Cognitive Effects of Combined Amisulpride and Quetiapine Treatment in Patients With Refractory Schizophrenia: A Naturalistic, Prospective Study.

BACKGROUND: Regarding the treatment of patients with resistant schizophrenia, different options exit, although they are supported by limited evidence. In this study, antipsychotic polypharmacy, comprising 1200 mg of amisulpride and 600 mg of quetiapine, was used. Clinical change evaluation was performed using neurocognitive evaluations. STUDY QUESTION: The use of amisulpride and quetiapine will imply a clinical improvement in patients affected by schizophrenia, which will be specially reflected in a cognitive improvement. STUDY DESIGN: Naturalistic and prospective study. Twenty-six patients were applied and assessed by a battery of neurocognitive evaluations since the pretreatment baseline until 6-month treatment. The patients had no biological response to medication, high social maladjustment, and a long clinical history of the disease. Kane and Brenner criteria for treatment-resistant schizophrenia were applied to choose the subjects. MEASURES AND OUTCOMES: The cognitive improvement will imply a significant betterment, from the pretreatment baseline until 6-month treatment, in the following cognitive tests: Stroop Test, WAIS Coding Subtest, and Comprehensive Trail Making Test (CTMT). An improvement in the Calgary Depression Scale, Simpson-Angus Scale, and Visual Analogue Scale (EVA) will also be observed. This scales were been used during the baseline, 3 months after, and then, 6 months. RESULTS: Subjects, after 6-month treatment with amisulpride and quetiapine, did show statistically significant differences in the assessed areas: WAIS Coding Subtest (P < 0.001), CTMT A and B (CTMT A P < 0.034; CTMT B P < 0.000), and Stroop Tests: Word (P < 0.001), Word-Color (P < 0.007), and Interference (P < 0.039). Furthermore, they showed a statistically significant difference in the Calgary Depression Scale (P < 0.002), Simpson-Angus Scale (P < 0.019), and EVA (P < 0.001). CONCLUSIONS: The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.

Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study.

OBJECTIVES: Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use. DESIGN AND METHODS: Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016-17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use. RESULTS: The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors). CONCLUSION: Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.

Efectividad de una intervención no sedativa para prevenir las reacciones ansiosas y claustrofóbicas en la resonancia magnética / Effectiveness of a non-sedative intervention to prevent anxious and claustrophobic reactions in magnetic resonance imaging

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Hyperventilation and electroconvulsive therapy: A literature review.

BACKGROUND: Hyperventilation has been proposed as an augmentation strategy in electroconvulsive therapy (ECT) in accordance with its proconvulsant effect. OBJECTIVE: This study reviews the existing literature on the application of hyperventilation in ECT, its efficacy, and tolerance. METHODS: A systematic search was performed in PubMed and EMBASE databases. Search terms ('electroconvulsive therapy' and 'hyperventilation', 'ventilation', 'hyperoxygenation', 'hyperoxia', 'hypocapnia') were used to retrieve works from 1966 to June 2016. Works that described hyperventilation manoeuvres in ECT settings and their clinical repercussion were included in the review. RESULTS: A total of 17 observational and experimental studies were selected. An important heterogeneity in study designs, samples and ECT conditions, was detected. Findings support a positive influence of hyperventilation on seizure duration, which is the main study variable across different works. Effects of hyperventilation on seizure threshold and quality parameters have been less thoroughly studied. Systematic recording of clinical outcomes and adverse effects of hyperventilation is uncommon. CONCLUSIONS: The literature suggests that hyperventilation may be an effective and safe technique to enhance ECT, but many aspects remain to be studied. Further investigations, especially controlled clinical trials, are necessary and should result in a specific and reliable hyperventilation protocol for ECT settings.

Psychopathology Related to Energy Drinks: A Psychosis Case Report.

Energy drinks (ED) are nonalcoholic beverages that have caffeine as their most common active substance. The rapid expansion of ED consumption has created concern in the scientific community as well as in the public opinion. We report a psychotic episode probably triggered by ED abuse in a young adult without previous psychotic disorders. We have reviewed the literature regarding the relationship between caffeine, energy drinks, and psychopathology. Few articles have been published about mental health effects of energy drinks and caffeine abuse. Nevertheless, this relationship has been suggested, specifically with anxiety disorders, manic episodes, suicide attempts, psychotic decompensation, and substance use disorder. ED consumption could represent a global public health problem because of the potential severe adverse effects in mental and physical health. To our knowledge, this article is probably the first case of psychosis related to ED abuse in an individual without previous psychotic disorders.

Psychiatric symptoms, substance use, and other medical conditions in patients with obesity who seek treatment for weight loss / Síntomas psiquiátricos, consumo de sustancias y otras condiciones médicas en pacientes con obesidad que buscan tratamiento para reducir peso

Abstract: INTRODUCTION: Scaling in obesity classes increases its effect on medical comorbidities and psychiatric symptoms. Anxiety and depression have a significant effect on treatment adherence and weight loss. OBJECTIVE: This study had three aims: a) to evaluate the prevalence of psychiatric symptoms; b) to evaluate the interactions between obesity classes and demographic variables in relation to psychiatric symptoms; and c) to analyze the interactions between obesity classes, demographic variables, and psychiatric symptoms in association with medical comorbidities in a sample of obese individuals seeking treatment for weight loss. METHOD: Medical record review of 22 weight loss clinics during January-December 2014. Binomial logistic regression was carried to assess univariate associations, second- and third-order interactions. RESULTS: Total sample was composed of 13,305 patients, mostly women (82.04%), married (53.66%), with elementary education (38.6%), mean body max index was 34.94 (SD = 4.39). The most prevalent psychiatric symptoms were anxiety (45.21%) and depression (16.36%). When analyzing interactions, it was found that men with class II obesity had higher odds for alcohol use (OR 1.56, IC 95% 1.10-2.22), and participants with obesity class III and married had more probability of diabetes II (OR 1.53, IC 95% 1.06-2.19). DISCUSSION AND CONCLUSION: Results show the complexity of the relation between demographic variables, psychiatric symptoms, medical comorbidities and obesity, underscoring the need to tailor treatments based in such variables, to promote adherence and weight loss.

Resumen: INTRODUCCIÓN: El incremento en el grado de obesidad se asocia con comorbilidades médicas y los síntomas psiquiátricos. La ansiedad y la depresión afectan la adherencia al tratamiento de la obesidad y la reducción de peso corporal. OBJETIVO: El estudio tuvo tres objetivos principales: a) Evaluar la prevalencia de síntomas psiquiátricos; b) evaluar las interacciones entre grados de obesidad, variables demográficas y síntomas psiquiátricos; c) analizar las interacciones entre grados de obesidad, síntomas psiquiátricos y comorbilidades médicas. MÉTODO: A través de revisión de expedientes médicos de 22 clínicas de reducción de peso entre enero-diciembre de 2014. Se analizó a través de regresión logística univariada y evaluando interacciones de segundo y tercer orden. RESULTADOS: La muestra total fue de 13305, mayormente mujeres (82.04%) la mayoría son casados (53.66%) con escolaridad de secundaria (38.6%) y preparatoria (36.7%), el IMC promedio fue de 34.94 (SD = 4.39). Las comorbilidades más prevalentes fueron síntomas de ansiedad (45.21%) y depresión (16.36%). Al analizar las interacciones los hombres con obesidad tipo II tuvieron mayor probabilidad de consumo de alcohol (OR 1.56 IC 95% 1.10-2.22), y los participantes con obesidad tipo III y casados tuvieron mayor probabilidad de diabetes (OR 1.53 IC 95% 1.06-2.19). DISCUSIÓN Y CONCLUSIÓN: Los resultados muestran la compleja relación entre variables demográficas, obesidad, síntomas psiquiátricos y comorbilidades, implicando la necesidad de desarrollar programas de tratamiento que tomen en cuenta dichas variables para promover la adherencia al tratamiento y la reducción de peso.

Guías para el tratamiento del Trastorno por Déficit de Atención e Hiperactividad: una revisión crítica / Treatment guidelines for Attention Deficit and Hyperactivity Disorder: A critical review

Una serie de guías clínicas para el Trastorno por Déficit de Atención e Hiperactividad a lo largo de la vida han sido publicadas en los últimos años. El objetivo es proporcionar una síntesis del mejor conocimiento científico disponible y facilitar el trabajo clínico así como hacer una revisión crítica de las guías clínicas más recientes basado en el tratamiento y las recomendaciones. Se revisaron las siguientes bases de datos: MEDLINE/ PubMed/ Index Medicus, PsycINFO/ PsyLIT y the Science Citation Index at Web of Science (ISI). La búsqueda se realizó usando los términos indexados en MeSH: «ADHD», «guideline», «therapeuticst». Se seleccionaron un total de 10 artículos y 9 guías. Las guías indican que el diagnóstico del TDAH se hace a través de la evaluación clínica y debe de llevarse a cabo por un profesional sanitario con formación y experiencia en el trastorno. El tratamiento multimodal es el ideal para el manejo integral del TDAH. La farmacoterapia permanece como tratamiento de primera elección para el tratamiento del TDAH a lo largo de la vida, en concreto la medicación estimulante y entre ella, destacando el tratamiento con metilfenidato y todas coinciden en que la terapia psicológica incrementa la eficacia del tratamiento como coadyuvante al tratamiento farmacológico

A series of clinical guidelines for Attention Deficit and Hyperactivity Disorder throughout life have been published in recent years. The aim is to provide a synthesis of the best available scientific knowledge and facilitate clinical work as well as to make a critical review of the latest clinical guidelines based on treatment and recommendations. Searches of the following databases were performed: MEDLINE/ PubMed/ Index Medicus, PsycINFO/ PsyLIT and the Science Citation Index at Web of Science (ISI). The indexed MeSH terms «ADHD», «guideline», «therapeutics» were used for the search, and a total of 10 articles and 9 guides were selected. The guidelines indicate that the diagnosis of ADHD is made by clinical assessment and must be performed by a health professional with training and experience in the disorder. Multimodal treatment is ideal for the integral management of ADHD. Pharmacotherapy remains the first choice treatment for ADHD throughout life, particularly stimulant medication and among them, highlighting treatment with methylphenidate and all guidelines agree that psychological therapy increases the effectiveness of treatment as co-adjuncts to pharmacotherapy

Treatment guidelines for Attention Deficit and Hyperactivity Disorder: A critical review.

A series of clinical guidelines for Attention Deficit and Hyperactivity Disorder throughout life have been published in recent years. The aim is to provide a synthesis of the best available scientific knowledge and facilitate clinical work as well as to make a critical review of the latest clinical guidelines based on treatment and recommendations. Searches of the following databases were performed: MEDLINE/ PubMed/ Index Medicus, PsycINFO/ PsyLIT and the Science Citation Index at Web of Science (ISI). The indexed MeSH terms “ADHD,” “guideline,” “therapeutics” were used for the search, and a total of 10 articles and 9 guides were selected. The guidelines indicate that the diagnosis of ADHD is made by clinical assessment and must be performed by a health professional with training and experience in the disorder. Multimodal treatment is ideal for the integral management of ADHD. Pharmacotherapy remains the first choice treatment for ADHD throughout life, particularly stimulant medication and among them, highlighting treatment with methylphenidate and all guidelines agree that psychological therapy increases the effectiveness of treatment as co-adjuncts to pharmacotherapy.

[Opinions and beliefs of the Spanish population on serious mental illnesses (schizophrenia and bipolar disorder)]. / Opiniones y creencias sobre las enfermedades mentales graves (esquizofrenia y trastorno bipolar) en la sociedad española.

INTRODUCTION: To find out the opinions, beliefs and concerns of the Spanish population on serious mental diseases: schizophrenia and bipolar disorder. MATERIAL AND METHODS: An ad-hoc questionnaire was constructed for the survey. A panel of seven experts extracted the contents. The Societies that involved were: ASAENES, ABBA, FEAFES-ANDALUCÍA, AMAFE, and AFAEM-5 advocacy societies were also involved. The questionnaire contained 12 questions about: knowledge of the diseases, diagnostic difficulties, symptoms, triggering factors, interference, treatments and effectiveness, beliefs and concerns. The questionnaire was administered during the IV Campaign of Social Awareness about Serious Mental Illness (Madrid and Seville, September-October 2009). RESULTS: A total of 5,473 questionnaires were collected, 55.8% in Seville. The majority (66.2%) of the sample were women, and the mean age was 35 years (SD=14.5). Both illnesses were known by 82% of the population, but 51% did not known any symptom of schizophrenia. Other notable opinions were; they are difficult to diagnose (59%), they were not diagnosed due to social rejection (27%), interfered quite a lot with daily life (49%) or prevented a normal life (42%), the effective treatments are psychological (72%). Beliefs were: social rejection, family burden, and patient suffering. Concerns included: dangerousness, social rejection, lack of information, and scarcity of resources. CONCLUSIONS: There is a lack of knowledge of the symptoms. The majority do not know about specific symptoms and highlight the negative ones. Combined pharmacological-psychological treatment is believed to be most effective. Social stigma and family and personal burden are concerns.

Estimation of a multiattribute utility function for the Spanish version of the TooL questionnaire.

OBJECTIVES: To estimate and assess the psychometric properties of a multiattribute utility function (MAUF) for the Spanish version of the Tolerability and Quality of Life (TooL questionnaire). METHODS: Balanced data on 243 patients diagnosed with schizophrenia or bipolar disorder were gathered. In addition to the demographic and clinical variables and the usual generic health-related quality of life (HRQoL) questionnaires (EuroQol-5D [EQ-5D] and Short Form-6D [SF-6D]), instruments considered included the Spanish versions of the Positive and Negative Symptoms of Schizophrenia Scale (PANSS), Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Udvalg for Kliniske Undersogelser (UKU), and Clinical Global Impression Severity (CGIS) scale. MAUF parameters estimation involved a number of visual analogue scale (VAS) and time trade-off (TTO) ratings that proved difficult to be performed by the patients. After checking for inconsistencies in patient responses, the original sample was reduced to a still balanced subsample of 70 individuals. A multiplicative-form MAUF was estimated following the standard methodology. RESULTS: Good convergent validity was demonstrated because utility estimates from the MAUF presented strong correlations with utilities from the generic HRQoL instruments included: SF-6D (0.66, P < 0.01), EQ-5D (0.69, P < 0.01), and moderate correlations with the rest of instruments considered: PANSS (-0.27, P = 0.10), YMRS (-0.30, P = 0.08), MADRS (-0.48, P < 0.01), UKU (-0.35, P < 0.01). Criterion validity was also met because differences in mean utilities by clinical severity were found (P < 0.01). Utilities from the MAUF covered a wider range of health states [0.04,1.00] than those from the SF-6D [0.53,1.00] and EQ-5D [0.23,0.96]. CONCLUSIONS: Utilities from the MAUF showed good psychometric properties, serving as a complement to generic health utilities. If misapplied, however, utilities from this instrument might favor the positive evaluation of drugs showing fewer associated side effects.