The effect of early life events on glucose levels in first-episode psychosis.

First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.

Evolution of metabolic risk factors over a two-year period in a cohort of first episodes of psychosis.

Patients with a first episode of psychosis (FEP) display a broad range of metabolic risk factors related to the development of diverse medical comorbidities. Initial stages of these disorders are essential in understanding the increased vulnerability of developing cardiometabolic disturbances, associated with a reduced life expectancy. This study aimed to evaluate the metabolic profile of a cohort of patients with a FEP and its evolution during a two year follow-up, as well as the factors that influence the changes in their metabolic status. 16 participating centers from the PEPs Project recruited 335 subjects with a FEP and 253 matched healthy controls, aged 9-35years. We investigated a set of anthropometric measures, vital signs and laboratory data obtained from each participant over two years in a prospective, naturalistic study. From the beginning of the study the FEP group showed differences in the metabolic profile compared to the control group, together with a progressive worsening in the major part of the analyzed variables during the follow-up period, with higher rates of obesity and metabolic syndrome. Certain risk factors were related to determinate clinical variables such as male gender, the presence of affective symptoms or an early onset or to treatment variables such as the use of antipsychotic polypharmacy, antidepressants or mood stabilizers. Our results highlight the extremely high risk of patients at early phases of schizophrenia and other psychotic disorders of developing cardiovascular comorbidity and the fast worsening of the metabolic profile during the first two years.

La formación del médico psiquiatra en España: de los estudios de pregrado a la formación especializada / The formation of the psychiatrist in Spain: from the undergraduate studies to the specialized training

En el presente trabajo se revisa el proceso de formación del médico especialista en psiquiatría en España. A puntode partida de la reforma educativa universitaria luego de la creación del Espacio Europeo de Educación Superior yel llamado Acuerdo de Bolonia, se introdujeron importantes reformas curriculares, metodológicas y tecnológicasen las Facultades de Medicina del país. Este proceso histórico llevó a la promulgación del Real Decreto de 2008,a través del cual se regula el nuevo programa de formación de la especialidad de Psiquiatría. Se comentan tambiénpropuestas del esperado “proyecto de troncalidad” que permita que la Psiquiatría sea una disciplina-eje, conPsiquiatría Infantil y del Adolescente como su rama específica.

This article reviews the training process of psychiatry’s specialist physician in Spain. With the university educationreform following the creation of the European Space of Superior Education and the Bologna Accord as points ofdeparture, important curricular, methodological and technological changes were introduced in Spanish medicalschools. This historical process led to the promulgation of the 2008 Royal Decree through which the new specialtytraining in Psychiatry was regulated. Proposals on the expected “troncality process” which will allow Psychiatryto become a unitary, axis-like discipline with Child and Adolescent fields as a specific branch are also commentedupon.

Switching to ziprasidone in the clinical practice setting: an open-label study.

OBJECTIVE: This observational study evaluates the long-term outcome of switching to ziprasidone in patients with schizophrenia in the clinical practice setting. METHODS: Patients (208) with schizophrenia who had been switched to ziprasidone monotherapy due to partial response or tolerability problems were followed for 1 year. Efficacy was assessed at baseline and months 1, 3, and 12 with Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression-severity (CGI-S), and CGI-improvement. Quality of life, functionality, and safety measures, including metabolic parameters, were also assessed; 195 subjects comprised the per protocol analysis population. RESULTS: A reduction > or = 30% in BPRS total score was observed in 42.5% of the subjects. Mean scores of the BPRS (global and positive and negative clusters), CGI-S and CGI-I significantly decreased at endpoint (p < 0.001). Ziprasidone treatment was also associated with statistically significant improvements in the GAF, WHO-DAS-II, and SF-12. After 1-year follow-up, a mean weight decrease of -1.6 kg (p < 0.05) was observed. Mean levels of LDL cholesterol and triglycerides also decreased (p < 0.01) while HDL cholesterol levels increased (p < 0.05) at endpoint. No significant changes in mean glucose levels at study end were detected. CONCLUSION: These findings suggest that switching to ziprasidone is effective and well tolerated in patients with schizophrenia requiring a change in antipsychotic medication.

Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP. Réplica / Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme. Reply

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[Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme]. / Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP.

INTRODUCTION: Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease. PATIENTS AND METHODS: Seventy-six patients were recruited and randomly assigned to either an experimental REHACOP group or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Both groups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions. RESULTS: The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions. Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. CONCLUSIONS: The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree of impairment and the stage of progress of the disease.

Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP / Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme

Introducción. La rehabilitación neuropsicológica en esquizofrenia tiene un recorrido reciente y su eficacia en muestras depoblación española se ha comprobado en escasas ocasiones. Recientemente se han diseñado programas terapéuticos específicos,como el REHACOP, programa de rehabilitación cognitiva en psicosis. El objetivo de este estudio es probar la eficacia del REHACOP en muestras de pacientes con esquizofrenia en población española en diferentes fases de la enfermedad. Pacientes y métodos. Se reclutaron 76 pacientes que fueron asignados aleatoriamente a un grupo experimental REHACOP o a un grupo control. El grupo REHACOP realizó tres sesiones estructuradas semanales durante tres meses, mientras que el grupo control acudió a sesiones de terapia ocupacional con la misma frecuencia e intensidad. Ambos grupos recibieron el tratamiento adicional estándar en función de su curso y evolución. Se evaluó a todos los pacientes antes y después dela intervención en atención, lenguaje, aprendizaje y memoria, velocidad de procesamiento y funciones ejecutivas. Resultados. El grupo REHACOP presentó mejorías significativas en todas las funciones cognitivas exploradas respecto algrupo control, incluyendo atención, integración visuomotora, aprendizaje y memoria o funciones ejecutivas. Asimismo, el grupo REHACOP mostró una mejoría clínica y emocional significativa respecto al grupo control y ganancias adicionales en su capacidad de insight sobre la enfermedad. Conclusión. Los datos de este estudio sugieren que el REHACOP puede ser un programa de intervención eficaz para inducirmejoras en el deterioro neuropsicológico en pacientes con esquizofrenia independientemente del grado de deterioro y del estado evolutivo de la enfermedad (AU)

Introduction. Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease.Patients and methods. Seventy-six patients were recruited and randomly assigned to either an experimental REHACOPgroup or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Bothgroups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions.Results. The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions.Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. Conclusions. The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree ofimpairment and the stage of progress of the disease (AU)

[REHACOP: a cognitive rehabilitation programme in psychosis]. / REHACOP: programa de rehabilitacion cognitiva en psicosis.

INTRODUCTION: In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. MATERIALS AND METHODS: The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. RESULTS AND CONCLUSIONS: This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies.

REHACOP: programa de rehabilitación cognitiva en psicosis / REHACOP: a cognitive rehabilitation programme in psychosis

Introducción. En el presente trabajo se presenta el programa REHACOP, programa de rehabilitación cognitiva en psicosis. Materiales y métodos. La fundamentación del programa REHACOP -su estructura, materiales, objetivos, metodología de trabajo y modos de implementación- se describe de modo detallado. Resultados y conclusiones. Se ofrece una nueva herramienta terapéutica con el objetivo de que pueda servir de orientación a profesionales que se planteen el diseño de una intervención de estas características en muestras de pacientes con esquizofrenia u otras patologías (AU)

Introduction. In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. Materials and methods. The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. Results and conclusions. This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies (AU)

An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms.

INTRODUCTION: Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. METHODS: We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. RESULTS: Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. CONCLUSIONS: Our findings suggest that PS and negative symptoms predict QoL in schizophrenia.

Un modelo explicativo de la calidad de vida en la esquizofrenia: el papel de la velocidad de procesamiento y los síntomas negativos / An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms

Introducción. Mejorar la calidad de vida de los pacientes con esquizofrenia es un objetivo fundamental en una enfermedad que resulta devastadora, pero no hay acuerdo sobre qué factores predicen la calidad de vida (CV) en el curso de la enfermedad. Metodología. En el presente estudio se examinaron a165 pacientes hospitalizados con esquizofrenia. Se incluyeron medidas de síntomas psiquiátricos (PANSS, insight y síntomas afectivos) y cognitivas. Un análisis factorial confirmatorio estableció una estructura cognitiva compuesta de seis factores, que incluyen atención, velocidad de procesamiento, memoria verbal, fluidez, memoria de trabajo y funciones ejecutivas. La calidad de vida fue medida mediante la Escala de Calidad de Vida de Heinrichs-Hanlon-Carpenter. Resultados. La edad, tiempo de duración de la enfermedad, mayor gravedad de síntomas negativos y la mayoría de factores cognitivos correlacionaron significativamente con los indicadores de CV. Los análisis de regresión mostraron que, muy por encima de los demás factores cognitivos, la velocidad de procesamiento (VP) es un importante predictor de la CV. Además, la interacción de la VP con los síntomas negativos, la edad del paciente y el nivel de deterioro en funciones ejecutivas modificaron el efecto de la VP sobre la CV. Finalmente, los síntomas positivos y otros datos sociodemográficos no guardaron relación con la CV en nuestro estudio. Conclusiones. Nuestros hallazgos sugieren que la VP y los síntomas negativos predicen la CV en la esquizofrenia (AU)

Introduction. Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. Methods. We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. Results. Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. Conclusions. Our findings suggest that PS and negative symptoms predict QoL in schizophrenia (AU)

[Mental disorders in psychiatric outpatients in Spain]. / Trastornos mentales en pacientes de atención especializada en el ámbito extrahospitalario español.

OBJECTIVES: The aim of data presented is to increase knowledge about the morbidity and impact of mental disorders in Spanish psychiatry. The objective is to describe, based on real practice conditions, the most prevalent mental disorders in a sample of Spanish patients treated in outpatient Psychiatry centers. MATERIAL AND METHOD: Epidemiological, naturalistic, prospective, cross-sectional study, carried out in the outpatient psychiatry setting in Spain in 2006. Mental disorders were assessed using the International Neuropsychiatric Interview (MINI). RESULTS: A total of 1,436 patients, 72% of whom were women, mean age of 49.2 ± 13.3 years, were included. According to the MINI assessment, 90.3 % of the patients were diagnosed of at least one mental disorder. The most prevalent mental disorders were: recurrent major depressive episode (27.2%, 353 patients); only current major depressive episode (2 weeks) (25.9%, 336 patients); current dysthymic disorder (last 2 years) (25.9%, 336 patients); current major depressive episode with melancholy symptoms (18.7%, 243 patients); current generalized anxiety disorder (16.6 %, 215 patients). CONCLUSIONS: The study results show the prevalence of mental disorders in a sample representative of the Spanish population, treated in outpatient specialized Psychiatry centers. Mood and generalized anxiety disorders were the most prevalent disorders.

Trastornos mentales en pacientes de atención especializada en el ámbito extrahospitalario español / Mental disorders in psychiatric outpatients in Spain

Objetivos. El propósito de los datos presentados es ampliar el conocimiento sobre la morbilidad y el impacto de los trastornos mentales en la psiquiatría española. El objetivo es describir, conforme a la práctica clínica habitual, los trastornos mentales más prevalentes en una muestra de pacientes españoles tratados en centros ambulatorios de Psiquiatría. Material y Método. Estudio epidemiológico, naturalístico, prospectivo, de corte transversal, realizado en el ámbito de la psiquiatría ambulatoria en España en el año 2006. Los trastornos mentales fueron evaluados mediante la Entrevista Neuropsiquiátrica Internacional (MINI).Resultados. Se incluyeron en el estudio un total de 1.436 pacientes, de los cuales el 72% fueron mujeres, con una edad media de 49,2 ± 13,3 años. Según la MINI el 90,3% de los pacientes fueron diagnosticados de al menos un trastorno mental. Los trastornos mentales más prevalentes fueron: episodio depresivo mayor recidivante (27,2%, 353 pacientes); solo episodio depresivo mayor actual (2 semanas) (25,9%, 336 pacientes); trastorno distímico actual (últimos 2 años) (25,9%, 336 pacientes); episodio depresivo mayor actual con síntomas melancólicos (18,7%, 243 pacientes); trastorno de ansiedad generalizada actual (16,6%, 215 pacientes). Conclusiones. Los resultados del estudio muestran la prevalencia de los trastornos mentales en una muestra representativa de la población española que acude a centros ambulatorios de Atención Especializada Psiquiátrica. Destacan por su mayor prevalencia los trastornos del estado del humor y trastorno de ansiedad generalizada (AU)

Objectives. The aim of data presented is to increase knowledge about the morbidity and impact of mental disorders in Spanish psychiatry. The objective is to describe, based on real practice conditions, the most prevalent mental disorders in a sample of Spanish patients treated in outpatient Psychiatry centers. Material and Method. Epidemiological, naturalistic, prospective, cross-sectional study, carried out in the outpatient psychiatry setting in Spain in 2006. Mental disorders were assessed using the International Neuropsychiatric Interview (MINI). Results. A total of 1,436 patients, 72% of whom were women, mean age of 49.2 ± 13.3 years, were included. According to the MINI assessment, 90.3 % of the patients were diagnosed of at least one mental disorder. The most prevalent mental disorders were: recurrent major depressive episode (27.2%, 353 patients); only current major depressive episode (2 weeks) (25.9%, 336 patients); current dysthymic disorder (last 2 years) (25.9%, 336 patients); current major depressive episode with melancholy symptoms (18.7%, 243 patients); current generalized anxiety disorder (16.6 %, 215 patients). Conclusions. The study results show the prevalence of mental disorders in a sample representative of the Spanish population, treated in outpatient specialized Psychiatry centers. Mood and generalized anxiety disorders were the most prevalent disorders (AU)

La opinión de los residentes de psiquiatría sobre la formación que reciben / The opinion of psychiatric residents on the training they receive

Se presentan y comentan los resultados de una encuesta llevada a cabo por la Comisión Nacional de Psiquiatría entre los MIR de psiquiatría de tercer y cuarto año. La encuesta tuvo por objeto conocer la opinión de los residentes sobre la formación que recibieron, así como el grado de satisfacción que experimentaron. Los resultados indican que la mayoría cumplieron con los requisitos del Programa Nacional de Formación Psiquiátrica y que su grado de satisfacción fue bueno. No obstante un porcentaje pequeño pero sustancial de residentes no cumplieron el programa de forma adecuada, particularmente en relación con la formación en psicoterapia, metodología de la investigación, gerontopsiquiatría, neurología y medicina general. Basándose en estos resultados la Comisión Nacional expone su opinión y presenta unas recomendaciones dirigidas a las partes interesadas en la formación de los residentes de psiquiatría en España (AU)

The results of a survey carried out by the Spanish National Board for Psychiatric Training among psychiatric trainees in their third and fourth year of training are presented and discussed. The aim of the survey was to know the resident’s opinion and level of satisfaction on the training they had received. The results indicate that the majority of residents had complied with the National Program for Psychiatric Training requirements and that their level of satisfaction was fair. However a small but substantial percentage did not comply adequately with the program, particularly in relation with the training in psychotherapy, research methodology, old age psychiatry, neurology and general medicine. Based on these results the National Board puts forward some recommendations meant for those involved in the training of psychiatrists in Spain (AU)

The opinion of psychiatric residents on the training they receive.

The results of a survey carried out by the Spanish National Board for Psychiatric Training among psychiatric trainees in their third and fourth year of training are presented and discussed. The aim of the survey was to know the resident's opinion and level of satisfaction on the training they had received. The results indicate that the majority of residents had complied with the National Program for Psychiatric Training requirements and that their level of satisfaction was fair. However a small but substantial percentage did not comply adequately with the program, particularly in relation with the training in psychotherapy, research methodology, old age psychiatry, neurology and general medicine. Based on these results the National Board puts forward some recommendations meant for those involved in the training of psychiatrists in Spain.

Insight in first episode psychosis. Conceptual and clinical considerations

Background and Objectives: Poor insight or impaired awareness of illness is a very common feature in psychosis. The purpose of this study is to review critically the conceptual approximations from different perspectives to insight in psychosis and address its relations to other clinical and psychopathological variables. Methods: We reviewed the principal factors that have been proposed to contribute to deficient insight in first episode psychosis patients from different conceptual frameworks, defence mechanisms or coping styles, structural or volumetric brain associations, cognitive deficits, and severity of clinical symptoms. Results: This review of literature suggests that insight is a complex mental faculty heavily influenced by additional factors, such as social and cultural aspects, among others. Results also show the correlates of insight in first episode psychosis and treatment adherence in the course of the illness, although it is not stable over time. In fact, adequate level of insight is a necessary, but not sufficient condition for an adequate adherence (AU)

Controversias en torno al tiempo de psicosis no tratada como variable pronóstica independiente del curso evolutivo de las psicosis esquizofrénicas / Controversies about duration of untreated psychosis as independent prognostic variable of the evolutive course of schizophrenic psychoses

El objetivo del presente trabajo es detallar aquellos aspectos, a nuestro entender más relevantes, extraídos de la creciente literatura sobre el tiempo de psicosis no tratada (DUP), incidiendo sobre dos aspectos nucleares y objeto de una creciente controversia, como son: a) aquellas razones que a lo largo de la última década han llevado a catapultar el DUP a la primera plana de la investigación en el terreno de los primeros episodios psicóticos, y b) el papel último del DUP a la hora de vertebrar el diseño y las diferentes estrategias de actuación en los programas de intervención precoz sobre las psicosis. Se aportan datos correspondientes a la evaluación del DUP, como variable pronóstica independiente, en una muestra de 231 pacientes, con un diagnóstico de trastorno esquizofrénico y/o trastorno esquizofreniforme (criterios DSM-IV) y un seguimiento de 24 meses. La conclusión final es que el DUP funciona más como un marcador de riesgo que como una variable pronóstica independiente, determinante del curso evolutivo de las psicosis esquizofrénicas. En este sentido su papel dentro de los programas de intervención precoz en las psicosis debería revisarse

This study reviews recent literature on duration of untreated psychosis (DUP) and its most relevant characteristics and controversial issues, such as: a) why DUP has been pointed out as a main variable in first-episode psychosis research, and b) the role of DUP in designing intervention programs for the design and different action strategies in early intervention programs in psychoses. The authors also present data from a 2 year follow-up study of 231 patients with a diagnosis of schizophrenia and/or schizophreniform disorder (according to DSM-IV criteria). Results are included, analyzing DUP as prognostic factor for clinical outcome. Our conclusions suggest that DUP is a risk marker but not an independent prognostic factor determining follow-up in schizophrenic psychoses. Therefore, DUP's role in early intervention programs should be redefined

Aproximación terapéutica al uso y abuso de drogas recreativas / Therapeutic strategies in “club drugs”

Objetivo: describir y analizar el estado actual del tratamiento del uso y abuso de las drogas recreativas y de sus efectos adversos de tipo psiquiátrico. Método: la información recopilada en la búsqueda bibliográfica se ha organizado por sustancias –MDMA, GHB (gammahidroxibutirato) y ketamina- y por el tipo de efectos. Resultados: a pesar de la escasez de publicaciones parece existir un cierto grado de acuerdo en el abordaje de los problemas con MDMA y GHB; para las complicaciones psiquiátricas agudas, subagudas y residuales por éxtasis se recomienda la utilización de benzodiazepinas, antidepresivos y/o antipsicóticos atípicos; para la intoxicación y síndrome de abstinencia producido por el GHB y similares, se recomienda la utilización de benzodiacepinas, y la utilización conjunta de estabilizadores del humor y antipsicóticos atípicos. En el caso del síndrome de abstinencia y de la sintomatología positiva, negativa y cognitiva que puede producir el consumo de Ketamina, ya que no existe un tratamiento protocolizado, se comentan resultados de recientes estudios. Conclusiones: dada la insuficiente experiencia clínica y terapéutica, así como la falta de estudios clínicos controlados, en la actualidad no existe un consenso terapéutico establecido para las drogas de recreo (AU)

Objective: to describe and analyze the state of the art of the treatment of use-abuse of “club drugs” and their psychiatric adverse effects. Method: data from literature were organized according to the type of drug –MDMA, GHB (Gammahidroxibutirate) and Ketamine- and to the type of adverse effects. Results: does exist certain agreements in how to approach problems related with the use of MDMA and GHB; for acute, subacute and residual psychiatric disorders induced by Ecstasy, the use of benzodiazepines, antidepressants and/or atypical antipsychotics has been suggested; for intoxication and withdrawal syndromes induced by GHB and similar drugs, the use of benzodiazepines, and the use of mood stabilizers and atypical antipsychotics has been suggested. With respect to withdrawal and positive, negative and cognitive simtomatology induced by Ketamine, and due to the fact that there is no treatment currently in use, the results reported by recent studies are discussed. Conclusion: due to the insuficient clinical and therapeutical experience and to the lack of controlled clinical trials, there is no therapeutic consensus for “club drugs” (AU)

Nimodipine in opiate detoxification: a controlled trial.

OBJECTIVE: To evaluate the use of L-type calcium channel blockers (CaCB) in out-patient opiate detoxification. DESIGN: Controlled trial with sequential allocation of patients to groups. METHODS: Three groups of individuals subject to opiate detoxification were involved: (1) the experimental group (n=30) received a course of nimodipine and dextropropoxiphen; (2) one control group (n=20) was detoxified with a course of dextropropoxiphen and benzodiazepine; and (3) a second control group (n=30) was treated with a standard course of alpha-2-adrenergic agents and naltrexone. In all cases, the detoxification course was scheduled to last 7 days. RESULTS: All the groups showed a significant opiate withdrawal syndrome (OWS) during detoxification (follow-up effect: Lambda=0.04; F6.52=201.89; P < 0.001), but from the first day the group treated with CaCB manifested fewer symptoms than the control groups (treatment effect: F2.57=97.99; P < 0.001). From the start, the intensity of the OWS was reduced by half in the CaCB group (M=6.67) compared with that manifested by the two other groups (M approximately 13). The clinical impression of the evolution of the detoxification was that it was comfortable and free of complications (significant side-effects were not observed). CONCLUSIONS: The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.