Compassionate use of esketamine intranasal in patients with severe major depressive disorder resistant to the treatment.

BACKGROUND: Treatment-resistant depression (TRD) is defined as the failure of at least two antidepressants in adequate doses and timing during a major depressive episode. Esketamine intranasal (ESK-IN) has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of TRD in combination with other antidepressants. AIMS: To assess the effectiveness and tolerability of a sample of TRD patients who received treatment with ESK-IN as part of the compassionate use program. METHODS: A retrospective, observational study was carried out on patients with a diagnosis of TRD enrolled in the early access program of ESK-IN in nine centers. Effectiveness was assessed with the Montgomery-Asberg depression rating scale (MADRS) at four time points: baseline, 28, 90, and 180 days of treatment. RESULTS: The sample included 71 patients (70% women) with a mean baseline MADRS score of 38.27 ± 5.9 and total or partial work disability rates of 85%. ESK-IN treatment was associated with a statistically and clinically significant reduction in the severity of depressive symptoms at all time points assessed. The presence of side effects was common but the majority were mild in severity and resolved after the observation period. Those patients who received psychotherapy in combination with ESK-IN showed a significantly lower MADRS score at 90 and 180 days than those patients who did not undergo psychotherapy. CONCLUSION: ESK-IN has proven to be effective and safe in a clinical sample of patients with severe TRD. To optimize clinical outcomes, the pharmacological treatment for TRD should always be integrated into a comprehensive therapeutic plan that encompasses strategies such as psychotherapy, social support, and family interventions.

Effectiveness of early and intensive intervention on suicide prevention: CARS programme.

The aim of this study was to evaluate the outcomes of the Programme for Management of Suicidal Behaviour and Suicide Prevention (CARS). Individuals treated in the emergency department of University Hospital Marqués de Valdecilla for suicidal thoughts or attempts (N = 401) between 1-March-2016 and 31-December-2018 were considered. No randomization by patients or groups was performed. Student's t-test, chi-square and repeated measure analysis of variance were used. Kaplan-Meier survival function and Cox proportional hazard regression models were employed to estimate the risks of relapse. Outcome of those who voluntary enrol CARS were compared with treatment as usual (TAU) at 6- and 12-months follow-up. The results indicate a significant reduction and delayed occurrence of suicidal behaviour over a 12-month follow-up period with the CARS programme compared to TAU, along with a decreased frequency of hospital admissions. CARS programme demonstrates a substantial impact, significantly reducing the risk of recurrent suicidal behaviour by 35.5 % and the risk of repeated suicidal attempts by 47.2 % at the 12-month follow-up. The programme exhibits a dual protective effect, diminishing suicidal behaviour and fostering improved long-term outcomes. In conclusion, CARS effectively reduced suicidal behaviour recurrence, achieving significant decreases in suicidal thoughts, plans and attempts.

Suicidal behaviour: emergency department attendance for suicidal recurrence and other psychiatric or medical reasons in the 6 months following the index episode.

The prevention of a complex phenomenon, such as suicide, requires an interdisciplinary approach that provides a comprehensive response to the care needs of people with suicidal behavior (SB). The aim of this study is to investigate the clinical and healthcare features of people presenting thoughts and/or attempts of suicide to define risk factors for recurrence.

Conducta Suicida: frecuentación en elservicio de urgencias por recurrenciasuicida y otros motivos psiquiátricos omédicos en los 6 meses posteriores alepisodio índice / Suicidal Behaviour: frequentation in the emergency emergency department for suicidal recurrence suicidal recurrence and other psychiatric or medical medical reasons in the 6 months after the index episode

Introducción: El suicidio es un fenómeno complejo cuyaprevención requiere un abordaje interdisciplinar que proporcione respuesta integral a las necesidades asistenciales de laspersonas con conductas suicidas (CS). El objetivo de este estudio es investigar las características clínicas y asistencialesde las personas que presentan ideas y/o tentativas de suicidiopara definir factores de riesgo de recurrencia.Método. Se ha llevado a cabo un estudio de cohorte conseguimiento de 6 meses. La cohorte está constituida por laspersonas atendidas en el servicio de urgencias del HospitalUniversitario Marqués de Valdecilla (Santander) por ideas y/otentativas de suicidio, durante un periodo de reclutamientode 4 meses: 1-marzo a 30-junio 2015. Se recogen variablessociodemográficas y clínicas en el episodio índice y las visitasal servicio de urgencias durante los siguientes 6 meses.Resultados. 143 pacientes valorados por CS, informacióndisponible para seguimiento en 110 (edad media 43,31 años;rango 16-84; 65% mujeres). Hubo 21% de recurrencia de CS:10% tentativas, 6% ideación, 5% ambas; 1 (0,7%) suicidio;con mayor frecuencia entre 30-65 años y con enfermedadmental. Durante el seguimiento el 60% consultó repetidamente no solo por CS sino también por otros motivos psiquiátricos o médicos, independientemente del seguimientoen salud mental.Conclusiones. La recurrencia de CS es frecuente a pesar deestar en seguimiento en el servicio de salud mental. Además,las personas con CS consultan frecuente y reiteradamente enurgencias por otros motivos psiquiátricos y médicos, lo quesugiere que el abordaje convencional de la comorbilidad conla CS resulta insuficiente. (AU)

Introduction: The prevention of a complex phenomenon, such as suicide, requires an interdisciplinary approachthat provides a comprehensive response to the care needs ofpeople with suicidal behavior (SB). The aim of this study isto investigate the clinical and healthcare features of peoplepresenting thoughts and/or attempts of suicide to define riskfactors for recurrence.Methods. A cohort study was carried out with a 6-monthfollow-up. The cohort consisted of persons admitted to theemergency department of the Hospital Universitario Marqués de Valdecilla (Santander) presenting thoughts and/orattempts of suicide, throughout a 4-month recruitment period: 1-March to 30-June 2015. Sociodemographic and clinical variables were collected in the index episode and visits tothe emergency department during the following 6 months.Results. 143 patients were assessed by SB, and it waspossible to collect information on recurrence in 110 (averageage of 43.31; range 16-84; 65% women). Twenty-one percent presented recurrence of SB: 10% attempted, 6% thoughts, and 5% both; 1 (0.7%) committed suicide; most frequently with age 30-65 years and with a history of mentalillness. During follow-up, 60% consulted repeatedly in theemergency department not only for SB but also for otherpsychiatric or medical reasons, independently of follow-upin the mental health service.Conclusions. Recurrence of SB is common despite beingfollowed up in the mental health service. In addition, peoplewith SB frequently and repeatedly consult the emergencydepartment for other psychiatric and medical reasons, suggesting that the conventional approach to comorbidity withSB is insufficient. Further studies are needed to define riskprofiles and design specific interdisciplinary strategies for SBmanagement and suicide prevention, avoiding fragmentation. This will contribute more efficiently to early identification, appropriate management and prevention of suiciderecurrences and deaths. (AU)

Recurrence of suicidal thoughts and behaviors during one year of follow-up: An exploratory study.

Suicidal thoughts and behaviors (STB) include suicidal ideation (SI), suicide attempt (SA) and completed suicide. We aimed to identify recurrence predictors of any type of STB, and separately for SA and SI, and to analyze the time until event. A 108-subject cohort presenting at Emergencies with STB was followed during one year. Recurrence risk factors were investigated by multiple Cox survival regressions. Within one year, 31.5%, 23.1% and 9.3% patients recurred with any STB, SA, and SI respectively. Most recurrences (~70%) occurred within the first 6 months. Seeking emergency psychiatric assistance for problems other than STB during follow-up was a common predictor for recurrence of any STB, and SA and SI specifically. Previous SA history and contact with psychiatry outpatient units during follow-up predicted both STB in general and SA in particular. A specific predictor for SA was hospitalization at index, while SI recurrence was associated to SI at index. These results highlight the importance of early intervention and multidisciplinary follow-up considering concurrent psychosocial or adaptive problems. A careful exploration at Emergencies is needed to target potential predictors.