Dual disorder: does expert clinical experience support the rationale for cariprazine use?

Comorbid substance use disorder (SUD) in patients with schizophrenia (dual disorder, DD) is a frequent occurrence in the psychiatric clinical practice and is positively associated with poorer outcomes. Despite a very high co-prevalence, clinical guidelines for SUD and severe mental illnesses tend to give limited consideration to co-existing disorders regarding diagnosis and management. This article is the result of a meeting held in February 2023 to discuss common challenges and best clinical practice initiatives for patients with schizophrenia and DD in different treatment settings. The authors identified issues in the clinical approach to DD in schizophrenia spectrum disorders and suggested the most suitable management based on their experience as a group of experts, identifying possible improvement areas. In conclusion, the panel recommends that individuals with DD should be cared for in a single center. Pharmacologic treatment in individuals with DD needing both control of symptoms related to schizophrenia spectrum disorders and substance withdrawal should ideally be based on using a non-sedative antipsychotic with anti-craving activity.

A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare.

BACKGROUND: Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. METHODS: Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. RESULTS: Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains. CONCLUSIONS: Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.

Inyectables de larga duración, de la farmacología a la clínica / No disponible

Los antipsicóticos inyectables de larga duración (AILD) y en particular los de segunda generación constituyen un elemento clave en el abordaje de los pacientes con esquizofrenia u otros trastornos psicóticos debido a su capacidad de asegurar la libe-ración de niveles plasmáticos estables del principio activo y asegurando así una mayor adherencia al tratamiento. A pesar de la probada eficacia y el mejor perfil de tolerabilidad de los AILD de segunda generación, estos fármacos son ampliamente infrau-tilizados y con frecuencia son relegados a etapas más avanzadas de la enfermedad a pesar de lo recomendado por la mayoría de guías clínicas internacionales. Aunque hay importantes diferencias entre los diversos AILD, este grupo de fármacos muestran importantes ventajas clínicas frente a los tratamientos orales

No disponible

Clinical guideline for the treatment of dual pathology in the adult population.

Editorial del vol 28-1.

Educación sanitaria en la farmacia comunitaria: estudio controlado en la provincia de Castellón / No disponible

Introducción: La educación para la salud es una de las actividades que debe realizar el farmacéutico comunitario orientada hacia el paciente. Con el objetivo de conocer la influencia de la educación sanitaria en los pacientes, se realizó un estudio controlado en farmacias comunitarias de la provincia de Castellón.Material y métodos: En el estudio participaron catorce oficinas de farmacia (siete en el grupo control y siete en el grupo intervención). En todas ellas se realizó una encuesta inicial a los pacientes sobre educación para la salud. En las farmacias del grupo intervención se realizaron cinco campañas de educación sanitaria y al finalizar cada campaña los pacientes completaron una encuesta para valorar la educación sanitaria recibida. En las farmacias del grupo control se pasaron las encuestas a los pacientes pero no se realizaron las campañas de educación sanitaria.Resultados y discusión: Los pacientes están significativamente más satisfechos con la formación que reciben en las farmacias que realizan educación sanitaria. Además, se incrementa significativamente la percepción que tiene la población del farmacéutico en la oficina de farmacia como punto de referencia a la hora de ayudar a resolver sus problemas de salud. La educación sanitaria permite que los pacientes reciban formación completa acerca de temas de salud que les preocupan y les proporciona más capacidad para resolverlos por ellos mismos(AU)

Introduction: Health education is one of the roles of the community pharmacist.A controlled study of pharmacies in the Spanish province of Castellón was carried out with the aim of determining the influence of health education on the general public.Material and methods: Fourteen pharmacies took part in the study: seven in the group control and seven in the intervention group. An initial survey about health education was conducted among the patients of all fourteen pharmacies. In the pharmacies in the intervention group five campaigns of health education were instigated; after each campaign patients answered a survey to evaluate the health education received. In the pharmacies in the control group the same surveys were carried out without the implementation of any educational campaigns.Results and discussion: Patients of the pharmacies in the intervention group were significantly more satisfied with their level of knowledge about health matters than those in the control other group. In addition, the same patients had a significantly more satisfied with the formation they received in the pharmacies that implemented the educational campaigns. In addition, patients of the pharmacies in the intervention group had a significantly better perception of the pharmacist and of the pharmacy as a reference point with respect to resolving their health problems. Health education informs patients about aspects of health and endows them with the aptitude to make decisions related to their health problems(AU)

Trastorno bipolar asociado al uso de sustancias adictivas (patología dual). Revisión sistemática de la evidencia científica y consenso entre profesionales expertos / Bipolar disorder associated to substance use disorders (dual diagnosis). Systematic review of the scientific evidence and expert consensus

El presente trabajo está focalizado en la llamada patología dual (PD): trastorno bipolar (TB) asociado a un trastorno por uso de sustancias (TUS). A pesar de que tanto los psiquiatras que tratan a pacientes con TB como los médicos que tratan a los pacientes con TUS encuentran frecuentemente esta asociación, lamentablemente las publicaciones que exploran la PD son escasas. El Grupo Español de Trabajo en Patología Dual en Trastorno Bipolar realizó una revisión del material publicado mediante una búsqueda bibliográfica en Medline y seleccionó los artículos relevantes publicados hasta el momento; a continuación se llevó a cabo un consenso de expertos y finalmente se realizó una encuesta a expertos en PD para responder a las áreas que no estaban suficientemente cubiertas por la evidencia científica o en las cuales no se llegó a un consenso dentro del grupo de trabajo. Se concluye que en las actuales circunstancias el establecimiento de un consenso constituye una herramienta muy útil para complementarla evidencia científica existente (AU)

The present work focuses on the so-called dual diagnosis (DD): bipolar disorder (BD) associated with substance use disorders (SUD). Although the psychiatrists who treat patients with BD and physicians in charge of patients with SUD frequently find this association with DD, unfortunately there are few scientific works that have studied this association. The Spanish Working Groupon Bipolar Disorders in Dual Diagnosis reviewed the published material using a Medline search and selected the most relevant articles. Following this, the Work Group developed an expert consensus in DD and finally, a survey was performed among a group of experts in this disorder to cover the areas that were not fully addressed by the scientific evidence or in those areas in which the Work Group was unable to reach a consensus. We conclude that, in view of the above, establishment of a consensus is a valid tool to complement the current scientific evidence (AU)

Bipolar disorder associated to substance use disorders (dual diagnosis). Systematic review of the scientific evidence and expert consensus.

The present work focuses on the so-called dual diagnosis (DD): bipolar disorder (BD) associated with substance use disorders (SUD). Although the psychiatrists who treat patients with BD and physicians in charge of patients with SUD frequently find this association with DD, unfortunately there are few scientific works that have studied this association. The Spanish Working Group on Bipolar Disorders in Dual Diagnosis reviewed the published material using a Medline search and selected the most relevant articles. Following this, the Work Group developed an expert consensus in DD and finally, a survey was performed among a group of experts in this disorder to cover the areas that were not fully addressed by the scientific evidence or in those areas in which the Work Group was unable to reach a consensus. We conclude that, in view of the above, establishment of a consensus is a valid tool to complement the current scientific evidence.

The role of personality disorders on drug dependence treatment outcomes following inpatient detoxification.

AIMS: The present 6 month follow-up study was conducted to investigate the possible influence of comorbid personality disorders on drug treatment, as well as associated psychopathology and HIV-related risk behaviors outcomes. SUBJECTS AND METHODS: Data were collected initially from a consecutive sample of 74 patients with a diagnosis of opiate abuse or dependence, admitted for inpatient detoxification. RESULT: During intake, 80.9% of patients reported at least one HIV-related risk behavior in the previous 6 months. Not using condoms during sexual intercourse was the most common and the only risk behavior that showed a statistically significant reduction over the follow-up period. A total of 58.1% of subjects had at least one personality disorder (PD). Borderline PD was the most prevalent. However, antisocial PD was the only PD that influenced substance use outcomes. The presence of this diagnosis increased the chance of worse opiate use outcomes, but decreased likelihood of not using condoms. Patients with low obsessive-compulsive PD dimensional scores showed a significant increase in the number of risk behaviors. However, these influences were only seen at the 3-month follow-up assessment. CONCLUSIONS: These results suggest that personality disorders need to be considered when planning effective interventions for opiate dependent individuals and when preparing and evaluating HIV risk-reduction interventions, particularly for the more severe substance dependent patients.

[Pharmacological treatment of substance dependence from a neuroscientific perspective (II): alcohol, benzodiazepines and nicotine]. / Tratamiento farmacológico de la dependencia de sustancias desde una perspectiva neurocientífica (II): alcohol, benzodiacepinas y nicotina.

The second part of this review deals with those neuroscientific aspects specific to the development and maintenance of dependence of three substances, two legal drugs (alcohol and tobacco) and a group of medications with abuse potential, benzodiazepines. Based on this context, the different pharmacological treatments of alcohol dependence, both related to detoxification and dehabituation, are discussed first. Treatment of the benzodiazepine withdrawal syndrome, together with the most outstanding aspects in the recent literature on relapse prevention, are reviewed. The publications on the treatment of nicotine dependence, both on replacement therapies and on bupropion, are analyzed. Finally, a critical reflection of the sources used to conduct this two-part review is done.

Emociones, motivación y trastornos adictivos: un enfoque biopsicosocial / Emotions, motivation and addictive disorders: a biopsychosocial approach

Objetivo: Emociones, motivación y trastornos adictivos son, cada día más, objeto de un análisis científico holístico que desde la perspectiva psicopatológica y basándose en los importantes avances psicobiológicos de las neurociencias, nos permiten una comprensión global de la realidad cotidiana que tratamos los clínicos. Material y métodos: Realizar una revisión de la literatura que desde la sociología y psicología hasta la medicina (psiquiatría y neurociencias en general) aborda la emoción, motivación y adicción, tan relacionadas entre sí pero, por sesgos lógicos, tan poco evaluadas en conjunto. Resultados: Las emociones, desde las más animales a las llamadas humanas, son la base de muchos constructos, e incluso hasta la propia inteligencia se fundamenta, en buena medida, en ellas. Sin embargo, y a pesar de tener una larga trayectoria, fundamentalmente en la filosofía, no es hasta hace relativamente poco tiempo que vuelven a ser objeto de interés y atención científica, junto a la motivación, para entender la personalidad y algunos trastornos psicopatológicos como los adictivos. Conclusiones: Este interés por la emoción y la motivación, que va desde la clínica a las neurociencias, nos permitirá entender mejor las adicciones y el comportamiento humano en su globalidad. (AU)

Tratamiento farmacológico de la dependencia de sustancias desde una perspectiva neurocientífica (II): alcohol, benzodiacepinas y nicotina / Pharmacological treatment of substance dependence from a neuroscientific perspective (II): alcohol, benzodiazepines and nicotine

En la segunda parte de esta revisión se abordan aquellos aspectos neurocientíficos específicos del desarrollo y mantenimiento de la dependencia de tres sustancias, dos drogas legales (alcohol y tabaco) y un grupo de fármacos, las benzodiacepinas, con potencial de abuso. A partir de esta contextualización se aborda el tratamiento farmacológico de la dependencia del alcohol, tanto de los aspectos determinantes en la desintoxicación como en la deshabituación. Luego se revisa el tratamiento del síndrome de abstinencia de benzodiacepinas, así como aquellos aspectos más destacados en la bibliografía reciente para la prevención de recaídas y se analizan las publicaciones referentes al tratamiento de la dependencia de nicotina, tanto de los tratamientos sustitutivos como de las aportaciones del bupropión. Por último, se realiza una reflexión crítica sobre las fuentes utilizadas para la realización de las dos partes de esta revisión. (AU)

[Pharmacological treatment of substance dependence from a neuroscientific perspective (I): opiates and cocaine]. / Tratamiento farmacológico de la dependencia de sustancias desde una perspectiva neurocientífica (I): opiáceos y cocaína.

In this review paper it is intended to analyze the most recent publications on pharmacological treatment of drug dependences from a neuroscientific perspective. It has been divided into two parts, the first one focuses on the treatment of illegal substance dependence, specifically opiates and cocaine; and the second part deals with the pharmacological treatments of three substances, two legal drugs such as alcohol and tobacco, and a group of medications with abuse potential, benzodiazepines. In this first part the neuroscientific aspects (genetic, neurochemistry, circuits involved, neuroimaging and neuropsychological deficits) relevant to understanding the pharmacological treatment of the main drug addictions are summarized. The pharmacotherapies of opiate dependence, both for detoxification and for dehabituation, are then discussed. Finally, the main medications that have been proposed to treat cocaine dependence are also reviewed.

[Heroin prescribing: Is there scientific evidence of its efficacy for the treatment of its dependence?]. / Prescripción médica de heroína: existe evidencia científica de su eficacia en el tratamiento de la dependencia de la misma?

It is in the United Kingdom where medical prescription of opiates has been more widely used. Although these practice had been increasing until the sixties, several factors caused a decreased since then, so that it is currently 1.6% of all maintenance programmes, becoming methadone prescription more important. Mainly through studies conducted in Switzerland, the debate over the appropriateness of this practice. In such studies, it appears that heroin prescription supports important improvements in the patients outcome, as it is associated with better retention rates, a reduction in abuse of illicit substances, and improvements in patients health and social aspects. However, methodological limitations of these studies and ambiguous results of studies carried out in other countries, make it difficult to determine the effectiveness or efficacy of this pharmacotherapy, so that more studies are needed to scientifically justify this practice.

Prescripción médica de heroína: ¿existe evidencia científica de su eficacia en el tratamiento de la dependencia de la misma? / Heroin prescribing: is there scientific evidence of its efficacy for the treatment of its dependence?

En el Reino Unido es donde más se ha utilizado la prescripción médica de heroína en el tratamiento de la dependencia de opiáceos. Aunque esta práctica fue incrementándose hasta la década de los sesenta, varios factores provocaron la disminución de la misma, hasta la actualidad donde sólo supone el 1,6 por ciento de los programas de mantenimiento, siendo más importante la prescripción de metadona. En la última década se ha reactivado el debate alrededor de la idoneidad de esta práctica, principalmente por los estudios realizados en Suiza. En estos estudios parece que la prescripción de heroína favorece importantes mejorías en la evolución de los pacientes, tanto por obtenerse mejores retenciones, como por la disminución del consumo ilícito de sustancias, observándose mejoras tanto en la salud como en la esfera social de los pacientes. Pero la pobreza metodológica de estos estudios y la ambigüedad de otros realizados en diferentes países no permiten pronunciarse sobre la efectividad o eficacia de este tratamiento, siendo necesarios más estudios al respecto para que el uso de esta práctica esté justificada científicamente (AU)

Los trastornos relacionados con el uso de sustancias desde la perspectiva de la psicopatología y las neurociencias / Substance use disorders from the perspective of psychopathology and the neurosciences

Introducción: las neurociencias explican, cada día más y mejor, los trastornos psicopatológicos y dentro de ellos los relacionados con el uso de sustancias. El conocimiento de la fisiología y anatomía de los sistemas de refuerzo, así como del resto de mecanismos de la adicción, junto a la psicopatología y comorbilidad asociada, nos permiten un mejor marco de referencia para el diagnóstico y tratamiento de estos trastornos. Material y método: revisión bibliográfica de los aspectos psicobiológicos de la adicción y su relación con los hallazgos clínicos dentro de los trastornos por uso de sustancias. Resultados: en la primera mitad del pasado siglo ya se apuntaron algunos aspectos clínicos que hacían pensar en la existencia de factores psicobiológicos de las drogodependencias, estos hechos confirmados en la segunda mitad del siglo se articulan en: unos mecanismos de refuerzo sustentados fundamentalmente en la transmisión dopaminérgica del mesoaccumbens, la existencia de otras áreas implicadas en el circuito de la recompensa; y la conceptualización de la adicción como factor primario, que junto a otros trastornos psíquicos, tanto primarios como drogoinducidos, dentro de un modelo de vulnerabilidad, da la patología dual. Conclusiones: el factor biológico, considerando como tal el efecto de las sustancias en los circuitos del refuerzo, y sobre otras estructuras y sistemas de neurotransmisión cerebrales, tiene que relacionarse con la psicopatología, previa o inducida, en un contexto social determinado. Solamente así se entenderá de forma adecuada los trastornos adictivos y la psicopatología asociada (AU)

El tratamiento de la dependenciade la nicotina en pacientes dependientesde otras drogas / Treatment of nicotine dependence in patients dependent to other drugs

Objetivos: se evalúa la relación neurobiológica, farmacológica y epidemiológica que existe entre fumar y el consumo de alcohol u otras drogas con el objetivo de valorar el impacto del tratamiento de la dependencia de nicotina durante el tratamiento de la dependencia del alcohol y otras substancias psicoactivas. Material y métodos: revisión comentada de la literatura científica a partir de una serie de búsquedas informatizadas. Resultados: el abuso de substancias psicoactivas en general, y el alcoholismo en particular, se asocia estrechamente con el fumar. Diversos estudios también sugieren que las terapias sustitutivas de la nicotina son bien toleradas por este grupo de pacientes. Conclusiones: los programas de tratamiento para pacientes dependientes del alcohol y otras drogas deberán proporcionar una mayor atención a la evaluación y tratamiento del tabaquismo, ya que el tratamiento para dejar de fumar puede ser positivo en la prevención de recaídas de la dependencia de otras substancias (AU)

La Buprenorfina / The Buprenorphine

No disponible

What makes alcohol-dependent individuals early in abstinence crave for alcohol: exposure to the drink, images of drinking, or remembrance of drinks past?

Craving is a major factor in addiction, predicting poorer outcome to treatment To improve our understanding of craving for alcohol, we have compared in the laboratory the effects of inducing craving for alcohol by exposure to the sight and the smell of an alcoholic beverage, imagery of craving scripts, and recall of autobiographical memories of craving. We used subjective measures of craving, together with autonomic measures, in 14 abstinent alcohol-dependent individuals in the first month after detoxification. All subjects reported a significant increase in ratings of urges after exposure to alcoholic drinks, following the imagery of craving and after recalling autobiographical memories of craving. Physiological measures have shown that craving imagery as well as memory induction were equally effective as exposure to alcoholic drinks in modestly increasing autonomic arousal (indicated by systolic blood pressure). Our preliminary findings support the existing evidence in nicotine and opiate dependence that images and memories are as effective as in vivo exposure in eliciting craving for drugs.

Gender differences in cocaine dependent patients: a 6 month follow-up study.

This 6-month follow-up study compared 64 men and 37 women hospitalized for cocaine dependence. Drug histories, sociodemographic characteristics, psychiatric diagnoses, and Addiction Severity Index (ASI) scores were compared during hospitalization; cocaine use and ASI scores were compared at 6 months. During hospitalization, women had significantly more severe family and social problems; men had more antisocial personality disorder. At follow-up, significantly more women had remained abstinent: family/social problem severity no longer differed. This replicates previous research showing better treatment outcome for cocaine dependent women. This may be related to specific characteristics of women who enter mixed-gender cocaine treatment programs.

[Depression and cognitive deterioration: a transversal study of comorbidity]. / Depresión y deterioro cognitivo: un estudio transversal de comorbilidad.

This cross-sectional study investigates the relation between a broad category of cognitive impairment and depression in a sample of 654 subjects aged 65 or over. This sample represents 74% of all subjects of that age living in a defined electoral district in North London, UK. The presence of depression and cognitive impairment was ascertained by interviewing all subjects with Short-CARE. Information was collected also for a variety of socto-demographic factors, level of social support and variables of functional limitation (i.e., impairment, disability and handicap). We found a cross-sectional association between depression and cognitive impairment (OR = 3.3; 95% CI: 2.1-3.1). However, when the analysis was adjusted for potential confounders using stratified analysis and logistic regression, we found that variables of functional limitation (especially disability and handicap) acted as confounders of the above association. This confounding effect did not differ significantly across sexes in our study.