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[Epidemiological and diagnostic axis I gender differences in dual diagnosis patients]. / Diferencias de género epidemiológicas y diagnósticas según eje I en pacientes con Patología Dual.

INTRODUCTION: Dual diagnosis is the co-occurrence of a substance abuse disorder and a psychiatric condition. Gender has been found to be associated with differences in prevalence of mental disorders as well as outcome, prognosis and treatment-seeking. MATERIAL AND METHODS: Articles published in Medline, Web of Science and Journal Citation Reports up to December 2009 that examined gender, prevalence and clinical characteristics of dual-diagnosis patients aged over 18 were reviewed. CONCLUSIONS: The distribution of Axis I disorders by gender is similar for dually diagnosed patients and single-disorder patients. The prevalence of psychotic and bipolar disorders is higher in men, whereas anxiety and affective disorders are more prevalent in women. Dually diagnosed females with psychotic disorders do not show better prognosis than men. Finally, polydrug use among dual-diagnosis individuals is more prevalent in males.

Diferencias de género epidemiológicas y diagnósticas según eje I en pacientes con Patología Dual / Epidemiological and diagnostic axis I gender differences in Dual Diagnosis patients

Introducción: La patología dual (PD) es la coexistencia de un trastorno por uso de sustancias (TUS) y otro trastorno mental. Se ha descrito que el género es un factor que influye en la prevalencia de las enfermedades psiquiátricas, su expresión sintomática, curso, pronóstico, demanda y respuesta al tratamiento. Material y métodos: Se revisan 40 estudios publicados en Medline, Web of Science, y Journal Citation Reports hasta diciembre de 2009que contienen información a cerca de las diferencias de género en la prevalencia y las características clínicas de pacientes duales mayores de 18 años. Conclusiones: La distribución de los trastornos mentales del Eje I en pacientes duales, según el género, se mantiene similar a la de los trastornos mentales no duales en la población general. Existe mayor prevalencia en hombres de trastornos psicóticos y bipolares, y en mujeres mayor prevalencia de trastornos de ansiedad y afectivos. El género femenino deja de ser factor de buen pronóstico en la psicosisdual. Por otra parte, el policonsumo es más frecuente en los varones (AU)

Introduction: Dual diagnosis is the co-occurrence of a substance abuse disorder and a psychiatric condition. Gender has been found to be associated with differences in prevalence of mental disorders as well as outcome, prognosis and treatment-seeking. Material and Methods: Articles published in Medline, Web of Science and Journal Citation Reports up to December 2009 that examined ender, prevalence and clinical characteristics of dual-diagnosis patients aged over 18 were reviewed. Conclusions: The distribution of Axis I disorders by gender is similar for dually diagnosed patients and single-disorder patients. The prevalence of psychotic and bipolar disorders is higher in men, whereas anxiety and affective disorders are more prevalent in women. Dually diagnosed females with psychotic disorders do not show better prognosis than men. Finally, poly drug use among dual-diagnosis individuals is more prevalent in males (AU)

[Smoking in affective psychosis: review about nicotine use in bipolar and schizoaffective disorders]. / Fumar en las psicosis afectivas: revisión sobre el consumo de nicotina en el trastorno bipolar y esquizoafectivo.

Affective psychoses include those disorders with psychotic and affective symptoms described in the DSM-IV-TR. In these pathologies, the prevalence of nicotine dependence is very high. The objective here is to carry out a review of the relation between nicotine use and psychiatric disorders considered as affective psychoses at the epidemiological, clinical, prognostic and treatment levels. We review studies published in the PubMed database that include the keywords smoking, tobacco, nicotine and schizoaffective or bipolar disorder. Comorbidity of bipolar and schizoaffective disorder with nicotine consumption is 66-82.5 % and 67%, respectively. On the basis of this review it can be concluded that smoking results in poorer prognosis and greater clinical seriousness of bipolar and schizoaffective disorders. Use of other substances, psychiatric diagnosis, clinical seriousness and caffeine consumption are risk factors for nicotine use. The most effective treatment approach is pharmacological treatment in combination with psychological interventions. The first-line medication for tobacco detoxification and dishabituation are substitution therapy (transdermal patches, sprays, sublingual tablets, sucking pills or nicotine chewing gums), varenicline and bupropion. The medically indicated treatment for psychotic symptoms is atypical antipsychotics, due to their better tolerability profile and better results in smoking cessation.

Fumar en las psicosis afectivas: revisión sobre el consumo de nicotina en el trastorno bipolar y esquizoafectivo / Smoking in affective psychosis: review about nicotine use in bipolar and schizoaffective disorders

Las psicosis afectivas incluyen aquellos trastornos con síntomas psicóticos y afectivos descritos en el DSM-IV-TR. En ellas, la prevalencia de la dependencia de nicotina es muy elevada. El objetivo es revisar la relación entre el consumo de nicotina y las psicosis afectivas a nivel epidemiológico, clínico, pronóstico, y de tratamiento. Se revisan los artículos publicados en la base PubMed que incluyen las palabras fumar, tabaco, nicotina y trastorno esquizoafectivo o bipolar. La comorbilidad del trastorno bipolar y el trastorno esquizoafectivo con el consumo de nicotina es de 66-82,5% y del 67% respectivamente. Tras esta revisión se puede concluir que el hábito tabáquico determina un peor pronóstico y mayor gravedad clínica del trastorno bipolar y esquizoafectivo. El consumo de otras sustancias, el diagnóstico, el consumo de cafeína y la gravedad clínica son factores de riesgo para el consumo de nicotina. El tratamiento más efectivo es el farmacológico en combinación con el psicológico. Los medicamentos de primera línea para la desintoxicación y deshabituación tabáquica son la terapia sustitutiva (parches transdérmicos, aerosoles, tabletas sublinguales, comprimidos para chupar o chicles de nicotina), la vareniclina y el bupropion. El tratamiento indicado para los síntomas psicóticos son los antipsicóticos atípicos por su mejor perfil de tolerabilidad y mejores resultados para el abandono del hábito tabáquico (AU)

Affective psychoses include those disorders with psychotic and affective symptoms described in the DSM-IV-TR. In these pathologies, the prevalence of nicotine dependence is very high. The objective here is to carry out a review of the relation between nicotine use and psychiatric disorders considered as affective psychoses at the epidemiological, clinical, prognostic and treatment levels. We review studies published in the PubMed database that include the keywords smoking, tobacco, nicotine and schizoaffective or bipolar disorder. Comorbidity of bipolar and schizoaffective disorder with nicotine consumption is 66-82.5% and 67%, respectively. On the basis of this review it can be concluded that smoking results in poorer prognosis and greater clinical seriousness of bipolar and schizoaffective disorders. Use of other substances, psychiatric diagnosis, clinical seriousness and caffeine consumption are risk factors for nicotine use. The most effective treatment approach is pharmacological treatment in combination with psychological interventions. The first-line medication for tobacco detoxification and dishabituation are substitution therapy (transdermal patches, sprays, sublingual tablets, sucking pills or nicotine chewing gums), varenicline and bupropion. The medically indicated treatment for psychotic symptoms is atypical antipsychotics, due to their better tolerability profile and better results in smoking cessation (AU)

[Concomitant lithium and methadone treatment in a bipolar patient: a case report]. / Tratamiento concomitante de litio y metadona en un paciente bipolar: a propósito de un caso.

Dual diagnosis requires complex therapeutic approaches to adapt treatment to the dual nature of the problem. It is important to understand the drug effects and the drug interactions that may be observed during the integral treatment of these pathologies. Given the scarcity of data on the effects of lithium and methadone treatment, the aim of this clinical case report is to explain the interactions produced between methadone and lithium carbonate, in a female patient with medical multi-pathology, opioid-dependent and with comorbid bipolar disorder, who was treated with both drugs. The most common adverse effects for each drug are described. Drug interactions and temporal correspondence of the two drugs, as well as their dosages, are described through review of the retrospective chart and prospective follow-up of the patient. After one year of follow-up the patient had experienced no interactions in the concomitant lithium and methadone treatment. It should be noted that treatment of bipolar patients with dual diagnosis is complex, and should only be carried out by experts.

Tratamiento concomitante de litio y metadona en un paciente bipolar: a propósito de un caso / Concomitant lithium and methadone treatment in a bipolar patient: a case report

La patología dual requiere aproximaciones terapéuticas complejas para adecuar el tratamiento a la doble naturaleza del problema. Es importante conocer los efectos e interacciones medicamentosas que puedan acontecer para evaluar la sintomatología que refiere el paciente. Dados los escasos datos sobre los efectos del tratamiento con litio y metadona, el objetivo de la exposición de este caso clínico es explicar las interacciones producidas entre metadona y carbonato de litio, en una paciente tratada con ambos fármacos, afecta de pluripatología médica y con dependencia de opiáceos y trastorno bipolar. Se exponen los diferentes efectos adversos más frecuentes de cada fármaco. Se describe de forma retrospectiva y prospectiva el manejo del tratamiento y las interacciones entre estos dos fármacos mediante la revisión de la historia clínica de la paciente y se detalla la correspondencia temporal entre las dosis de cada uno de ellos y la evolución. Tras un año de seguimiento, la paciente no ha sufrido interacciones en el tratamiento concomitante de litio y metadona. El tratamiento en pacientes bipolares duales es complejo y debe ser realizado por equipos expertos (AU)

Dual diagnosis requires complex therapeutic approaches to adapt treatment to the dual nature of the problem. It is important to understand the drug effects and the drug interactions that may be observed during the integral treatment of these pathologies. Given the scarcity of data on the effects of lithium and methadone treatment, the aim of this clinical case report is to explain the interactions produced between methadone and lithium carbonate, in a female patient with medical multi-pathology, opioid-dependent and with comorbid bipolar disorder, who was treated with both drugs. The most common adverse effects for each drug are described. Drug interactions and temporal correspondence of the two drugs, as well as their dosages, are described through review of the retrospective chart and prospective follow-up of the patient. After one year of follow-up the patient had experienced no interactions in the concomitant lithium and methadone treatment. It should be noted that treatment of bipolar patients with dual diagnosis is complex, and should only be carried out by experts (AU)