación socioeconómica y la demanda asistencial a los servicios de salud mental. Métodos: Se ha realizado un análisis de correlación de los datos de morbilidad (incidencia y prevalencia) administrativa de enfermedad mental, que fueron obtenidos del Registro Acumulativo de Casos Psiquiátricos de Asturias, y tres indicadores socioeconómicos (paro, índice de precios de consumo -IPC- y producto interior bruto -PIB- per cápita ajustado por inflación). Resultados: El incremento en la tasa de paro se asocia a una clara disminución de la demanda incidente y prevalente en salud mental. El IPC presenta una correlación positiva débil con la tasa de incidencia administrativa de algunos trastornos mentales (Trastornos neuróticos, Esquizofrenia y Toxicomanías). El PIB no presenta una correlación significativa con la demanda incidente y se asocia, de forma robusta, con un incremento de la tasa de prevalencia administrativa, más intensa en el caso del alcoholismo, trastornos neuróticos, retraso mental y demandas por códigos Z (CIE-10). Conclusión: En Asturias, la variación de los indicadores socioeconómicos observado en el presente periodo de crisis económica no se asocia con un incremento en la demanda asistencial por trastorno mental. La correlación de la tasa de desempleo con la demanda asistencial es negativa
Introduction: The economic crisis has negative effects on the populations physical and mental health. Our objective has been to study the association between socioeconomic status and number of people demanding mental health services. Methods: We performed a correlation analysis of administrative morbidity data (incidence and prevalence) of mental illness (obtained from the Asturias Cumulative Psychiatric Case Register) and three economic indicators (unemployment, consumer price index and gross domestic product). Results: The increase in the unemployment rate is associated with a clear decrease in both new and prevalent mental health demand. CPI has a minor weak positive correlation with the administrative incidence of some mental disorders (Neurotic disorders, Schizophrenia and addictions). GDP does not show a significant correlation with the administrative incidence and it is strongly associated with an increased administrative prevalence that is more intense in the case of alcoholism, neurotic disorders, mental retardation and Z codes (ICD-10).Conclusion: The variation of the socioeconomic indicated observed in the economic crisis period in Asturias was not associated with increased care demand for any mental disorders. There is a negative correlation of unemployment rate with care demand
Subject(s)
Humans , Mental Disorders/epidemiology , Unemployment/psychology , Economic Recession/trends , Socioeconomic FactorsABSTRACT
INTRODUCTION: The economic crisis has negative effects on the population's physical and mental health. Our objective has been to study the association between socioeconomic status and number of people demanding mental health services. METHODS: We performed a correlation analysis of administrative morbidity data (incidence and prevalence) of mental illness (obtained from the Asturias Cumulative Psychiatric Case Register) and three economic indicators (unemployment, consumer price index and gross domestic product). RESULTS: The increase in the unemployment rate is associated with a clear decrease in both new and prevalent mental health demand. CPI has a minor weak positive correlation with the administrative incidence of some mental disorders (Neurotic disorders, Schizophrenia and addictions). GDP does not show a significant correlation with the administrative incidence and it is strongly associated with an increased administrative prevalence that is more intense in the case of alcoholism, neurotic disorders, mental retardation and Z codes (ICD-10). CONCLUSION: The variation of the socioeconomic indicated observed in the economic crisis period in Asturias was not associated with increased care demand for any mental disorders. There is a negative correlation of unemployment rate with care demand.
Subject(s)
Economic Recession , Mental Disorders/epidemiology , Mental Health Services/supply & distribution , Female , Humans , Male , Mental Disorders/therapy , Registries , Socioeconomic Factors , Spain , Time FactorsABSTRACT
Los trastornos por uso de sustancias y los trastornos de ansiedad presentan una gran comorbilidad (entre el 18% y 37%), lo cual complica el tratamiento y empeora el pronóstico de los pacientes (incluido mayor riesgo de suicidio). Son pocos los trabajos de investigación terapéutica que hayan abordado de forma específica el tratamiento farmacológico de los trastornos de ansiedad en caso de patología dual. La mayor parte de los autores apuestan por el abordaje de ambos trastornos de forma integral y simultánea. Los datos procedentes de la revisión de la literatura indican que los fármacos recomendados habitualmente en el tratamiento para los trastornos de ansiedad también son eficaces en el tratamiento de la ansiedad dual. Los antidepresivos ISRS constituyen el tratamiento de primera línea en los trastornos de ansiedad duales, mientras que las benzodiacepinas son fármacos a evitar. En los últimos años se observa una gran tendencia a utilizar fármacos antiepilépticos de última generación, los cuales muestran resultados prometedores en estudios abiertos y series de casos, en especial la pregabalina en el trastorno de ansiedad generalizada
Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%), and such comorbidity complicates treatment and worsens prognosis (including higher suicide risk). There are not many research works on the specific pharmacologic treatment of dual comorbid anxiety disorders. Most authors recommend a simultaneous approach of both, anxiety and substance use, disorders. Research data on pharmacotherapy suggest that psychotropics used in the treatment of anxiety disorders are also effective in dual diagnosis. SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiacepines should be avoided. New generation antiepileptic have shown efficacy in case series and open label studies in the latest years, thus being a promising treatment option for dual comorbid anxiety disorders, specially pregabalin in generalized anxiety disorder
Subject(s)
Humans , Male , Female , Diagnosis, Dual (Psychiatry)/methods , Diagnosis, Dual (Psychiatry) , Anxiety/epidemiology , Anxiety/prevention & control , Anxiety Disorders/epidemiology , Anxiety Disorders/prevention & control , Drug Therapy , Psychotherapy/methods , Psychotherapy/trends , Anxiety/drug therapy , Anxiety Disorders/drug therapy , Comorbidity , Clinical ProtocolsABSTRACT
En el momento actual no existen pruebas específicas para el diagnóstico de la dependencia de heroína, de modo que una correcta anamnesis y la exploración clínica adecuada constituyen el pilar básico del mismo. No obstante existen una serie de instrumentos que abordan aspectos relevantes de esta patología, tales como la gravedad de la dependencia y la gravedad del síndrome de abstinencia, que pueden resultar de gran ayuda, al clínico, a la hora de establecer estrategias terapéuticas. La elevada prevalencia de comorbilidad psiquiátrica (sobre todo trastornos de la personalidad) detectada en estos pacientes hace necesario un abordaje comprehensivo de los mismos, siendo recomendable una evaluación detallada para descartar éstas u otras patologías psiquiátricas. Recordar, por último, que la dependencia de heroína se acompaña de gran discapacidad, siendo conveniente la valoración de su impacto. En líneas generales, se recomienda la utilización de instrumentos que cuenten con propiedades psicométricas reconocidas y que hayan sido adaptados y validados en castellano (AU)
No specific tests currently exist for the diagnosis of heroin dependence. Thus, diagnosis has to be based on an anamnesis and complete clinical examination. However, several questionnaires which embrace relevant aspects of this pathology exist. Assessment of the severity of addiction and the withdrawal syndrome can be a great help for the clinician at the time of establishing therapeutic approaches. The high prevalence of psychiatric comorbidity (personality disorders above all) detected in these patients makes necessary a comprehensive approach, and a careful evaluation is recomended to rule out these or other psychiatric disorders. Finally, as heroin dependence brings considerable disability, the evaluation of the impact of it is highly necessary. The employment of instruments with well known psychometric properties, and which have been validated and adapted for use in Spain, is recommended (AU)