[Adoption and behavioural disturbances in adolescence. A hospital patient sample]. / Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria.

INTRODUCTION: The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. METHODS: Prospective data were collected over 56 months (n=431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. RESULTS: Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=.086). CONCLUSIONS: The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more.

Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes.

OBJECTIVE: To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years' follow-up. METHOD: Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or "other psychosis". The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed. RESULTS: Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. "other psychosis". Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio=1.383; 95% confidence interval, 1.205-1.587; P=0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis. CONCLUSION: The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.

Trastorno de pánico y fibrilación auricular / Panic disorder and atrial fibrillation

Este trabajo analiza la relación bidireccional entre la fibrilación auricular y el trastorno de pánico. El diagnóstico diferencial se plantea frecuentemente en los servicios de urgencias y en la consulta del médico de atención primaria. Diferentes estudios nos hablan de una alta tasa de prevalencia de trastornos de ansiedad en pacientes que han recibido el diagnóstico de fibrilación auricular. Por otra parte, se ha observado que los pacientes con trastornos de ansiedad presentan una mayor prevalencia de enfermedades cardiovascular. Los pacientes con trastorno de pánico presentarán con frecuencia quejas somáticas indicativas de enfermedad cardíaca que es obligatorio descartar mediante pruebas complementarias. El correcto diagnóstico conlleva, además, el tratamiento considerado óptimo para cada afección y, como consecuencia, la reducción del gasto sanitario (AU)

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis (AU)

[Panic disorder and atrial fibrillation]. / Trastorno de pánico y fibrilación auricular.

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis.

Basurto-IGPP. A manual-directed approach of integrative group psychotherapy in psychosis.

A manual on Integrative Group Psychotherapy for outpatients with schizophrenia and other psychoses (Basurto-PGIP) is presented. The model takes into account group specific therapeutic factors. It integrates influences from other integrative psychotherapeutic models, interpersonal group therapy, group analysis and recent developments in cognitive behavioural therapy for psychotic symptoms. The manual is structured in levels of different complexity that can be applied in a progressive manner. The intervention tries to adapt to patients features, therapists ability and training, and centres resources. It can be applied in two possible settings: a short term closed group and a long term open group. Advantages and disadvantages of the model are described.

Basurto-PGIP. Un abordaje manualizado de psicoterapia grupal integradora en psicosis / Basurto-PGIP. A manualized approach on Integrative Group Psychotherapy

Se presenta un manual sobre psicoterapia grupal integradora para pacientes ambulatorios con esquizofrenia y otras psicosis que denominamos Basurto-PGIP. El modelo tiene en cuenta los factores terapéuticos específicamente grupales. Integra influencias provenientes de otros modelos de psicoterapia integradora, de la terapia grupal interpersonal, del análisis grupal y de los recientes desarrollos de la terapia cognitivo-conductual de los síntomas psicóticos. El manual se estructura en distintos niveles de complejidad que pueden ser aplicados de forma progresiva. La intervención trata de adaptarse a las características de los pacientes, las capacidades y la formación de los terapeutas, y los recursos de los centros. La aplicación es posible en dos encuadres: un grupo cerrado de duración limitada y un grupo abierto de duración prolongada. Se describen además las ventajas e inconvenientes del modelo (AU)

A manual on Integrative Group Psychotherapy for outpatients with schizophrenia and other psychoses (Basurto-PGIP) is presented. The model takes into account group specific therapeutic factors. It integrates influences from other integrative psychotherapeutic models, interpersonal group therapy, group analysis and recent developments in cognitive behavioural therapy for psychotic symptoms. The manual is structured in levels of different complexity that can be applied in a progressive manner. The intervention tries to adapt to patients features, therapy stability and training, and centres resources. It can be applied in two possible settings: a short term closed group and a long term open group. Advantages and disadvantages of the model are described (AU)

Assessment of the impact of eating disorders on quality of life using the disease-specific, Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire.

OBJECTIVE: To evaluate and compare the quality of life (QOL) in patients with eating disorders (ED) and general population, using the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire. METHODS: A total of 358 patients with ED completed the HeRQoLED questionnaire as well as the SF-12 and the Eating Attitudes Test (EAT-26) at baseline; 273 patients completed the same instruments after 1 year of multidisciplinary treatment. A total of 305 individuals recruited from the general population completed the HeRQoLED once. Comparison of means was used to assess change. Multivariate models were created to determine variables predictive of change in HeRQoLED scores. RESULTS: Patients with anorexia nervosa had higher baseline scores (indicating worse perception of QOL) on the HeRQoLED questionnaire and experienced smaller improvements than patients with other diagnoses after 1 year of treatment. After adjustment by relevant variables, body-mass index (BMI) and EAT-26 scores were associated with changes in QOL. SF-12 scores showed significant improvement in the physical health component but not in mental health. General population had lower baseline scores on the HeRQoLED. CONCLUSIONS: As measured by the disease-specific HeRQoLED and generic instruments, QOL in patients with ED improved after 1 year of treatment, though it did not reach the values of the general population.

[Analysis of prescription patterns of antipsychotic agents in psychiatry]. / Análisis de los patrones de prescripción de antipsicóticos en psiquiatría.

INTRODUCTION: We describe the different diseases in which conventional and second generation antipsychotic (APS) prescriptions are made. METHOD: Observational, retrospective, multicenter study based on the review of 300 clinical records of public and private sites, hospital and out-patient clinics, located in Salamanca, Vigo, Bilbao, Barcelona, Valencia, Oviedo and Malaga. RESULTS: The mean age of the population studied was 42 +/- 17 years; 56.6 % were men. Atypical drugs (67 %) were used basically versus classical ones (33 %). Classical APS are basically prescribed in bipolar disorder with/without psychotic symptoms (20.6 %), schizophrenia (18.3%) and delusional disorder (11.5 %). Atypical APS are fundamentally prescribed in schizophrenia (31.5 %), bipolar disorders with/without psychotic symptoms (12.5 %) and other psychotic disorders (8.9 %). When the psychotic disorders are considered by groups (schizophrenia, bipolar disorder with psychotic symptoms, delusional disorder and other psychotic disorders), classical APS are used in 47.4 % and atypical APS in 62.5%. APS were used ((outside the indication)) (off-label) in 32.8%, including resistant depressions, serious obsessive-compulsive disorder and borderline personality disorder, with similar percentages for both conventional and atypical ones. In dementia, atypical APS were used in 5.1 % versus 1.5 % of the conventional ones. The most frequent reasons for prescription of classical APS were control of psychotic symptoms (33.6 %), aggressiveness-agitation (31.3 %), severe insomnia (16 %), impulsivity (6.9 %) and severe anxiety (6.1 %). Atypical APS were preferably used in the control of psychotic symptoms (58.8%) and aggressiveness-agitation (25.5%). CONCLUSIONS: The use of APS basically occurs within their authorized indications (67.2 %). The off-label use (32.8 %) occurs both for the classical as well as atypical APS and occurs in serious diseases in which there are no alternative treatments.

[Quality of life and social functioning in schizophrenic patients treated with olanzapine: 1 year follow-up naturalistic study]. / Calidad de vida y funcionamiento social en pacientes con esquizofrenia en monoterapia con olanzapina: estudio naturalístico de 1 año de seguimiento.

OBJECTIVE: To measure health related quality of life (HRQL) and social functioning in schizophrenic patients treated with olanzapine under regular clinical practice conditions. METHODS: Out-patients diagnosed of schizophrenia and beginning treatment with olanzapine, quetiapine, risperidone or typical oral antipsychotics were included. Information on socio-demographic characteristics was obtained and in each visit (baseline, 3, 6 and 12 months) they were administered the generic HRQL questionnaire Euro-QoL-5D (EQ-5D) and the Social Functioning Scale (SFS). RESULTS: A total of 1,198 patients were followed-up for 12 months. Mean age (SD) was 38.6 (13.3) years and 62.9 % of them were men. In basal conditions the most affected dimensions of EQ-5D were anxiety/depression (76 %), and daily activities (73.6 %). After 12 months treatment the cohort of patients treated with olanzapine showed a better HRQL in the self-care dimension compared to all other treatments (p < 0.05), and in the dimensions of pain/discomfort, anxiety/depression and usual activities compared to the group treated with quetiapine and risperidone (p < 0.05). The Visual Analogue Scale (VAS) of the EQ-5D questionnaire showed a better health state after 12 months in the group treated with olanzapine compared to the groups of quetiapine or risperidone (p < 0.05). The SFS showed a better improvement in the cohort of olanzapine in the three studied dimensions after 12 months: isolation and social relationships in comparison to the risperidone group (p < 0.05), interpersonal communication in comparison to the risperidone and quetiapine group (p < 0.05) and independence performance in comparison to all the other treatments (p < 0,05). CONCLUSION: Schizophrenic patients treated with olanzapine for one year show a better improvement in HRQL and social functioning than those treated with other antipsychotics.

Calidad de vida y funcionamiento social en pacientes con esquizofrenia en monoterapia con olanzapina: estudio naturalístico de 1 año de seguimiento / Quality of life and social functioning in schizophrenic patients treated with olanzapine: 1 year follow-up naturalistic study

Objetivo. Evaluar la calidad de vida relacionada con la salud (CVRS) y funcionalidad social de los pacientes esquizofrénicos tratados en monoterapia con olanzapina en condiciones de práctica clínica habitual. Métodos. Se reclutaron pacientes ambulatorios diagnosticados de esquizofrenia que iniciasen tratamiento en monoterapia con olanzapina, quetiapina, risperidona o antipsicóticos típicos orales. Se recogieron las variables sociodemográficas del paciente. En cada visita (basal, 3, 6, 12 meses) se administró el cuestionario genérico de CVRS EuroQoL-5D (EQ-5D) y la Escala de Funcionamiento Social. Resultados. Se siguieron un total de 1.198 pacientes. La edad media (DE) era de 38,6 (13,3) y un 62,9 % era hombres. Según el cuestionario EQ-5D basalmente las dimensiones más afectadas fueron ansiedad/depresión (76 %) y actividades cotidianas (73,6 %). A los 12 meses la cohorte tratada con olanzapina presentó una mejor CVRS en la dimensión de cuidado personal respecto al resto de tratamientos (p < 0,05) y un porcentaje menor en las dimensiones de dolor/malestar, ansiedad/ depresión y actividades habituales respecto al grupo tratado con quetiapina o risperidona (p < 0,05). Según la Escala Visual Analógica (EVA) del cuestionario EQ-5D la cohorte tratada con olanzapina presentó mejor estado de salud a los 12 meses que los tratados con quetiapina o risperidona (p<0,05). La Escala de Funcionamiento Social demostró una mejora a los 12 meses en los pacientes tratados con olanzapina en las tres dimensiones estudiadas: aislamiento y relaciones sociales respecto a los tratados con risperidona (p<0,05), comunicación interpersonal respecto a los tratados con risperidona o quetiapina (p < 0,05) e independencia de ejecución respecto al resto de tratamientos (p<0,05). Conclusión. La mejora en la CVRS y funcionamiento social al año de seguimiento es mayor en aquellos pacientes tratados con olanzapina que con otros antipsicóticos

Objective. To measure health related quality of life (HRQL) and social functioning in schizophrenic patients treated with olanzapine under regular clinical practice conditions. Methods. Out-patients diagnosed of schizophrenia and beginning treatment with olanzapine, quetiapine, risperidone or typical oral antipsychotics were included. Information on socio-demographic characteristics was obtained and in each visit (baseline, 3, 6 and 12 months) they were administered the generic HRQL questionnaire Euro- QoL-5D (EQ-5D) and the Social Functioning Scale (SFS). Results. A total of 1,198 patients were followed-up for 12 months. Mean age (SD) was 38.6 (13.3) years and 62.9 % of them were men. In basal conditions the most affected dimensions of EQ-5D were anxiety/depression (76 %), and daily activities (73.6 %). After 12 months treatment the cohort of patients treated with olanzapine showed a better HRQL in the self-care dimension compared to all other treatments (p < 0.05), and in the dimensions of pain/discomfort, anxiety/depression and usual activities compared to the group treated with quetiapine and risperidone (p < 0.05). The Visual Analogue Scale (VAS) of the EQ-5D questionnaire showed a better health state after 12 months in the group treated with olanzapine compared to the groups of quetiapine or risperidone (p < 0.05). The SFS showed a better improvement in the cohort of olanzapine in the three studied dimensions after 12 months: isolation and social relationships in comparison to the risperidone group (p < 0.05), interpersonal communication in comparison to the risperidone and quetiapine group (p < 0.05) and independence performance in comparison to all the other treatments (p < 0,05). Conclusion. Schizophrenic patients treated with olanzapine for one year show a better improvement in HRQL and social functioning than those treated with other antipsychotics

[GEOPTE Scale of social cognition for psychosis]. / Escala GEOPTE de cognición social para la psicosis.

INTRODUCTION: Despite the large number of scales to assess cognitive function, these are rarely used in clinical practice, both because of the time they require and because they do not give useful information to the clinician. The aim of this article is to present the characteristics and psychometric properties of a scale which aims, with its simplicity of use and design, to be of use in the clinical practice for measuring social cognition in psychosis. METHODS: The new GEOPTE Scale gathers information from two sources: the patient's subjective perception of his/her deficits and that of the informant or caregiver. It consists of 15 items (7 for basic cognitive functions and 8 for social cognition). The scale was applied to 87 patients with a diagnosis of psychosis (according to DSM-IV), and general clinical data, clinical global impression, mood and degree of insight were gathered. RESULTS: The GEOPTE Scale presented excellent internal consistency (Cronbach's alpha 0.84 for patient and 0.87 for informants). Factorial analysis identified two factors which explained a total variance of 39%. The first factor was related to the basic cognitive function items and the second to the social cognition items. Regarding the validity of the construct, the scores on the scale are closely related to clinical global impression, degree of insight and depressive symptoms. CONCLUSIONS: The GEOPTE Scale for measuring social cognition in psychosis has an excellent psychometric behavior both in the degree of internal consistency and in correlation with clinical global variables, mood and degree of insight.

[Differential characteristics of families of adolescents and young adults that have attempted suicide]. / Aspectos diferenciales de las familias de adolescentes y jóvenes adultos que realizan tentativas de suicidio.

INTRODUCTION: Families of adolescent and young adult suicide attempters are studied to analyze their role in these extremely dangerous behaviors. METHOD: 72 adolescents and young adults (aged 15-24) who have made a suicide attempt and 72 normal controls matched by sex, age and marital status, are studied in a case-control design. Several aspects of each family are explored: composition, degree of stability in parental couple, type of relationships among the members, labor status of parents and medical-psychiatric and legal family history. RESULTS AND CONCLUSIONS: Only parameters analyzing parents-offspring interactions can differentiate both groups. Keep an unsatisfactory relation with any of the living parents are the family factors which place the young or adolescent subject in risk of making a suicide attempt in our surrounding.

[Evaluation of the efficacy of psychoeducative groups in schizophrenic patients]. / Evaluación de la eficacia de los grupos psicoeducativos en pacientes esquizofrénicos.

One of the main difficulties we find in psychopharmacologic treatment of schizophrenia is medication compliance. Following Kissling, only 40-50% of patients adequately follow prescription directions. This phenomenon becomes one of the major factors of the high relapse rates in schizophrenia. Several studies have been made in recent oriented to improve medication compliance through psychoeducational groups involving patients and their closest relatives. Our results confirm the hypothesis. Statistically significant differences (p < 0.0001) are found between readmission rates in control group (2.32%) and in group of patients participating in psychoeducational groups (0.30%). Significant differences are also found when considering separately first episode patients (1.61% controls vs. 0.04% cases, p < 0.0001) and patients with previous history (3.05% controls vs. 0.61% cases, p < 0.0001).

[Organic personality disorder: response to carbamazepine]. / Trastorno orgánico de la personalidad. Respuesta a carbamazepina.

Organic Personality Disorder is a clinical diagnosis included in ICD-10 classification and also, under a different name, in DSM-IV. Many different treatments have been proposed to improve this condition, carbamazepine being one of them. A case report is presented of a 28 years old patient who, six years before, had suffered a severe brain injury in a car accident. From then on, an intensification of previous personality traits could be observed besides sexual exhibitionism, promiscuity, aggressive episodes, suspiciousness and low impulse control. A chaotic socio-familial situation induced two psychiatric admissions. The patient was initially treated with neuroleptics, benzodiazepines and antidepressants, with no response. Treatment with carbamazepine was then started, reaching a dose of 1,200 mg/day and maintaining plasma levels of 8.8 mcg/ml. After two months of this treatment a marked improvement was observed with absence of exhibitionistic behavior and aggressive episodes, a tendency towards normalization of mood and anxiety, stabilization of his social and family relationships and starting some paid work.

Schizophrenia: gender, family risk, and plasma homovanillic acid.

Plasma homovanillic acid concentration was assessed in 60 young schizophrenic patients, with and without first-degree relatives with schizophrenia, before treatment, and 3 days after starting haloperidol treatment. The baseline concentration of homovanillic acid in plasma was no different in the two groups before treatment; it was, however, significantly higher in the patients with relatives than in those without relatives diagnosed of schizophrenia after 3 days of haloperidol treatment.

Morning variations of plasma homovanillic acid in untreated schizophrenic patients.

Plasma concentrations of homovanillic acid were determined in samples obtained at 8.30 a.m. and 12.30 p.m. from 29 untreated schizophrenic patients, 14 males and 15 females. When the earlier samples were compared with the later, a significant decrease in mean plasma homovanillic acid level was observed, but only in the male patients. The morning fall was observed in 10 of 14 male patients and 6 of the 15 female patients. This morning rhythm in plasma homovanillic acid concentration may mask the putative rises in plasma homovanillic acid provoked by neuroleptic administration and may explain some of the observed differences between findings in studies involving the assessment of this metabolite.