Early response and remission as predictors of a good outcome of a major depressive episode at 12-month follow-up: a prospective, longitudinal, observational study.

OBJECTIVE: The goal of treating major depressive disorder (MDD) should be not only achieving remission in a particular episode but also avoiding relapses and attaining long-term recovery. The current study was designed to evaluate whether response and remission achieved within the first 6 weeks of antidepressant treatment are associated with a 12-month good outcome (achieving remission by 6 months and remaining in remission until the end of follow-up). METHOD: This prospective, longitudinal, multicenter study included adult outpatients who had a DSM-IV diagnosis of MDD, baseline scores ≥ 15 on the 17-item Hamilton Depression Rating Scale (HDRS(17)), Clinical Global Impressions-Severity of Illness scores ≥ 4, and a minimum remission period of 12 weeks between the index episode and the immediately prior episode (or who were in their first MDD episode). The primary efficacy measure was early response (a 50% decrease from baseline in HDRS(17) score by week 6). The secondary efficacy measure was early remission (HDRS(17) score ≤ 7 by week 6). RESULTS: Among the total of 930 patients included from December 2006 to June 2007, 38.2% showed early response, and 20.5% showed early remission. Of the early responders, 76.1% had a 12-month good outcome as compared to 81.1% of early remitters. Logistic regression showed that factors associated with a good outcome included early response (odds ratio [OR] = 4.14), being employed, and the absence of physical comorbidities. Early remission was also strongly associated with a good outcome (OR = 4.72). CONCLUSIONS: Either response or remission achieved by week 6 is the strongest prognostic factor for the 12-month good outcome of an episode of MDD.

Historical perspectives of the role of Spain and Portugal in today's status of psychiatry and mental health in Latin America.

This paper shows how the community of Latin-American and Spanish psychiatry represents a solid platform for the so-called 'continental thought' to meet the analytical Anglo-Saxon thought. It reviews what both Latin America and the Spanish and Portuguese languages represent in the American continent; the relation between Spanish psychiatry and Spanish-speaking psychiatry in America during the twentieth century; the reality of psychiatric research and profession in Latin America; the evolution of Spanish psychiatry in the twentieth century from the post civil war diaspora to the beginning of the twenty-first century, and research on mental health in Spain and the foreseeable future.

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Un nuevo comienzo / A new begining

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Antipsicóticos atípicos en cicladores rápidos con trastorno bipolar / Atypical antipsychotics in rapid cycling bipolar disorders

Objetivo. Observar la efectividad de los antipsicóticos como tratamiento de mantenimiento en pacientes bipolares con ciclación rápida (CR) en una serie de casos. Métodos. En siete pacientes con criterios de CR se añadió un antipsicótico a su tratamiento habitual durante un período de observación mínimo de seis meses (6-48 meses). Se valoró la eficacia del tratamiento por la desaparición de criterios DSM-IV para la CR. Se cuantificó el grado de mejoría mediante la escal de Impresión Clínica Global basal y al final del período observacional. Resultados. Cinco pacientes frenaron la CR: Los otros dos mejoraron sintomáticamente. La mejoría dela CGI Global tras el tratamiento con antipsicóticos fue significativa respecto de la basal (p=0,017). Conclusiones. Los antipsicóticos podrían ser, como fármacos de clase, una opción terapéutica de mantenimiento en los bipolares con CR. Se necesitan ensayos clínicos controlados que lo confirmen

Aim. To observe the effectiveness of antipsychotics as an ongoing treatment in rapid cycling (RC) bipolar patients, in a series of cases. Methods. An antipsychotic was added to the usual medication of seven patients meeting RC criteria for a minimun observation period of six months (6-48 months). The effectiveness of the treatment was measured by the disappearance of DSM-IV criteria for RC. The degree of improvement was measured on the Clinical Global Impression scale, from the start to the end of the observation period. Results. RC diminished in five patients. The symptoms of the other two improved. There was a significant improvement in the overall CGI compared to the base reading after treatment with antypsychotics (P=0.017). Conclusion. Antipsychotic drugs, as a class, could be one option for the ongoing treatment of bipolar patients with RC. This finding would need to be confirmed in controlled clinical trials

Valoración y control del riesgo metabólico y cardiovascular en los pacientes con esquizofrenia / Assessment and control of metabolic and cardiovascular risk in patients with schizophrenia

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Demographic and clinical features of adolescents and young adults with alcohol-related disorders admitted to the psychiatric emergency room.

OBJECTIVES: To determine the incidence of alcohol related problems (ARP) among adolescents admitted to the Psychiatric Emergency Room (PER) and to describe the demographic and clinical characteristics. METHODS: The study was a retrospective review of admissions to the PER, where we reviewed the psychiatric records of all of the 14-30 year olds admitted to the PER during the three-month period between April 1st, 2003 and June 30th, 2003. Demographic and clinical data of subjects with and without ARP were compared. RESULTS: During the three-month time period, 108 patients between the age of 14 and 30 were admitted to the PER. 14 (13.2%) of these had ARP, and ARP tended to occur more in males (chi2 = 3.81; df=l; p = 0.05). The number of psychiatric diagnoses among those who had ARP was significantly higher than among those who did not have ARP (t = -3.12; df=104; p = 0.002). ARP were found to be associated with personality disorder and misuse of other substances. 37.5% of those adolescents and young adults with ARP had a personality disorder, while 13% of those without ARP had a personality disorder (chi2 = 4.64; df=1; p = 0.03). 50% of those with ARP consumed (an)other substance/s, while 12.0% of those patients without ARP consumed (an)other substance/s (chi2 = l2.48; df=1; p < 0.001). Of the female adolescents and young adults with ARP, 50% were admitted to PER after an episode of self-poisoning. CONCLUSION: ARP in young adults admitted to the PER for acute psychiatric care are associated with greater psychiatric comorbidity, especially personality disorders. In females, ARP may be associated with an increased risk for self-poisoning. Adequate detection of ARP in the PER could promote earlier specific interventions specifically tailored to ARP among adolescents and young adults.

Venlafaxine extended-release in patients older than 80 years with depressive syndrome.

OBJECTIVES: The aim of this evaluation was to assess the efficacy and safety of venlafaxine extended-release (ER) in very old primary care out-patients with depressive syndrome and associated anxiety symptoms. METHODS: This was an observational, naturalistic, multicenter, prospective, open-label study in an outpatient population with a diagnosis of depressive syndrome with anxiety symptoms. Minimum scores of 17 and 10 on the Hamilton Rating Scale for Depression (HAM-D(17)) and Anxiety (HAM-A), respectively, were required. Daily doses of 75 mg to 225 mg of venlafaxine extended release (ER) were administered for 24 weeks. Effectiveness for depressive-anxious symptomatology was assessed using the HAM-D(17) and HAM-A scales. PATIENTS: The 97 patients discussed in this report are a subgroup comprising all elderly patients, aged >or= 80 years, who were part of the larger observational, naturalistic, multicenter, prospective, open-label study and who had received venlafaxine ER for a maximum duration of 24 weeks. RESULTS: At endpoint, remission rates were 57.1% (HAM-D(17)

¿Es ético realizar ensayos clínicos controlados con placebo en el desarrollo de un nuevo fármaco para el trastorno depresivo mayor? (y II). Relación beneficio/riesgo y consentimiento informado. Conclusiones / Is it ethical conducting placebo-controlled clinical trials as part of the development of new drugs for the treatment of major depressive disorder? (and II). Benefit/risk ratio and informed consent. Conclusions

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Gender differences in treatment response to sertraline versus imipramine in patients with nonmelancholic depressive disorders.

There is evidence of gender differences in depressive disorders in terms of epidemiology and clinical manifestations. However, few studies have addressed the gender differences in terms of antidepressant treatment response in clinical practice. The aim of this study was to examine gender differences in the acute antidepressant response to sertraline and imipramine in nonmelancholic depressive disorders. A total of 239 patients with nonmelancholic major depression or dysthymia (DSM-III-R) and a score of >/=18 at baseline on the Hamilton Depression Rating Scale (HAM-D) were randomised in a 1:1 ratio treatment with flexible doses of sertraline (50-200 mg/day) or imipramine (75-225 mg/day) for 8 weeks in a multicenter, randomised, open-labeled, parallel group comparative trial. Depressive and anxiety symptoms were assessed using the HAM-D and the Hamilton Anxiety Rating Scale (HAM-A). Using HAM-D criteria, women were significantly more likely to respond to sertraline than to imipramine (72.2% vs. 52.1%, P=.008), whilst men respond similarly to sertraline and to imipramine (56.5% vs. 59.3%, P>.05). Response analysis based on HAM-A shows similar results (women: 68.9% vs. 43.6%, P=.001; men: 56.5% vs. 51.9%, P>.05). Women taking sertraline show statistically significant higher reductions in HAM-D, HAM-A, and in CGI-S than women taking imipramine. The proportion of women who dropped out due to adverse events was much lower in sertraline than in imipramine (10.9% vs. 27.8%, P=.006), with no differences between treatments in men (8.3% vs. 11.5%, P>.05). It was concluded that sertraline is more effective and better tolerated than imipramine in the acute treatment of nonmelancholic depressive disorders in women, whereas men responded similarly to sertraline and to imipramine.

Sertraline is more effective than imipramine in the treatment of non-melancholic depression: results from a multicentre, randomized study.

The acute treatment efficacy, tolerability, and effects on health-related quality of life of sertraline (50-200 mg/day) versus imipramine (75-225 mg/day) were compared in outpatients with non-melancholic depression. The study employed an open-label, parallel-group design. One hundred and sixteen patients were randomized to receive sertraline and 123 to receive imipramine for 8 weeks. In the intent-to-treat (ITT), last-observation-carried-forward (LOCF) analysis, sertraline produced statistically significantly greater improvements in depressive (21-item Hamilton Depression Rating Scale [HAM-D(21)] scores of 24.9 and 24.4 were reduced to 10.3 and 13.1 at endpoint, P<.005) and anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] scores of 21.8 and 21.9 were reduced to 9.5 and 13.9, P<.01), as well as in response (69.0% versus 53.7% at endpoint, P=.016) and remission rates (51.3% versus 38.0% at endpoint, P=.041) from week 4 onwards compared with imipramine. The proportion of patients who were 'very much improved' or 'much improved' (Clinical Global Impressions Scale of Improvement [CGI-I] score of 1 or 2) was significantly higher at endpoint in the sertraline group (76.1%) than in the imipramine group (62.8%) (P=.028). At week 8, patients in both treatment groups showed clear improvements in quality of life, although nonstatistically significant differences were evident in the quality of life of sertraline- versus imipramine-treated patients. Sertraline was significantly superior in tolerability with less discontinuations due to adverse events (10.3%) compared with the imipramine group (24.4%) (P=.004). It was concluded that sertraline is more effective than imipramine in the acute treatment of depressive and anxiety symptoms in patients with non-melancholic depression.

Trastorno por estrés postraumático: estudio en una población de riesgo / Post-traumatic Stress Disorder: A study carried out in an at-risk population

Introducción: La población policial, dada la frecuente exposición a la violencia que padece, puede ser considerada como grupo de riesgo para el padecimiento del trastorno por estrés postraumático. En este trabajo se investigó la incidencia y los factores de riesgo para el desarrollo del trastorno por estrés postraumático (TEPT) y la comorbilidad en la población policial de nuestro país. Material y método: Se estudiaron todos los policías que habían experimentado un suceso traumático durante el año 1990. Se utilizó una entrevista semiestructurada que contenía: datos sociodemográficos, personales y familiares, el test de personalidad de Cattell, el cuestionario de sucesos vitales de Paykel, la entrevista SCID para valorar comorbilidad y cuestionarios especiales para evaluar las características del suceso traumático y el apoyo social recibido. Se definieron tres grupos: grupo CONTROL, formado por los policías que habían sufrido un suceso estresante que no cumplía características de traumático según criterios DSM-III-R; grupo TEPT formado por aquellos policías que sufrieron un suceso traumático y desarrollaron un TEPT; los policías que habiendo sufrido un suceso traumático no desarrollaron un TEPT fueron incluidos en el grupo NO TEPT. Se realizaron análisis chi-cuadrado y t de student para comparar las características diferenciales entre los grupos y se utilizó un análisis de regresión logística ara evaluar los factores de riesgo. Resultados: Durante el año 1990 un 0,066 por ciento de la policía española desarrolló un TEPT. Entre los 94 policías que sufrieron un suceso traumático 31 (32,98 por ciento) cumplió criterios DSM-III-R de TEPT. En el análisis de regresión logística, aparecieron los siguientes factores de riesgo: los sentimientos de amenaza de la vida durante el suceso (OR = 22,3), aumento de los conflictos familiares (OR = 5,6) y el cambio en las condiciones de trabajo (OR = 5,4). El apoyo social (OR = 75,8) apareció como un factor protector para esta población. El 74,2 por ciento de los afectados de TEPT presentaron al menos una patología psiquiátrica concomitante. Conclusiones: La exposición a sucesos traumáticos se sigue en casi una tercera parte de los casos del desarrollo de un TEPT en la policía. Los sentimientos de muerte durante el suceso constituyen el mayor factor de riesgo en el desarrollo de este trastorno, mientras que la presencia de un apoyo social adecuado puede actuar como un factor protector frente al TEPT. La comorbilidad de otras patologías psiquiátricas fue muy alta entre los afectados (AU)

Nuevas perspectivas en formación médica continuada: el empleo de las nuevas tecnologías de telecomunicaciones / New perspectives in Continous Medical Education (CME): use of new telecommunication technologies

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