Preliminary data from a 4-year mirror-image and multicentre study of patients initiating paliperidone palmitate 6-monthly long-acting injectable antipsychotic: the Paliperidone 2 per Year study.

Background: Paliperidone palmitate 6-monthly (PP6M) is the first long-acting antipsychotic injectable (LAI) to allow for only two medication administrations per year, though there is presently limited insight into its effectiveness and potential added value in real clinical practice conditions. Objectives: To present our ongoing study and draw its preliminary data on patient characteristics initiating PP6M and adherence during the first year of treatment. Methods: The paliperidone 2 per year (P2Y) study is a 4-year, multicentre, prospective mirror-image pragmatic study taking place at over 20 different sites in Europe. The mirror period covers 2 years either side of the PP6M LAI initiation. Retrospective data for the previous 2 years are collected for each patient from the electronic health records. Prospective data are recorded at baseline, 6, 12, 18 and 24 months of drug administration and also cover information on concomitant psychiatric medication, relapses, hospital admissions, side effects, discontinuation and its reasons. Meanwhile, here we present preliminary data from the P2Y study at basal and 6-month period (first and second PP6M administration). Results: At the point of PP6M initiation, the most frequent diagnosis was schizophrenia (69%), the clinical global impression scale mean score was 3.5 (moderately markedly ill) and the rate of previous hospital admissions per patient and year was 0.21. PP6M was initiated after a median of 3-4 years on previous treatment: 146 (73%) from paliperidone palmitate 3-monthly, 37 (19%) from paliperidone palmitate 1-monthly and 17 (9%) from other antipsychotics. The mean dose of the first PP6M was 1098.9 mg. The retention rate at 6 months and 1 year of treatment on PP6M in our cohort was 94%. Conclusion: Patient and clinician preference for LAIs with longer dosing intervals was the main reason for PP6M initiation/switching resulting in high treatment persistence. Future data are needed to evaluate the full impact of PP6M in clinical practice.

Diagnostic concordance between Primary Care and Mental Health.

To analyse the diagnostic concordance index between Primary Care and Mental Health.

Concordancia diagnóstica entre Atención Primaria y Salud Mental / Diagnostic concordance between Primary Care and Mental Health

Objetivo: Analizar la concordancia diagnóstica entreAtención Primaria (AP) y Salud Mental (SM).Metodología. Estudio descriptivo y retrospectivo realizado en el Centro de SM de Villaverde, Madrid, España.La muestra está conformada por 1050 pacientes adultosnuevos consecutivos derivados desde AP a SM desde eneroa diciembre del año 2016. Se registraron las siguientes variables: Centro de AP de origen de la derivación, edad, sexo,tipo de actividad solicitante en la derivación (Psiquiatría oPsicología), diagnóstico establecido por AP y diagnósticoestablecido por SM.Resultados. La concordancia diagnóstica entre AP y SMpresentó un coeficiente de kappa global de 0,383 (IC 95 %0,333-0,433). Los grupos diagnósticos con menor concordancia fueron el trastorno adaptativo (kappa: 0,200), eltrastorno de ansiedad (kappa: 0,242) y el trastorno afectivodepresivo (kappa: 0,340). Los grupos diagnósticos con mayorconcordancia fueron el trastorno bipolar (kappa: 0,816) y eltrastorno psicótico (kappa: 0,689). El trastorno adaptativofue el diagnóstico más frecuentemente diagnosticado en SMentre los no coincidentes con AP (38,99 %).Conclusiones. La concordancia diagnóstica entre AP ySM es baja, lo cual podría afectar a la calidad asistencialofrecida a los pacientes. Se considera necesario el planteamiento de nuevas estrategias que permitan aumentar estaconcordancia. (AU)

Objetive: To analyse the diagnostic concordance indexbet-ween Primary Care and Mental Health.Methodology. Retrospective and descriptive study inMental Health Centre of Villaverde, Madrid, Spain. The sample consists of 1050 consecutive new adult patients referredfrom Primary Care to Mental Health Center from Januaryto December 2016. The following variables were recorded:Primary Health Center of origin, age, sex, type of activityrequested in the referral (Psychiatry or Psychology), diagnosis established by Primary Care and diagnosis established byMental Health.Results. Diagnostic concordance between Primary Careand Mental Health presented a global kappa coefficient of0.383 (IC 95 % 0.333-0.433). The diagnostic groups with thelowest concordance were adaptive disorder (kappa: 0.200),anxiety disorder (kappa: 0.242) and depressive affective disorder (kappa: 0.340). The diagnostic groups with the highestconcordance were bipolar disorder (kappa: 0.816) and psychotic disorder (kappa: 0.689). Adaptive disorder was themost frequently diagnostic in Mental Health among thosewho did not coincide with Primary Care (38.99 %).Conclusions. Diagnostic concordance between PrimaryCare and Mental Health is low, which could affect the quality of care offered to patients. New strategies are needed to increase this diagnostic concordance. (AU)