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2.
Front Psychiatry ; 12: 675033, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34093282

RESUMEN

The standardization of cannabis doses is a priority for research, policy-making, clinical and harm-reduction interventions and consumer security. Scientists have called for standard units of dosing for cannabis, similar to those used for alcohol. A Standard Joint Unit (SJU) would facilitate preventive and intervention models in ways similar to the Standard Drink (SD). Learning from the SD experiences allows researchers to tackle emerging barriers to the SJU by applying modern forecasting methods. During a workshop at the Lisbon Addictions Conference 2019, a back-casting foresight method was used to address challenges and achieve consensus in developing an SJU. Thirty-two professionals from 13 countries and 10 disciplines participated. Descriptive analysis of the workshop was carried out by the organizers and shared with the participants in order to suggest amendments. Several characteristics of the SJU were defined: (1) core values: easy-to use, universal, focused on THC, accurate, and accessible; (2) key challenges: sudden changes in patterns of use, heterogeneity of cannabis compounds as well as in administration routes, variations over time in THC concentrations, and of laws that regulate the legal status of recreational and medical cannabis use); and (3) facilitators: previous experience with standardized measurements, funding opportunities, multi-stakeholder support, high prevalence of cannabis users, and widespread changes in legislation. Participants also identified three initial steps for the implementation of a SJU by 2030: (1) Building a task-force to develop a consensus-based SJU; (2) Expanded available national-level data; (3) Linking SJU consumption to the concept of "risky use," based on evidence of harms.

3.
Int J Methods Psychiatr Res ; 30(3): e1875, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33951258

RESUMEN

OBJECTIVES: This contribution provides insights into the methodology of a pan-European population-based online survey, performed without external funding during the COVID-19 pandemic. We present the impact of different dissemination strategies to collect data from a non-probabilistic convenience sample and outline post-stratification weighting schemes, to provide guidance for future multi-country survey studies. METHODS: Description and comparison of dissemination strategies for five exemplary countries (Czechia, Germany, Lithuania, Norway, Spain) participating in the Alcohol Use and COVID-19 Survey. Comparison of the sample distribution with the country's actual population distribution according to sociodemographics, and development of weighting schemes. RESULTS: The dissemination of online surveys through national newspapers, paid social media adverts and dissemination with the support of national health ministries turned out to be the most effective strategies. Monitoring the responses and adapting dissemination strategies to reach under-represented groups, and the application of sample weights were helpful to achieve an analytic sample matching the respective general population profiles. CONCLUSION: Reaching a large pan-European convenience sample, including most European countries, in a short time was feasible, with the support of a broad scientific network.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , COVID-19/epidemiología , Adolescente , Adulto , República Checa/epidemiología , Femenino , Alemania/epidemiología , Humanos , Lituania/epidemiología , Masculino , Persona de Mediana Edad , Noruega/epidemiología , España/epidemiología , Encuestas y Cuestionarios , Adulto Joven
4.
Eur J Emerg Med ; 28(5): 373-379, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33709997

RESUMEN

BACKGROUND AND IMPORTANCE: SBIRT programs (Screening Brief Intervention and Referral to Treatment) for at-risk drinkers in emergency departments (ED) have shown to be effective, particularly at short term. In this article, we report mid and long-term follow-up results of a specialized SBIRT program. A short-term follow-up after 1.5 months showed encouraging results, with more than a 20% greater reduction of at-risk drinking in the intervention group and more than double of successful referrals to specialized treatment. OBJECTIVE: We aimed to evaluate the mid and long-term efficacy of an SBIRT program conducted by psychiatrist specialists in addictive disorders and motivational interviewing in the ED of a tertiary hospital. DESIGN, SETTINGS AND PARTICIPANTS: We conducted a secondary analysis of a previously published randomized controlled trial of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the AUDIT-C scale. INTERVENTION OR EXPOSURE: Patients were randomized into two groups, with the control group receiving two leaflets: one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. OUTCOMES MEASURE AND ANALYSIS: Long-term assessment primary outcome was the proportion of at-risk alcohol use measured by AUDIT-C scale. The main effectiveness analysis at 18 weeks and 12 months' follow-up was conducted with multilevel logistic regression analyses. Missing values were imputed with the last observation carried forward. MAIN RESULTS: Of 200 patients included in the study, 133 (66.5%) and 131 (65.5%) completed 18 weeks and 1-year follow-up respectively. Although the proportion of risky drinkers was substantially lower in the intervention group (38.5 vs. 57.4% at 4.5 months and 58.5 vs 68.2% at 1 year), these results did not reach statistical significance (OR = 2.15; CI, 0.87-5.33). CONCLUSIONS: In this secondary analysis for mid- and long-term effects of a specialized SBIRT program, there was no significant difference in the reduction of risky drinkers at 18 weeks and 1 year. The small size of the studied sample and the low retention rate precluded any significant conclusion, although point estimates suggest a positive effect. Overall, SBIRT programs are an effective tool to reduce alcohol use at short time and to refer patients to specialized treatment; however, its effects seem to decay over time.


Asunto(s)
Alcoholismo , Consumo de Bebidas Alcohólicas , Alcoholismo/diagnóstico , Alcoholismo/terapia , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Humanos , Derivación y Consulta
6.
JMIR Res Protoc ; 9(6): e16964, 2020 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-32579124

RESUMEN

BACKGROUND: Monitoring mental health outcomes has traditionally been based on heuristic decisions, often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the digital phenotype, which refers to the analysis of data collected by measuring human behavior with mobile sensors and smart bracelets, is a promising tool for filling this gap in current clinical practice. OBJECTIVE: The objectives of this study are to develop the digital phenotyping of patients with alcohol use disorder and anxiety symptoms using data collected from a mobile device (ie, smartphone) and a wearable sensor (ie, Fitbit) and to analyze usability and patient satisfaction with the data collection service provided by the app. METHODS: We propose to conduct a study among a group of 60 participants split into two subgroups-experimental and control-of 30 participants each. The experimental group will be recruited by physicians from the Hospital Clínic de Barcelona, and the control group will be recruited on a volunteer basis through fliers and social media. All participants will go through pretraining to ensure technological capability and understanding of tasks, then each participant will download the HumanITcare app and will be given a wearable sensor (ie, Fitbit). Throughout the 4-month period, participants will be monitored on a range of factors, including sleep cycle, heart rate, movement patterns, and sociability. All data from the wearable sensors and the mobile devices will be saved and sent to the HumanITcare server. Participants will be asked to complete weekly questionnaires about anxiety, depression, and alcohol use disorder symptoms. Research assistants will ensure timely responses. The data from both sensors will then be compared to the questionnaire responses to determine how accurately the devices can predict the same symptoms. RESULTS: The recruitment phase was completed in November 2019 and all the data were collected by the end of December 2019. Data are being processed; this process is expected to be completed by October 2020. CONCLUSIONS: This study was created and conducted as a pilot study with the Hospital Clínic de Barcelona, with the purpose of exploring the feasibility of our approach. The study is focused on patients diagnosed with anxiety and alcohol use disorder, but participants were also monitored for depressive symptoms throughout the trial, although these were not part of the initial inclusion criteria. A limitation to our study was the exclusive use of Android smartphones over iOS devices; this could result in a potential selection bias, due to the accessibility and affordability of Android phones as opposed to iOS-based phones. Another limitation might be that reviews of usability and satisfaction could be confounded by factors such as age and familiarity. An additional function that we might add in future studies is the ability for patients to manage their own data. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16964.

7.
Subst Use Misuse ; 49(12): 1665-83, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24870987

RESUMEN

Alcohol prevention policies alone neither cause nor explain changes in alcohol consumption, nor in related harm. Alcohol consumption in Spain throughout the period 1962-2008 was analyzed considering selected contextual factors and alcohol policies. Increased urbanization was found to be associated with higher consumption, especially of beer. Restrictive policies regulating purchase age, advertising, and licensing premises to sell alcohol were associated with decreased alcohol consumption, while lower blood alcohol concentration limits were followed by an increase. Study limitations are noted. Changes in the evolution of socioeconomic, sociodemographic, and cultural factors should be carefully analyzed to inform alcohol policy planning and evaluation.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Política de Salud , Accidentes de Tránsito/mortalidad , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Bebidas Alcohólicas , Femenino , Humanos , Hepatopatías/mortalidad , Masculino , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , España/epidemiología
8.
Subst Use Misuse ; 46(10): 1288-303, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21692604

RESUMEN

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Consumo de Bebidas Alcohólicas/tendencias , Alcoholismo/prevención & control , Cultura , Políticas , Comparación Transcultural , Europa (Continente) , Femenino , Humanos , Masculino
9.
J Neuropsychiatry Clin Neurosci ; 22(4): 401-8, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21037125

RESUMEN

An open-label, experimental, prospective 5-month follow-up study was performed with 19 patients with psychogenic nonepileptic seizures and anxiety disorder and/or depression who were treated with venlafaxine. The authors held monthly visits and evaluated changes in baseline Hamilton Depression Rating Scale scores, Hamilton Anxiety Rating Scale scores, and the number of psychogenic nonepileptic seizures. HAM-D scores, HAM-A scores, and the number of nonepileptic seizures showed a statistically significant decrease which was maintained over the study period. Based on this study, the authors conclude that venlafaxine may help reduce nonepileptic seizures in patients with additional anxious and/or depressive symptoms.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Ciclohexanoles/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Convulsiones/tratamiento farmacológico , Convulsiones/psicología , Adolescente , Adulto , Anciano , Trastornos de Ansiedad/complicaciones , Trastorno Depresivo/complicaciones , Electroencefalografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Convulsiones/complicaciones , Estadísticas no Paramétricas , Clorhidrato de Venlafaxina , Grabación en Video/métodos , Adulto Joven
10.
Prog Neuropsychopharmacol Biol Psychiatry ; 33(3): 463-9, 2009 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-19302831

RESUMEN

PURPOSE: To study the power of CRF stimulation test to predict relapse in a sample of melancholic depressive patients in depressed phase, followed-up over a two-year period from the moment they achieved complete remission of depressive symptoms. METHODS: Fifty-one outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV were assessed with the CRF test. The Structured Clinical Interview for DSM-IV (SCID-IV) was used for diagnosis. Monthly follow-up visits were held over a two-year period after remission; relapse was established using HDRS according to Frank's criteria [Frank E, Prien RF, Jarret RB, Keller MB, Kupfer DJ, Lavori PW, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991;48:851-5]. Forty-three patients completed the study. Non-controlled antidepressant treatment protocols were used. Predictive statistical analysis was performed through logistic regression. FINDINGS: The final predictive model included three variables: net area under cortisol curve (NAUCC), previous suicide attempt, and stress during follow-up. Sensitivity was of 89%, and specificity was of 92%. NAUCC has shown a predictive power of 80%, with an optimal cut-off point of 251.24 microg/ml/min. CONCLUSIONS: Cortisol is the hormone of the HPA axis which shows the highest power to predict relapse. NAUCC is the most relevant variable. The complete predictive model is a complex combination of biological, clinical and psychoenvironmental variables (NAUCC, previous suicide attempts, and stress during follow-up). Further studies with better control of the psychoenvironmental variables are required to obtain more precise neuroendocrine findings.


Asunto(s)
Hormona Liberadora de Corticotropina , Trastorno Depresivo/diagnóstico , Hormona Adrenocorticotrópica/sangre , Adulto , Distribución de Chi-Cuadrado , Hormona Liberadora de Corticotropina/administración & dosificación , Trastorno Depresivo/sangre , Trastorno Depresivo/fisiopatología , Femenino , Humanos , Hidrocortisona/sangre , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica , Curva ROC , Radioinmunoensayo/métodos , Recurrencia , Estudios Retrospectivos , Factores de Tiempo
11.
Prog Neuropsychopharmacol Biol Psychiatry ; 31(5): 1027-33, 2007 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-17433515

RESUMEN

PURPOSE: Basal adrenocorticotropin hormone (ACTH) and cortisol levels and their response to corticotropin-releasing factor (CRF) test were studied in melancholic depressive patients in depressed state and recovery, and compared with healthy controls. METHODS: Fifty-four outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV and 23 healthy controls were included in the study. The Structured Clinical Interview for DSM-IV (SCID-IV) was used for diagnosis. Twenty-nine patients were in recovery, while 25 were in depressed state at the moment of the administration of the CRF test. FINDINGS: No differences were found between the recovered and depressed groups with respect to CRF test. Lower ACTH and higher cortisol levels with significant differences were shown in the neuroendocrine variables at 15, 30, and 60 min, and in peak response and increase, in the ACTH and cortisol response curves to CRF challenge between the groups of melancholic patients, both recovered and depressed, compared with the healthy control subjects. Moreover, recovered and depressed melancholic patients had a higher whole cortisol area under the curve with significant differences than the healthy control subjects. CONCLUSIONS: The crossover clinical status at the moment of the CRF test doesn't differentiate changes in the HPA axis in melancholic patients, while we did find significant differences in the group of healthy controls in comparison with the groups of melancholic patients both in depressive state and recovery. This supports the hypothesis that hypothalamic pituitary adrenal (HPA) axis shows alterations that remain in depressive patients even after recovery.


Asunto(s)
Hormona Adrenocorticotrópica/sangre , Hormona Liberadora de Corticotropina , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Hidrocortisona/sangre , Adulto , Anciano , Trastorno Depresivo/sangre , Relación Dosis-Respuesta a Droga , Educación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Factores Socioeconómicos
12.
Seizure ; 16(3): 218-25, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17204436

RESUMEN

OBJECTIVE: To evaluate the psychiatric disorders over a 1-year period in a group of TLE patients who underwent surgery. METHODS: Prospective, open study in a sample of 70 TLE patients. Psychiatric disorders' assessment was made before surgery, and at 1, 6 and 12 months after surgery, with the structured clinical diagnostic interview for DSM-IV axis I diagnoses (SCID). Presurgical psychiatric and neurological variables were compared with the outcomes of surgery and the course of psychiatric pathology over the follow-up through parametric and non-parametric tests. RESULTS: Depression decreased from 17.2% before surgery to 4.3% at 12 months after surgery (chi(2)=5.41, d.f.=1, p=0.071), anxiety disorders decreased from 21.5% before surgery to 14.2% at 12 months after surgery (chi(2)=10.309, d.f.=1, p<0.005). Patients with no presurgical psychiatric condition had lower postsurgical rate of psychiatric disorders than those with psychiatric history (X(2)=9.87, gl=1, p< or =0.001), with psychiatric disorders in the presurgical evaluation (X(2)=12.02, gl=1, p< or =0.001), or with both conditions (chi(2)=15.28, d.f.=1, p<0.001). No association was found between psychiatric disorders and the outcomes after surgery. No association was found between the course of psychiatric disorders before and after surgery and neurological or neurosurgical variables. CONCLUSIONS: Surgery in TLE patients does not worsen the global psychopathological status. Presurgical psychiatric morbidity was found to be related to the presence of psychiatric disorders after surgery. Specific psychiatric assessment should be made before and after surgery.


Asunto(s)
Epilepsia del Lóbulo Temporal/psicología , Trastornos Mentales/epidemiología , Adulto , Epilepsia del Lóbulo Temporal/cirugía , Femenino , Humanos , Masculino , Periodo Posoperatorio , Estudios Prospectivos , Resultado del Tratamiento
14.
Eur. j. psychiatry ; 19(3): 165-171, jul.-sept. 2005. ilus, graf
Artículo en En | IBECS | ID: ibc-044270

RESUMEN

The frequency of delirium in elderly inpatients is high, resulting in poor hospital outcomes. The objective of this study is to assess whether delirium is an independent predictor for mortality over a three-month period. Methods: Prospective, observational study in a cohort of 171 inpatients aged over 65years. Presence of delirium and/or dementia, severity of delirium and incapacity due to illness were assessed at baseline using DSM-IV diagnostic criteria, the Confusion Assessment Method (CAM), the MMSE, the Delirium Rating Scale (DRS) and the Karnofsky Performance Status (KPS). Mortality rates were evaluated over a three-month follow-up period after enrollment. Kaplan-Meier survival curves were constructed and the adjusted effect of asset of covariates was evaluated with the Cox multiple regression analysis. Results: By 3 months after enrollment, 34.4% of the patients with delirium died, compared with 16.5% of those without delirium. The survival analysis shows a statistically significant difference between the two groups (log-rank=11.92; d.f.=1; P=0.0006). After adjustment for covariates, delirium was found to be independently associated with higher mortality. Conclusions: Delirium was found to be an independent marker for mortality in older medical patients over a three-month follow-up (AU)


Asunto(s)
Masculino , Femenino , Anciano , Humanos , Delirio/mortalidad , Mortalidad/estadística & datos numéricos , Estudios Prospectivos , Pronóstico , Factores de Riesgo
15.
J Affect Disord ; 82(2): 291-6, 2004 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-15488260

RESUMEN

BACKGROUND: Rates of relapse and predictive relapse factors were studied over more than 4 years in a sample of Spanish outpatients with DSM-III-R criteria for unipolar major depressive episode. METHODS: A final sample of 139 outpatient was followed monthly in a naturalistic study. The Structured Clinical Interview for DSM-III-R was used. Phases of evolution were recorded using the Hamilton Depression Rating Scale, applying the Frank criteria. Survival analysis, Kaplan-Meier product limit and proportional hazards models were used. RESULTS: A higher rate of relapses was observed in the partial remission group (91.4%) compared to the complete remission one (51.3%). The four factors with predictive relapse value were: "partial remission versus complete remission", "the intensity of clinical symptoms", "the age" and "the number of previous depressive episodes". The existence of partial remission was the most powerful predictive factor. LIMITATIONS: The decreasing sample size during the follow-up and the difficulty in warranting the treatment compliance. CONCLUSIONS: At medium term, relapse rates for a major depressive episode are high. Partial remission after a depressive episode seems to be an important predictive factor for relapses in a 4-year follow-up. CLINICAL RELEVANCE: Not reaching complete remission is a strong risk factor for relapses in a 4-year follow up study.


Asunto(s)
Trastorno Depresivo Mayor/epidemiología , Adulto , Anciano , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/psicología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Inhibidores de la Captación de Serotonina/uso terapéutico , España , Análisis de Supervivencia
16.
Gen Hosp Psychiatry ; 26(4): 310-5, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15234827

RESUMEN

The aim of this study was to examine clinical characteristics in patients with psychogenic nonepileptic seizures and to analyze the Minnesota Multiphasic Personality Inventory (MMPI) profiles and their relation to psychopathology. Thirty patients with nonepileptic seizures confirmed through video-electroencephalography were included. A structured clinical interview (Structured Clinical Interview for DSM-III-R), a measure of personality variables (MMPI), and several structured interviews designed for collecting data on clinical and personal history were administered. Descriptive and comparative statistical methods were used. Of the sample, 67.7% met criteria for two or more simultaneous Axis I diagnoses, and 60% for an Axis II personality disorder. The most frequently elevated scales of the MMPI were Schizophrenia and Depression. There were multiple scale elevations in 12 profiles, the 91.7% of which had elevated "neurotic" and "psychotic" scales. The subgroup with personality disorders showed higher scores on the MMPI Paranoia and Hypomania scales, and the subgroup with traumatic experiences showed higher scores on the MMPI Hypomania scale. Our sample comprising patients with nonepileptic seizures showed a significant degree of psychopathology and absence of a unique character substrate. According to grades of clinical severity of pseudoseizures, several subgroups and different therapeutic implications may be defined.


Asunto(s)
Depresión/diagnóstico , Depresión/epidemiología , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/epidemiología , MMPI , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiología , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Electroencefalografía , Femenino , Humanos , Masculino , Psicometría , Índice de Severidad de la Enfermedad , España/epidemiología , Grabación en Video
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