Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis.

The aim of this work is to investigate the effectiveness of Deep Brain Stimulation (DBS) in patients with severe Obsessive Compulsive Disorder (OCD) who are resistant to pharmacological treatments, focusing on obsessive compulsive, depressive and anxiety symptoms as well as global function. A systematic review and meta-analysis including 25 studies (without language restrictions) from between 2003 and 2020 was performed. A total of 303 patients were evaluated twice (before and after DBS). After DBS treatment OCD patients with resistance to pharmacological treatments showed a significant improvement of obsessive-compulsive symptoms (25 studies; SMD=2.39; 95% CI, 1.91 to 2.87; P<0.0001), depression (9 studies; SMD= 1.19; 95%CI, 0.84 to 1.54; P<0.0001), anxiety (5 studies; SMD=1.00; 95%CI, 0.32 to 1.69; P=0.004) and functionality (7 studies; SMD=-3.51; 95%CI, -5.00 to -2.02; P=0.005) measured by the standardized scales: Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Global Assessment of Function (GAF). Publication bias were discarded by using funnel plot. The main conclusions of this meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms.

Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study.

OBJECTIVE: To compare quality of life (QoL), anxiety and depressive symptoms, alcohol consumption and other correlates between patients with psoriasis and controls; and to identify features of psoriasis associated with lower levels of QoL. METHOD: Case-control study including 70 subjects with moderate-severe psoriasis and 140 controls without psoriasis. All participants answered the Short Form Health Survey (SF-36), with physical and mental component scores of quality of life, and the Hospital Anxiety and Depression Scale (HADS). Among subjects with psoriasis, the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were used, respectively, to measure the severity of psoriasis and the impact of psoriasis on the specific quality of life. RESULTS: Compared to controls, patients with psoriasis showed higher HADS depression score and alcohol consumption, and lower QoL. Among subjects with psoriasis, multivariate analysis showed: 1) poorer physical QoL was associated with older age, articular lesions and anxious symptoms, whereas poorer mental QoL was associated with younger age, female sex, genital lesions and depressive symptoms; 2) the higher the severity of psoriasis, the lower the level of QoL and the higher the levels of anxious or depressive symptoms; and 3) female sex and articular or genital location of lesions are linked with higher HADS scores. CONCLUSION: Higher scores in anxiety and depression and lower QoL is common in psoriasis, especially among women and those with genital or articular lesions. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.

Disordered eating behaviors among Christian and Muslim adolescents in Ceuta, a multicultural town.

Studies on disordered eating behaviors (DEB) in multicultural populations with multiple religious/cultural affiliations are needed in order to clarify the relationship between cultural background and DEB. Therefore, we compared the presence of DEB among Christian and Muslim adolescents who share their school environment, controlling for the effect of body mass index, demographic variables and lifestyle habits. A sample of 493 girls and boys (339 Christian, 138 Muslim) whose mean (±SD) age was 14.8 (±1.7) years completed self-reporting questionnaires and underwent measurements of anthropometric data. Religious/cultural affiliation was defined by self-identification. The dependent variable, DEB was assessed by means of the Eating Disorders Inventory (EDI-2). Muslim girls and boys score higher than Christians on EDI-2 total scores, especially on the perfectionism subscale. Bivariate and multivariate analyses were used to determine the characteristics associated with DEB, which were detected in 24% of participants (19% of Christians and in 35% of Muslims). Among girls, DEB were directly associated with overweight or obesity, the presence of frequent quarrels with parents, academic failure and spending more than 3 h a day watching screen images. Among boys, DEB were directly associated with overweight or obesity and Muslim background; and inversely associated with age and socioeconomic status.

Manejo de la psicosis en pacientes con VIH: a propósito de un caso / Psychosis management in patients with HIV: case report

La infección por el virus de la inmunodeficiencia humana (VIH) puede dar lugar a alteraciones neuropsiquiátricas tales como déficits cognitivos, alteraciones comportamentales o sintomatología psiquiátrica como manía o psicosis secundaria. La evolución y curso pronóstico de los individuos con VIH que presentan comorbilidad psiquiátrica dependerá en gran medida de que se ofrezca un tratamiento adecuado que incluya, por una parte, tratamiento del factor etiológico (VIH) y, por otra, tratamiento de los síntomas psíquicos en cuestión. A partir de la presentación del caso clínico de una paciente con encefalitis en el contexto de una infección por VIH no conocida, que debuta con sintomatología psicótica en forma de trastorno por ideas delirantes de tipo somático, ofrecemos una revisión acerca del manejo de la psicosis en pacientes VIH. Dicha revisión se centra en la epidemiología, etiopatogenia y presentación clínica de la psicosis asociada al VIH así como en el manejo farmacológico recomendado (antirretroviral y antipsicótico) y su particular respuesta al mismo. Ofrecemos al mismo tiempo amplia información acerca de las principales interacciones entre los fármacos antipsicóticos y antirretrovirales que otorgarán al clínico un manejo más adecuado de dichos pacientes

Human immunodeficiency virus (HIV) infection can cause neuropsychiatric disorders such as cognitive impairment, behavioural difficulties or psychiatric symptoms -for instance, mania and psychosis. HIV patients with psychiatric comorbidities need an appropriate treatment which tackles the HIV infection as much as the particular mental symptoms. Here we present the case of a patient suffering from delusions, which turned out to be caused by encephalitis secondary to a previously unknown HIV infection. A review of psychosis in HIV-infected patients is also presented. This review is focused on the epidemiology, etiopathogenesis and clinical presentation of HIV-induced psychosis, as well as the recommended pharmacological treatment (antiretroviral therapy and antipsychotic medication) and the expected treatment response. We also present wide information concerning pharmacological interactions between antiretroviral and antipsychotic medications that we hope will help the clinician to better manage this complex condition

Psychosis management in patients with hiv: case report.

Human immunodeficiency virus (HIV) infection can cause neuropsychiatric disorders such as cognitive impairment, behavioural difficulties or psychiatric symptoms –for instance, mania and psychosis. HIV patients with psychiatric comorbidities need an appropriate treatment which tackles the HIV infection as much as the particular mental symptoms. Here we present the case of a patient suffering from delusions, which turned out to be caused by encephalitis secondary to a previously unknown HIV infection. A review of psychosis in HIV-infected patients is also presented. This review is focused on the epidemiology, etiopathogenesis and clinical presentation of HIV-induced psychosis, as well as the recommended pharmacological treatment (antiretroviral therapy and antipsychotic medication) and the expected treatment response. We also present wide information concerning pharmacological interactions between antiretroviral and antipsychotic medications that we hope will help the clinician to better manage this complex condition.

Factores asociados a malestar psicológico o trastornos mentales comunes en poblaciones migrantes a lo largo del mundo / Factors associated with psychological distress or common mental disorders in migrant populations across the world

Se revisan sistemáticamente los factores asociados a la presencia de malestar psicológico o trastornos mentales comunes en poblaciones migrantes. Se revisaron los artículos publicados entre enero de 2000 y diciembre de 2014, de los que se seleccionaron 85 que aplicaban análisis estadísticos multivariantes. Los trastornos mentales comunes se asociaban significativamente a características sociodemográficas y psicológicas, lo mismo que se observa en grandes estudios epidemiológicos de poblaciones generales. La probabilidad de trastornos mentales comunes aumentó significativamente entre grupos de migrantes, además de por la región de origen, por los siguientes factores: sucesos traumáticos previos; migración forzosa, escasamente planificada o ilegal; bajo nivel de aculturación, vivir solo o separado de la familia en el nuevo país, falta de apoyo social, discriminación percibida y tiempo transcurrido en el nuevo país. Para diseñar estrategias preventivas se ha de tener en cuenta los factores asociados al riesgo de morbilidad psiquiátrica en poblaciones migrantes (AU)

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants’ residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies (AU)

Temporal sequencing of nicotine dependence and major depressive disorder: A U.S. national study.

Major Depressive Disorder (MDD) and Nicotine dependence (ND) often co-occur. However, little attention has been given to the temporal order between the two disorders. We compared the sociodemographic and clinical characteristics of individuals whose onset of ND preceded (ND-prior) or followed the onset of MDD (MDD-prior). Binary logistic regression models were computed to compare ND-prior (n=546) and MDD-prior (n=801) individuals from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n=43,093). We found that MDD-prior were more likely to have a history of suicide attempts and a family history of both depression and antisocial behavior, to have had psychiatric hospitalization, and to have an earlier age of onset of the first depressive episode; but a later age of onset for both daily smoking and ND. On average, MDD-prior individuals showed a significantly longer transition time from daily smoking to ND (15.6±0.6 vs. 6.9±0.4 years, P<0.001). In contrast, ND-prior subjects had a significantly greater proportion of withdrawal symptoms, and of lifetime alcohol use or alcohol use disorder. We conclude that the phenomenology and course of ND and MDD vary significantly, depending on which disorder had earlier onset.

Factors associated with psychological distress or common mental disorders in migrant populations across the world. / Factores asociados a malestar psicológico o trastornos mentales comunes en poblaciones migrantes a lo largo del mundo.

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants' residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies.

Risk factor assessment and counselling for 12 months reduces metabolic and cardiovascular risk in overweight or obese patients with schizophrenia spectrum disorders: The CRESSOB study.

BACKGROUND: Metabolic syndrome (MS) and cardiovascular risk factors (CRF) have been associated with patients with schizophrenia. The main objective is to assess the evolution of CRF and prevalence of MS for 12 months in a cohort of overweight patients diagnosed with schizophrenia schizophreniform disorder or schizoaffective disorder in which the recommendations for the assessment and control of metabolic and cardiovascular risk were applied. METHODS: The Control of Metabolic and Cardiovascular Risk in Patients with Schizophrenia and Overweight (CRESSOB) study is a 12-month, observational, prospective, open-label, multicentre, naturalistic study including 109 community mental health clinics of Spain. The study included a total of 403 patients, of whom we could collect all variables related to CRF and MS in 366 patients. Of these 366 patients, 286 completed the follow-up, (baseline, months 3, 6 and 12) where they underwent a complete physical examination and a blood test (glucose, cholesterol and triglycerides), they were asked about their health-related habits (smoking, diet and exercise) and they were given a series of recommendations to prevent cardiovascular risk and MS. RESULTS: A total of 403 patients were included, 63% men, mean age (mean; (SD)) 40.5 (10.5) years. After 12 months, the study showed statistically significant decrease in weight (p<0.0001), waist circumference (p<0.0001), BMI (p<0.0001), blood glucose (p=0.0034), total cholesterol (p<0.0001), HDL cholesterol (p=0.02), LDL cholesterol (p=0.0023) and triglycerides (p=0.0005). There was a significant reduction in the percentage of smokers (p=0.0057) and in the risk of heart disease at 10 years (p=0.0353). CONCLUSION: Overweight patients with schizophrenia who receive appropriate medical care, including CRF monitoring and control of health-related habits experience improvements with regard to most CRFs.

La evaluación de factores de riesgo y el asesoramiento durante 12 meses reduce el riesgo metabólico y cardiovascular en pacientes con trastornos del espectro esquizofrénico con sobrepeso u obesidad: Estudio CRESSOB / Risk factor assessment and counselling for 12 months reduces metabolic and cardiovascular risk in overweight or obese patients with schizophrenia spectrum disorders: The CRESSOB study

Introducción. Se ha asociado la presencia del síndrome metabólico (SM) y de factores de riesgo cardiovascular (FRC) a pacientes con esquizofrenia. El principal objetivo es evaluar la evolución de los FRC y la prevalencia del SM durante 12 meses en una cohorte de pacientes con sobrepeso diagnosticados de esquizofrenia esquizofreniforme o de trastorno esquizoafectivo a la que se aplicaron las recomendaciones para la evaluación y control del riesgo cardiovascular. Método. El estudio del control del riesgo metabólico y cardiovascular en pacientes con esquizofrenia y sobrepeso [Control of Metabolic and Cardiovascular Risk in Patients with Schizophrenia and Overweight (CRESSOB)] es un estudio de 12 meses, observacional, prospectivo, abierto, multicéntrico, naturalístico que incluye 109 centros de salud mental en España. El estudio incluyo un total de 403 pacientes, de los cuales se recopilaron todas las variables relacionadas con FRC y SM en 366 pacientes. De esos 366, 286 completaron el seguimiento, (basal, a los 3, 6 y 12 meses) en el que se llevaron a cabo un examen físico completo y una analítica de sangre (glucosa, colesterol y triglicéridos), se les preguntó sobre hábitos de salud (tabaco, dieta y ejercicio) y se les ofreció una serie de recomendaciones para prevenir el riesgo cardiovascular y el SM. Resultados. Un total de 403 pacientes fueron incluidos en el estudio, 63% hombres, de mediana edad [media 40,5 años; DE: (10,5)]. Transcurridos 12 meses, el estudio mostró descensos estadísticamente significativos en el peso

Background. Metabolic syndrome (MS) and cardiovascular risk factors (CRF) have been associated with patients with schizophrenia. The main objective is to assess the evolution of CRF and prevalence of MS for 12 months in a co hort of overweight patients diagnosed with schizophrenia schizophreniform disorder or schizoaffective disorder in which the recommendations for the assessment and control of metabolic and cardiovascular risk were applied. Methods. The Control of Metabolic and Cardiovascular Risk in Patients with Schizophrenia and Overweight (CRESSOB) study is a 12-month, observational, prospective, open-label, multicentre, naturalistic study including 109 community mental health clinics of Spain. The study included a total of 403 patients, of whom we could collect all variables related to CRF and MS in 366 patients. Of these 366 patients, 286 completed the follow-up, (baseline, months 3, 6 and 12) where they underwent a complete physical examination and a blood test (glucose, cholesterol and triglycerides), they were asked about their health-related habits (smoking, diet and exercise) and they were given a series of recommendations to prevent cardiovascular risk and MS. Results. A total of 403 patients were included, 63% men, mean age (mean; (SD)) 40.5 (10.5) years. After 12 months, the study showed statistically significant decrease in weight (p<0.0001) waist circumference (p<0.0001), BMI (p<0.0001), HDL colesterol (p=0.02), LDL colesterol (p=0.0023) and triglycerides (p=0.0005). There was a significant reduction in the percentage of smokers (p=0.0057) and in the risk of heart disease at 10 years (p=0.0353). Conclusion. Overweight patients with schizophrenia who receive appropriate medical care, including CRF monitoring and control of health-related habits experience improvements with regard to most CRFs

Caffeine consumption in a long-term psychiatric hospital: Tobacco smoking may explain in large part the apparent association between schizophrenia and caffeine use.

This study further explores the association between schizophrenia and caffeine use by combining two prior published Spanish samples (250 schizophrenia outpatients and 290 controls from the general population) with two Spanish long-term inpatient samples from the same hospital (145 with schizophrenia and 64 with other severe mental illnesses). The specific aims were to establish whether or not, after controlling for confounders including tobacco smoking, the association between schizophrenia and caffeine is consistent across schizophrenia samples and across different definitions of caffeine use. The frequency of caffeine use in schizophrenia inpatients was not significantly higher than that in non-schizophrenia inpatients (77%, 111/145 vs. 75%, 48/64) or controls but was significantly higher than in schizophrenia outpatients. The frequency of high caffeine users among caffeine users in schizophrenia inpatients was not significantly higher than in non-schizophrenia inpatients (45%, 50/111 vs. 52%, 25/48) or controls, but was significantly lower than in schizophrenia outpatients. Smoking was significantly associated with caffeine use across all samples and definitions. Between 2 and 3% of schizophrenia inpatients, schizophrenia outpatients and non-schizophrenia inpatients showed caffeinism (>700 mg/day in smokers). Several of these smoking patients with caffeinism were also taking other inducers, particularly omeprazole. The lack of consistent association between schizophrenia and caffeine use is surprising when compared with the very consistent association between tobacco smoking and caffeine use across all of our analyses (use and high use in users) and all our samples. The confounding effects of tobacco smoking may explain in large part the apparent association between schizophrenia and caffeine use.

[Prevalence of metabolic syndrome in Spanish patients with schizophrenia and overweight. The CRESSOB Study]. / Prevalencia del síndrome metabólico en pacientes españoles con esquizofrenia y sobrepeso. El estudio CRESSOB.

INTRODUCTION: Metabolic syndrome (MS) (visceral obesity, dyslipidemia, hyperglycemia, and hypertension), has become one of the major public-health challenges worldwide. Patients with schizophrenia are more likely to suffer from MS than the general population. OBJECTIVE: The primary aim of this study was to analyze the prevalence of MS in Spanish patients with schizophrenia and overweight and to compare the best method to calculate the MS prevalence in this population. A secondary aim of the CRESSOB study was to determine whether the presence of the metabolic syndrome (MS) is associated or not with clinical remission of schizophrenia. METHODS: The Control of Metabolic and Cardiovascular Risk in Patients with Schizophrenia and Overweight (CRESSOB) study is a 12-month, prospective, naturalistic study including 110 community mental health clinics selected at random. Each site enrolled four consecutive patients with a diagnosis of schizophrenia, according to DSM-IV TR criteria, and who were overweight (Body Mass Index (BMI) >25 kg/m2). To assess the prevalence of MS we analyzed the baseline results of the CRESSOB study. The National Cholesterol Education Program (NCEP-ATP III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definitions were used to establish the presence of MS. The Positive and Negative Syndrome Scale (PANSS) was used to determine the percentage of patients in remission. Psychosocial functioning was measured by the Global Assessment of Functioning (GAF) scale. RESULTS: A total of 391 patients were enrolled in the study (mean age 40.5 years, 63.8% men). 75.9% of the patients did not meet criteria for remission, using the selected PANSS items. The mean GAF score was 52.7 (Standard Deviation (SD) 15.4). Overall, 59.0% of males and 58.3% of females fulfilled the NCEP-ATP III criteria, 71.1% of males and 65.8% of females fulfilled the IDF criteria and 70.1% of males and 65.1% of females fulfilled the AHA/ NHLBI criteria. The patients who fulfilled remission criteria were younger, had a lower BMI, and a higher GAF score. CONCLUSIONS: MS is highly prevalent in Spanish patients with schizophrenia who are overweight. Given that metabolic syndrome is an important risk factor for cardiovascular disease, these patients should receive appropriate clinical monitoring for this syndrome.

Prevalencia del síndrome metabólico en pacientes españoles con esquizofrenia y sobrepeso. El estudio CRESSOB / Prevalence of Metabolic Syndrome in Spanish Patients with Schizophrenia and Overweight. The CRESSOB Study

Introducción: El síndrome metabólico (SM) (obesidad visceral, dislipemia, hiperglucemia e hipertensión) se ha convertido en uno de los mayores retos de salud pública en todo el mundo. Los pacientes con esquizofrenia son más propensos a sufrir SM que la población general. Objetivos: El objetivo principal de este estudio fue analizarla prevalencia del SM en pacientes españoles con esquizofrenia y sobrepeso y comparar el mejor método para calcular la prevalencia de SM en esta población. Un objetivo secundario del estudio CRESSOB fue determinar si la presencia del síndrome metabólico (SM) está asociada o no con la remisión clínica de la esquizofrenia. Método: El estudio de control del riesgo metabólico y cardiovascular en pacientes con esquizofrenia y sobrepeso (CRESSOB) es un estudio a 12 meses, prospectivo y naturalístico, que incluye 110 centros de salud mental seleccionados al azar. Cada centro seleccionó cuatro pacientes consecutivos con diagnóstico de esquizofrenia, según los criterios DSM-IV TR y que además tuvieran sobrepeso (índice de masa corporal (IMC)> 25 kg/m2). Para evaluar la prevalencia del SM se analizaron los resultados de la línea de base del estudio CRESSOB. Se utilizaron las definiciones del programa Nacional de Educación sobre el Colesterol (NCEP-ATP III), de la Federación Internacional de Diabetes (FID) y de la Asociación Americana del Corazón, el Pulmón y la Sangre (AHA/NHLBI) para establecer la presencia de SM. La escala de los Síndromes Positivo y Negativo (PANSS) se utilizó para determinar el porcentaje de pacientes en remisión. El funcionamiento psicosocial se midió mediante la Evaluación Global de Funcionamiento (GAF). Resultados: Se incluyeron en el estudio un total de391 pacientes (edad media 40,5 años, 63,8% de hombres). El 75,9% de los pacientes no cumplía los criterios de remisión, utilizando los elementos seleccionados de la PANSS. La puntuación media del GAF fue de 52,7 (desviación estándar (DE) de 15,4). En total, el 59,0% de los varones y el 58,3% de las mujeres cumplían los criterios del NCEP-ATP III, el 71,1% de los varones y el 65,8% de las mujeres cumplieron con los criterios de la FID y el 70,1% de los varones y el 65,1% de las mujeres cumplieron con los criterios de la AHA/NHLBI. Los pacientes que cumplieron los criterios de remisión fueron más jóvenes, tenían un índice de masa corporal más bajo y una puntuación superior en el GAF. Conclusiones: El SM es altamente prevalente en pacientes españoles con esquizofrenia que tienen sobrepeso. Dado que el síndrome metabólico es un factor de riesgo importante para la enfermedad cardiovascular, estos pacientes deben recibir una monitorización clínica adecuada para este síndrome

Introduction: Metabolic syndrome (MS) (visceral obesity, dyslipidemia, hyperglycemia, and hypertension), has become one of the major public-health challenges worldwide. Patients with schizophrenia are more likely to suffer from MS than the general population. Objective: The primary aim of this study was to analyze the prevalence of MS in Spanish patients with schizophrenia and overweight and to compare the best method to calculate the MS prevalence in this population. A secondary aim of the CRESSOB study was to determine whether the presence of the metabolic syndrome (MS) is associated or not with clinical remission of schizophrenia. Methods: The Control of Metabolic and Cardiovascular Risk in Patients with Schizophrenia and Overweight (CRESSOB) study is a 12-month, prospective, naturalistic study including 110 community mental health clinics selected at random. Each site enrolled four consecutive patients with a diagnosis of schizophrenia, according to DSM-IV TR criteria, and who were overweight (Body Mass Index (BMI) >25 kg/m2). To assess the prevalence of MS we analyzed the baseline results of the CRESSOB study. The National Cholesterol Education Program (NCEP-ATP III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definitions were used to establish the presence of MS. The Positive and Negative Syndrome Scale (PANSS) was used to determine the percentage of patients in remission. Psychosocial functioning was measured by the Global Assessment of Functioning (GAF) scale. Results: A total of 391 patients were enrolled in the study (mean age 40.5 years, 63.8% men). 75.9% of the patients did not meet criteria for remission, using the selected PANSS items. The mean GAF score was 52.7 (Standard Deviation (SD) 15.4). Overall, 59.0% of males and 58.3% of females fulfilled the NCEP-ATP III criteria, 71.1% of males and 65.8% of females fulfilled the IDF criteria and 70.1% of males and 65.1% of females fulfilled the AHA/NHLBI criteria. The patients who fulfilled remission criteria were younger, had a lower BMI, and a higher GAF score. Conclusions: MS is highly prevalent in Spanish patients with schizophrenia who are overweight. Given that metabolic syndrome is an important risk factor for cardiovascular disease, these patients should receive appropriate clinical monitoring for this syndrome

World region of origin and common mental disorders among migrant women in Spain.

Migration can affect the mental health of migrants. This cross-sectional study has two objectives: (1) to compare the prevalence of common mental disorder (CMD) between migrants (n = 458) living in Granada (Spain) and Spanish-born women (n = 448); (2) within migrants, to analyse the associations of world region of origin, other sociodemographic factors and post-migration features with the presence of CMD. Participants answered a questionnaire, including sociodemographic characteristics, post-migration features and CMD that was measured by Kessler K6-scale. Logistic regression analyses showed that CMD (K6 ≥ 13) was significantly higher among migrants than Spaniards. Compared with Spaniards, the odds of CMD were 3.6 [95 % confidence intervals (CI) 2.1­6.0] and 2.9 (CI 1.6­5.3), respectively, for Latin Americans and for Moroccan and other African women. Among migrants, Latin Americans as opposed to the reference group (migrants from other countries), had higher probability of CMD (OR 2.3, CI 1.1­4.9). This study supports the hypothesis that migration leads to mental distress. Consideration of world region of origin may clarify the differences observed in mental health across different migrant groups.

La sobrecarga del cuidador en el trastorno bipolar / Caregivers burden in bipolar disorder

La sobrecarga del cuidador de pacientes con trastorno bipolar ha sido estudiada con especial atención en los últimos años. Este artículo de revisión pretende hacer un resumen sobre esta cuestión. En concreto queremos conocer como es el nivel de sobrecarga en esta enfermedad, cuales son las variables clínicas que se asocian a un nivel mayor o menor de sobrecarga, que estilos de afrontamiento desarrollados por los cuidadores son más adaptativos para soportar dicha carga, cual es el impacto que sufre el cuidador a nivel sanitario, familiar, legal, económico y laboral, y que programas psicoeducativos han demostrado ser eficaces a la hora de tratar a los cuidadores (AU)

The excessive workload of the caregivers of patients with bipolar disorder has been studied with special attention in recent years. This review article intends to sum up the information and conclusions reported in studies to date. Specifically, we attempt to describe how the level of overload may be assessed, which clinical variables are associated with a greater or lesser overload, what coping mechanisms adopted by caregivers may be more adequate, what type of repercussions or impact may be suffered by the caregiver in terms of family, work, economic or legal matters, and which psychoeducational programs have proven more effective for treating caregivers (AU)

Phosphate levels as a possible state marker in panic disorder: preliminary study of a feasible laboratory measure for routine clinical practice.

OBJECTIVE: Low serum phosphate level is considered one of the metabolic adaptations to the respiratory alkalosis induced by hyperventilation associated with panic disorder. The aim of this study was to assess phosphatemia as a possible state marker for panic disorder. METHODS: Sixteen panic disorder patients underwent clinical assessment with a semi-structured interview, a set of rating scales and the self-rated State and Trait Anxiety Inventory (STAI), as well as extraction of venous blood samples at baseline and after 12 weeks of pharmacological treatment. Ten healthy volunteers of similar sex, age and educational level filled out the STAI and gave blood samples at baseline and 12 weeks later. RESULTS: The median (25th-75th percentiles) of phosphate levels (mg/dl) was 2.68 (2.22-3.18) among patients and 4.13 (3.74-4.70) among healthy volunteers respectively (P < 0.001). Seven (44%) patients and no healthy volunteers presented low serum phosphate (<2.50 mg/dl) at baseline; this patient abnormality was corrected in all cases after successful treatment. At baseline, the age-adjusted correlation between phosphate levels and state-anxiety was -0.66 (P < 0.001) among all 26 participants and -0.51 (P = 0.05) among the 16 panic disorder patients. CONCLUSIONS: Measurement of phosphate levels could be easily introduced into clinical practice as a possible marker for chronic hyperventilation in panic disorder, although further investigations with larger sample sizes are necessary to characterize panic disorder patients with low versus normal phosphate levels.

Temporal sequencing of nicotine dependence and bipolar disorder in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Bipolar disorder (BD) and nicotine dependence (ND) often co-occur. However, the mechanisms underlying this association remain unclear. We aimed to examine, for the first time in a national and representative sample, the magnitude and direction of the temporal relationship between BD and ND; and to compare, among individuals with lifetime ND and BD, the sociodemographic and clinical characteristics of individuals whose onset of ND preceded the onset of BD (ND-prior) with those whose onset of ND followed the onset of BD (BD-prior). The sample included individuals with lifetime BD type I or ND (n = 7958) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43093). Survival analyses and logistic regression models were computed to study the temporal association between ND and BD, and to compare ND-prior (n = 135) and BD-prior (n = 386) individuals. We found that ND predicted the onset of BD and BD also predicted the onset of ND. Furthermore, the risk of developing one disorder following the other one was greatest early in the course of illness. Most individuals with lifetime ND and BD were BD-prior (72.6%). BD-prior individuals had an earlier onset of BD and a higher number of manic episodes. By contrast, ND-prior individuals had an earlier onset of both daily smoking and ND, and an increased prevalence of alcohol use disorder. In conclusion, ND and BD predict the development of each other. The phenomenology and course of ND and BD varied significantly depending on which disorder had earlier onset.

Predictors of quit attempts and successful quit attempts in a nationally representative sample of smokers.

Although most current smokers report that they would like to quit, most quit attempts fail suggesting that predictors of quitting attempts may differ from those of successful attempts. We examined sociodemographic and clinical predictors of quit attempts and successful quit attempts in a nationally representative sample of US adults. Data was collected in 2001-2002 (Wave 1) and 2004-2005 (Wave 2). Almost 40% of individuals who had not previously attempted to quit, tried to quit over the next three years; only 4.6% of those who tried had succeeded at the time of the evaluation. Hispanics, Asians, individuals with high income, and those with college education were less likely to attempt to quit, whereas those with daily nicotine use, younger age at first use and most symptoms of dependence were more likely to do so. Having an educational level below high school and older age at first nicotine use were predictors of successful quitting. Despite relatively high rates of quit attempts, rates of success are extremely low, indicating a gap between the public health need of decreasing tobacco use, and existing means to achieve it. Although there is a need to encourage people to quit tobacco, there may be an equally large need to develop more effective interventions that increase the rate of successful quit attempts.

Adherence to the Mediterranean dietary pattern and personality in patients attending a primary health center.

Personality influences lifestyle behaviors, and particularly dietary behavior. The possible association of personality with adherence to the Mediterranean diet pattern (MDP) has not been reported. The objective of this study was to analyze the possible association of personality traits with adherence to the MDP, controlling for sociodemographic variables, presence of chronic illnesses, minor psychiatric morbidity, body mass index (BMI), daily smoking, and physical activity. This cross-sectional study included 206 patients, age 18 to 65 years, recruited at a primary health service in Granada, Spain, during 2007 to 2008. The participants answered a questionnaire, including sociodemographic characteristics, data on personality, and MDP. Personality was measured by the Temperament and Character Inventory (TCI-125). Adherence to MDP was measured using the validated 14-point Mediterranean Diet Adherence Screener (MEDAS). MEDAS score was directly associated with the character dimension of self-directedness, age, and minor psychiatric morbidity score; and inversely with marital status (widowed, separated, or divorced) and BMI. Because highly self-directed individuals may respond better to diet advice, consideration of personality may prove helpful in the design of interventions to enhance the adherence to MDP. To improve the adherence to MDP in interventions with patients with low self-directedness, more intensive professional support and counseling with tailored messages about the health benefits of MDP may be indicated.

Stability of sex differences by diagnosis in psychiatric hospitalizations.

We examined sex differences in the distribution of psychiatric diagnoses among hospitalized patients, controlling for socio-demographic variables. The sample included 1865 psychiatric inpatients consecutively admitted during a 9-year period. The finding of a higher proportion of men among patients hospitalized for schizophrenia or substance use disorder and a higher proportion of women among those admitted for affective disorders, including bipolar disorder, was stable over time. A better understanding of these differences may help to establish more effective treatment strategies.