A replication study of JTC bias, genetic liability for psychosis and delusional ideation.

BACKGROUND: This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation. METHODS: Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses. RESULTS: JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences. CONCLUSIONS: These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.

Sex differences in neurocognitive and psychosocial functioning in bipolar disorder.

BACKGROUND: Sex differences influence the clinical characteristics and course of illness of bipolar disorder (BD). OBJECTIVE: Therefore, the aim of the present study was to examine the role of sex differences in neurocognitive performance and psychosocial functioning in a large sample of euthymic patients suffering from BD. METHODS: The sample included 462 individuals, 347 patients with BD (148 males and 199 females) and 115 healthy controls (HC) (45 males and 70 females). Performance on a comprehensive neuropsychological battery assessing six cognitive domains and psychosocial functioning was compared between groups using linear mixed models, with sex and group as main effects, group by sex interactions and center as a random effect. RESULTS: Males performed better than females in working memory (p < 0.001), whereas females outperformed males in the verbal learning (p = 0.03) and memory recognition (p = 0.03) tasks. No significant group by sex interactions were detected in cognitive performance. There were no overall sex differences or group by sex interactions in psychosocial functioning. LIMITATIONS: Lack of assessment of visuo-spatial working memory. CONCLUSIONS: There were no overall sex differences in neurocognition and psychosocial functioning. However, small sex differences in some measures of working memory and verbal memory were found. Individual differences of each patient, including sex perspective, should be considered in order to perform a tailored intervention plan adjusted to specific needs in the context of personalized treatment.

Spanish Validation of the MAP-SR: Two Heads Better Than One for the Assessment of Negative Symptoms of Schizophrenia.

BACKGROUND: There is little research on self-reported negative symptomatology measures in schizophrenia. The aims of this study were to validate the Spanish version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) and determine the concordance between patient-reported outcome measures for reflecting the severity of negative symptoms of schizophrenia and clinician-rated outcome measures. METHOD: A sample of 174 subjects who completed the MAP-SR and 104 who completed the Self-Evaluation of Negative Symptoms (SNS) were analyzed. The clinician-reported outcome measures (CROMs) were the Spanish versions of the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS), while the patient-reported outcome measures (PROMs) were MAP-SR and SNS. Cronbach's a, bivariate analyses and Lin's concordance correlation coefficient (CCC) were calculated. RESULTS: The Spanish version of the MAP-SR demonstrated excellent reliability (Cronbach's α=.923). Its correlation coefficients were higher with CAINS [CAINS-Total: r=.608, p<.005; CAINS-Motivation and Pleasure subscale(CAINS-MAP): r=.662, p<.005] than with PANSS negative scales [PANSS-Negative scale(PANSS-N): r=.393, p<.005; PANSS-Marder Negative Factor(PANSS-MNF): r=.478, p<.005]. Finally, concordance between clinician and patient ratings was low in all cases, varying from a CCC of 0.661 to .392. CONCLUSIONS: We found poor concordance between patient and clinician ratings, hence we believe that the two evaluations are not mutually exclusive but complementary.

Impact of the coronavirus outbreak on mental health in the different Spanish regions.

COVID-19 is an infectious disease that has affected millions of people worldwide, Spain being one of the countries most affected by the pandemic. It is key to study its impact on the mental health of the Spanish population during the lockdown situation.

Impacto de la pandemia COVID-19sobre la salud mental en las diferentescomunidades autónomas españolas / Impact of the COVID-19 pandemic on mental health in different countries on mental health in the different Spanish Spanish autonomous communities

Introducción: La COVID-19 es una enfermedad infecciosa que está afectando a millones de personas alrededor delmundo, siendo España uno de los países más afectados porla pandemia. Es fundamental evaluar el impacto en la saludmental de la población española durante el periodo de confinamiento. El objetivo es analizar las respuestas desadaptativas en cada comunidad autónoma durante las dos primerassemanas tras la declaración del estado de alarma en España.Metodología. A través de un cuestionario “online”, serecogieron variables clínicas y sociodemográficas de los participantes del 19 al 26 de marzo. Para estudiar las respuestasdesadaptativas, se utilizaron los cuestionarios DASS-21 y EIE.Resultados. 21.152 personas completaron el cuestionario.La edad media fue 39,75 (DE 14,039) y el 69,6 % eran mujeres.La mayoría de los participantes vivía en Asturias (36,2 %) yCantabria (11,9 %). La respuesta desadaptativa más frecuentede la muestra fueron los síntomas depresivos (46,7 %), seguidadel estrés (33,2 %) y la ansiedad (10,7 %). Los resultados dela DASS-21 desvelaron que en Andalucía [n = 1979 (9,3 %)]se observó un mayor porcentaje en los tres dominios: síntomas depresivos (59,7 %), estrés (41,7 %) y ansiedad (16,2 %).Castilla-La Mancha tuvo el porcentaje más alto de respuestaintrusiva (31,2 %) y Andalucía de respuesta evitativa (55,7 %).Conclusiones. Casi la mitad de la muestra presentórespuestas desadaptativas, siendo los síntomas depresivos yla conducta evitativa las más frecuentes. El impacto sobrela salud mental durante y tras eventos traumáticos de granescala debería de abordarse minuciosamente para minimizarlas respuestas desadaptativas en la población general. (AU)

Introduction: COVID-19 is an infectious disease that hasaffected millions of people worldwide, Spain being one ofthe countries most affected by the pandemic. It is key tostudy its impact on the mental health of the Spanish population during the lockdown situation.The aim is to analyse maladaptive responses in eachautonomous community during the first two weeks afterthe state of emergency was declared in Spain.Material and Methods. Through an online questionnaire, clinical and sociodemographic information was collected from participants between 19 and 26 March 2020. TheDASS-21 and the IES questionnaires were used to evaluatethe maladaptive psychological responses.Results. A total of 21,152 people completed the questionnaire. Mean age was 39.75 (SD 14.039), and 69.6% werewomen. Most of the participants lived in Asturias (36.2%)and Cantabria (11.9%). In the sample as a whole, among themaladaptive responses, depressive symptoms represented thehighest percentage (46.7%), followed by stress (33.2%) andanxiety (10.7%) symptoms. The results of the DASS-21 revealed that a higher proportion of the people from Andalusia[n = 1979 (9.3%))]were affected in all three domains: depressive (59.7%), stress (41.7 %), and anxiety (16.2%) symptoms,Castilla La Mancha had the highest percentage of intrusiveresponse (31.2%), while Andalusia had the highest percentage of avoidance behaviour (55.7%). Conclusions. Almost half of the sample showed maladaptive reactions, depressive symptoms and avoidance behaviour being the most common responses. Repercussionson mental health during and after large-scale traumaticevents should be addressed carefully to minimize maladaptive responses in the general population. (AU)

Early Psychological Correlates Associated With COVID-19 in A Spanish Older Adult Sample.

OBJECTIVE: Main aims of the study are to examine the early psychological correlates associated with the COVID-19 pandemic and lockdown on the mental health of a Spanish older adult sample and to analyze the influence of past mental disorder (PMD) and current mental disorder (CMD) on those correlates. METHODS: Cross-sectional study based on an online snowball recruiting questionnaire. Psychological correlates assessed with the Depression, Anxiety, and Stress Scale (DASS-21) and Impact of Event Scale (IES). Binary and multinomial logistic regression models were used to identify risk and protective factors. RESULTS: Final sample included 2,194 individuals aged 60 years or more (mean age [SD]: 65.62 [5.05]; females: 1,198 [54.6%]). There were 342 (15.6%) individuals who reported a PMD and 162 (7.4%) who reported a CMD. Avoidant (32.1%) and depressive (25.6%) styles were the most prevalent, regardless of mental health status. Main risk factors for negative affectivity were female gender and history CMD or PMD. However, job stability and the ability to enjoy free time were generally associated with better outcomes. No differences were found in psychological correlates between those with no lifetime history of mental disorder versus PMD on the DASS-21 or IES. However, CMD was associated with higher anxiety scores on the DASS-21 (odds ratio: 1.838, p < .001). CONCLUSION: Regardless of mental status, avoidant and depressive styles were the most prevalent in this older adult sample. Main protective factor in all subgroups was the ability to enjoy free time, whereas the main risk factors were being female and current or past history of mental disorder.

Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder.

BACKGROUND: In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. AIM: To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. METHODS: A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL. MAIN OUTCOME MEASURES: Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. RESULTS: The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. CLINICAL IMPLICATIONS: Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. STRENGTHS & LIMITATIONS: Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. CONCLUSIONS: Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.

A clinical staging model for bipolar disorder: longitudinal approach.

Bipolar disorder (BD) has been identified as a life-course illness with different clinical manifestations from an at-risk to a late stage, supporting the assumption that it would benefit from a staging model. In a previous study, we used a clustering approach to stratify 224 patients with a diagnosis of BD into five clusters based on clinical characteristics, functioning, cognition, general health, and health-related quality of life. This study was design to test the construct validity of our previously developed k-means clustering model and to confirm its longitudinal validity over a span of 3 years. Of the 224 patients included at baseline who were used to develop our model, 129 (57.6%) reached the 3-year follow-up. All life domains except mental health-related quality of life (QoL) showed significant worsening in stages (p < 0.001), suggesting construct validity. Furthermore, as patients progressed through stages, functional decline (p < 0.001) and more complex treatment patterns (p = 0.002) were observed. As expected, at 3 years, the majority of patients remained at the same stage (49.6%), or progressed (20.9%) or regressed (23.3%) one stage. Furthermore, 85% of patients who stayed euthymic during that period remained at the same stage or regressed to previous stages, supporting its longitudinal validity. For that reason, this study provides evidence of the construct and longitudinal validity of an empirically developed, comprehensive staging model for patients with BD. Thus, it may help clinicians and researchers to better understand the disorder and, at the same time, to design more accurate and personalized treatment plans.

Sex differences in bipolar disorder: Impact of lifetime cannabis use on clinical course, functioning, and quality of life in bipolar disorder.

BACKGROUND: Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex. METHODS: Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life. RESULTS: A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p<0.005) than those without LCU, regardless of sex. Among women, LCU was associated with being single (p = 0.006), worse sexual functioning (p = 0.006), financial functioning (p = 0.009), QoL [bodily pain (p = 0.009), vitality (p = 0.027), social functioning (p = 0.037), emotional role (p = 0.038), mental health (p = 0.001), and mental summary component (p = 0.012)]. After controlling for confounders, among women, LCU was associated with worse QoL, specifically on bodily pain (p = 0.049) and mental health (p = 0.016) subscales. Among males, no statistically significant differences were found between LCU and no LCU (NLCU) in any of the variables of the study. LIMITATIONS: This study was a secondary analysis not powered specifically to analyze cannabis use. CONCLUSIONS: LCU was associated with a younger age at first hospitalization in both women and men, while only women reported worse QoL on bodily pain and mental health subscales. Clinicians and public health providers should be aware of this and inform their patients and the general population of these detrimental effects.

Estadificación clínica en los trastornos mentales graves: trastorno bipolar, depresión y esquizofrenia / Clinical staging in severe mental disorders; bipolar disorder, depression and schizophrenia

La estadificación clínica es una herramienta diagnóstica utilizada en otras especialidades de la medicina que surge de la combinación de un enfoque categorial y dimensional. En las últimas 2 décadas, se ha planteado su aplicación en el campo de la psiquiatría, fundamentalmente como herramienta de ayuda diagnóstica, de orientación terapéutica y pronóstica. En este trabajo se revisan los modelos de estadificación clínica que han sido propuestos hasta la fecha para el trastorno bipolar, la depresión y la esquizofrenia. Se realizó una búsqueda bibliográfica en las bases de datos PubMed y Medline. Se seleccionaron con base en los criterios de inclusión y exclusión un total de 15 estudios. Se describen y comparan las características de cada uno de los modelos agrupados según el tipo de trastorno para el que fueron propuestos (trastorno bipolar: 4; depresión: 5; esquizofrenia: 6). Como conclusión, identificamos la necesidad de validar empíricamente dichos modelos para así demostrar que son una herramienta útil en la práctica clínica habitual

Clinical staging is a diagnostic tool used in other medical specialties, which has resulted from the combination of a categorical and dimensional approach. In the last 2 decades, the usefulness of its application in the field of psychiatry has been suggested, mainly as a tool for diagnostic help, and therapeutic and prognostic orientation. In this paper we review the clinical staging models that have been proposed to date for bipolar disorder, depression and schizophrenia. A literature search was performed in PubMed and Medline databases. A total of 15 studies were selected according to inclusion and exclusion criteria. Models were grouped according to the type of disorder for which staging was proposed (bipolar disorder: 4, depression: 5, schizophrenia: 6), and their characteristics were described. As a conclusion, we identify the need to empirically validate these models to demonstrate that staging is a useful tool for clinical practice

Breadth and depth of working memory and executive function compromises in mild cognitive impairment and their relationships to frontal lobe morphometry and functional competence.

INTRODUCTION: The extent of working memory (WM) and executive function (EF) impairment in mild cognitive impairment (MCI) is not well-characterized. METHODS: We compared 48 patients with MCI, 124 noncognitively impaired elderly healthy controls, and 57 patients with Alzheimer's disease (AD) on multiple WM/EF measures, frontal lobe integrity indexes, and functioning. RESULTS: Patients with MCI demonstrated worse performance on nearly all WM/EF tests. This profile of impairment was refined in a factor analysis that identified three primary WM/EF constructs: WM storage; speed and controlled visual search; and manipulation of information and problem solving. EF impairments were associated with reductions in prefrontal cortical thickness. WM/EF accounted for over 50% of the variance in functional competence. DISCUSSION: In MCI, WM/EF impairments are far from rare, based on specific compromises to frontal cortex circuitry, and are associated with loss of everyday functioning. WM/EF impairments, even at this potentially prodromal stage of AD, have clinically deleterious consequences.

¿Pueden ser la interleucina-2 y la interleucina-1ß biomarcadores específicos de la sintomatología negativa en la esquizofrenia? / Can interleukin-2 and interleukin-1ß be specific biomarkers of negative symptoms in schizophrenia?

Introducción: Hay evidencias que sugieren la existencia de alteraciones de algunas citocinas en pacientes con esquizofrenia, pero su asociación con la psicopatología aún no está clara. El objetivo de este estudio es determinar si los niveles de citocinas proinflamatorias (factor de necrosis tumoral-alfa, interleucina [IL]-6, IL-2, IL-1ß, IL-1RA) están aumentados en pacientes ambulatorios clínicamente estables en comparación con individuos sanos, y analizar si podrían ser biomarcadores específicos de las diferentes dimensiones clínicas de la esquizofrenia. Métodos: Se evaluaron 73 pacientes con esquizofrenia en sus primeros 10 años de evolución de la enfermedad y 73 controles sanos pareados por edad y sexo. Se realizó una evaluación precisa de las dimensiones clínicas (positiva, negativa, depresiva y cognitiva) en estos pacientes. Resultados: Solo los niveles de IL-6 están significativamente elevados en los pacientes tras controlar por índice de masa corporal, perímetro abdominal, tabaquismo y tratamiento psicofarmacológico en comparación con sus controles sanos. Tras ajustar por varios factores de confusión, los modelos de regresión lineal múltiple identificaron cómo las concentraciones de IL-1ß predicen los síntomas negativos, psicopatología general y gravedad global de la Escala del Síndrome Positivo y Negativo, mientras los niveles de IL-2 predicen el dominio motivación y placer de la Entrevista de Evaluación Clínica para Síntomas Negativos y la puntuación global en la Escala de Funcionamiento Personal y Social. Sin embargo, el rendimiento cognitivo, la gravedad de los síntomas depresivos y positivos no correlacionaron con ninguna de las citocinas. Conclusiones: Nuestros hallazgos sugieren que las concentraciones de IL-6 permanecen elevadas en pacientes estables con esquizofrenia. Mientras que la IL-2 marca específicamente la gravedad en el dominio motivación y placer de la sintomatología negativa, la IL-1ß no es específica para esta dimensión, ya que también predice la gravedad de la sintomatología general y global

Introduction: Evidence suggests the existence of cytokine disturbances in patients with schizophrenia but their association with psychopathology is still unclear. The aim of the current study was to determine if pro-inflammatory cytokine levels (tumor necrosis factor-alfa, interleukin (IL)-6, IL-2, IL-1ß, IL-1RA) are increased in stable outpatients compared with healthy subjects, and to analyze if they could be specific biomarkers of clinical dimensions in schizophrenia. Methods: We studied 73 stable outpatients with schizophrenia in their first 10 years of illness and 73 age- and sex-matched healthy controls. An accurate assessment of clinical dimensions (positive, negative, depressive, cognitive) was performed in patients. Results: Only IL-6 levels were significantly increased in patients after controlling for body mass index, waist circumference, smoking, and psychopharmacological treatment, compared with healthy subjects. After adjusting for several confounders, multiple linear regression models identified that Positive and Negative Syndrome Scale negative symptoms, general psychopathology, and global severity are predicted by IL-1ß concentrations, while motivation and pleasure domain of Clinical Assessment Interview for Negative Symptoms and Personal and Social Performance global functioning scores are predicted by IL-2 levels. Cognitive performance, positive, and depressive symptom severity did not correlate with any cytokine. Conclusions: Our findings suggested that IL-6 concentrations are elevated in stable patients with schizophrenia. Whereas IL-2 specifically marks severity of the motivation and pleasure domain of negative symptoms, IL-1ß is not specific to this dimension as it also predicts severity of general and global symptomatology

Classification of patients with bipolar disorder using k-means clustering.

INTRODUCTION: Bipolar disorder (BD) is a heterogeneous disorder needing personalized and shared decisions. We aimed to empirically develop a cluster-based classification that allocates patients according to their severity for helping clinicians in these processes. METHODS: Naturalistic, cross-sectional, multicenter study. We included 224 subjects with BD (DSM-IV-TR) under outpatient treatment from 4 sites in Spain. We obtained information on socio-demography, clinical course, psychopathology, cognition, functioning, vital signs, anthropometry and lab analysis. Statistical analysis: k-means clustering, comparisons of between-group variables, and expert criteria. RESULTS AND DISCUSSION: We obtained 12 profilers from 5 life domains that classified patients in five clusters. The profilers were: Number of hospitalizations and of suicide attempts, comorbid personality disorder, body mass index, metabolic syndrome, the number of comorbid physical illnesses, cognitive functioning, being permanently disabled due to BD, global and leisure time functioning, and patients' perception of their functioning and mental health. We obtained preliminary evidence on the construct validity of the classification: (1) all the profilers behaved correctly, significantly increasing in severity as the severity of the clusters increased, and (2) more severe clusters needed more complex pharmacological treatment. CONCLUSIONS: We propose a new, easy-to-use, cluster-based severity classification for BD that may help clinicians in the processes of personalized medicine and shared decision-making.

Can interleukin-2 and interleukin-1ß be specific biomarkers of negative symptoms in schizophrenia? / ¿Pueden ser la interleucina-2 y la interleucina-1ß biomarcadores específicos de la sintomatología negativa en la esquizofrenia?

INTRODUCTION: Evidence suggests the existence of cytokine disturbances in patients with schizophrenia but their association with psychopathology is still unclear. The aim of the current study was to determine if pro-inflammatory cytokine levels (tumor necrosis factor-α, interleukin (IL)-6, IL-2, IL-1ß, IL-1RA) are increased in stable outpatients compared with healthy subjects, and to analyze if they could be specific biomarkers of clinical dimensions in schizophrenia. METHODS: We studied 73 stable outpatients with schizophrenia in their first 10 years of illness and 73 age- and sex-matched healthy controls. An accurate assessment of clinical dimensions (positive, negative, depressive, cognitive) was performed in patients. RESULTS: Only IL-6 levels were significantly increased in patients after controlling for body mass index, waist circumference, smoking, and psychopharmacological treatment, compared with healthy subjects. After adjusting for several confounders, multiple linear regression models identified that Positive and Negative Syndrome Scale negative symptoms, general psychopathology, and global severity are predicted by IL-1ß concentrations, while motivation and pleasure domain of Clinical Assessment Interview for Negative Symptoms and Personal and Social Performance global functioning scores are predicted by IL-2 levels. Cognitive performance, positive, and depressive symptom severity did not correlate with any cytokine. CONCLUSIONS: Our findings suggested that IL-6 concentrations are elevated in stable patients with schizophrenia. Whereas IL-2 specifically marks severity of the motivation and pleasure domain of negative symptoms, IL-1ß is not specific to this dimension as it also predicts severity of general and global symptomatology.

Clinical staging in severe mental disorders; bipolar disorder, depression and schizophrenia. / Estadificación clínica en los trastornos mentales graves: trastorno bipolar, depresión y esquizofrenia.

Clinical staging is a diagnostic tool used in other medical specialties, which has resulted from the combination of a categorical and dimensional approach. In the last 2decades, the usefulness of its application in the field of psychiatry has been suggested, mainly as a tool for diagnostic help, and therapeutic and prognostic orientation. In this paper we review the clinical staging models that have been proposed to date for bipolar disorder, depression and schizophrenia. A literature search was performed in PubMed and Medline databases. A total of 15 studies were selected according to inclusion and exclusion criteria. Models were grouped according to the type of disorder for which staging was proposed (bipolar disorder: 4, depression: 5, schizophrenia: 6), and their characteristics were described. As a conclusion, we identify the need to empirically validate these models to demonstrate that staging is a useful tool for clinical practice.

Sleep disturbances, functioning, and quality of life in euthymic patients with bipolar disorder.

There is scarce knowledge about the impact of sleep disturbances on functioning and quality of life (QoL). This study aims to investigate the links between sleep satisfaction and duration, and functioning and QoL in euthymic BD patients. We made a secondary analysis of a cross-sectional, naturalistic, multicenter study. Inclusion criteria: DSM-IV BD diagnosis; age > 17 years; written informed consent. Sample: 119 Spanish euthymic BD outpatients. Hierarchical multiple regressions were performed controlling for confounding factors. We found that almost half of the patients reported at least one sleep complaint, nighttime awakenings (60.5%) and difficulty falling asleep (31.9%) were the most frequent. Long sleep duration was associated with worse global functioning, and also with worse occupational functioning along with caffeine consumption. Sleep satisfaction was negatively associated with worse QoL in the mental health subscale and the summary mental. In both cases, the use of benzodiazepines negatively affects these QoL domains. In conclusion, euthymic bipolar patients frequently present sleep disturbances that seem to contribute to the impairment of their functioning and QoL. Also, the use of benzodiazepines negatively affects the QoL of these patients. Thus, a detailed sleep evaluation should be performed, and the use of benzodiazepines should be reduced to the minimum.

Are affective temperaments determinants of quality of life in euthymic patients with bipolar disorder?

BACKGROUND: Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment. OBJECTIVE: Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients. METHODS: A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify the potential confounding variables and select the affective temperaments as potential predictors on the PCS and MCS of QoL in BD patients, as well as the control group. RESULTS: QoL scores in terms of PCS and MCS in BD patients were significantly lower than in healthy individuals. Whereas anxious temperament, anxiety disorder comorbidity, and age were the best predictors of PCS impairment in BD patients, anxious temperament, subclinical depressive symptoms, and age were the best predictors of MCS impairment. LIMITATIONS: Further longitudinal studies with unaffected high-risk relatives are needed to examine the potential interaction between affective temperament and psychopathology. CONCLUSIONS: Anxious temperament has an impact on QoL in BD in terms of both the physical component and the mental component. Systematic screening of temperament in BD would give clinicians better knowledge of QoL predictors. Further research should allow more individualized treatment of BD patients based on temperamental factors.

It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline.

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a 12-week smoking cessation programme for patients with SMD in the community under real-world clinical conditions. Eighty-two adult outpatients with schizophrenic/bipolar disorder smoking ≥15 cigarettes/day were assigned by shared decision between doctors and patients to transdermal nicotine patches (TNP) [36(46.2%)] or varenicline [39(50%)]. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes/day=0 and breath carbon monoxide levels≤9ppm) prevalence was 49.3%, without statistically significant differences between medications (TNP 50.0% vs varenicline 48.6%, chi-square=0.015, p=1.000). Long-term efficacy: At weeks 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and Tolerability: no patients made suicide attempts/required hospitalization. There was no worsening on the psychometric scales. Patients significantly increased weight [TNP 1.1(2.8) vs varenicline 2.5(3.3), p=0.063], without significant changes in vital signs/laboratory results, except significant decreases in alkaline phosphatase and low-density lipoprotein-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (p<0.0005), patients under TNP experienced skin reactions more frequently (p=0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.