Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder.

BACKGROUND: Cognitive and psychosocial impairment has been associated with increased levels of C-reactive protein (CRP) and homocysteine in bipolar disorder, but gender differences have seldom been studied. METHODS: Two hundred and twenty-four bipolar outpatients were included. Cognitive performance was assessed through the Screen for Cognitive Impairment in Psychiatry (SCIP). Psychosocial functioning was evaluated using the Functioning Assessment Short Test (FAST) and the General Assessment of Functioning (GAF). Homocysteine and CRP levels were determined. Separate analyses were performed by gender. Partial correlations were calculated to test for associations between biomarkers and cognitive and psychosocial functioning. Hierarchical multiple regression was used to assess factors predicting cognitive and psychosocial functioning. Covariates were: age, education, duration of illness, hospital admissions, depressive symptoms, tobacco consumption, and BMI. RESULTS: A better performance was noted in women in delayed verbal learning (p = 0.010), along with better occupational functioning (p = 0.027) and greater leisure time impairment (p = 0.034). In men, CRP and homocysteine levels were associated with psychosocial dysfunction (interpersonal relationships and financial functioning, respectively). In women, CRP levels correlated with cognitive performance (SCIP total raw score, immediate and delayed verbal learning, and verbal fluency). CRP was a predictor of cognitive performance in women only. LIMITATIONS: The choice of the cognitive scale and covariates and the lack of a control group may be the main limitations. CONCLUSIONS: A gender difference was found in biomarker modulation of cognition and psychosocial functioning. A gender-based approach to cognition and real-world functioning should be considered in bipolar disorder to ensure an optimal outcome.

Clinical guideline for the treatment of dual pathology in the adult population.

Editorial del vol 28-1.

Spanish validation of the Brief Assessment in Cognition in Schizophrenia (BACS) in patients with schizophrenia and healthy controls.

Neurocognitive impairment is a core feature of schizophrenia and is closely associated with functional outcome. The importance of cognitive assessment is broadly accepted today, and an easy-to-use, internationality validated cognitive assessment tool is needed by researchers and in daily clinical practice. The Brief Assessment of Cognition in Schizophrenia (BACS) has been validated in English, French, Japanese and Italian. It is as sensitive to cognitive dysfunction as a standard test battery, with the advantage of requiring less than 35minutes to complete. In our study, we tested the psychometric characteristics of a Spanish version of the BACS in 117 patients with schizophrenia-spectrum disorders and 36 healthy controls. All BACS cognitive subtests discriminated between patients and controls (P<.001), and the concurrent validity between the BACS and a traditional neuropsychological test battery was similar to that reported in other languages. We conclude that the BACS can facilitate the comparison of the cognitive performance of patients with schizophrenia in many different countries.

Olanzapine orally-disintegrating tablet in severe psychotic agitation: a naturalistic study.

INTRODUCTION: This study was conducted to determine effectiveness and safety of olanzapine in patients with severe agitation. METHOD: A naturalistic, open-label study in 80 acutely agitated psychotic patients visited in our psychiatric emergency department. Patients received either a 20-mg olanzapine orally-disintegrating tablet or conventional treatment depending on attending psychiatrist's preference. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale (ACES) and pragmatic variables (second pharmacological intervention and need for physical restraints). RESULTS: 60 % patients completed a 6 hour trial. Both groups showed a significant reduction in mean PANSS-EC score. The olanzapine-treated group showed statistically significant improvements: PANSS-EC (F=122.9; df=2.4; p=0.000), ACES (F=68.2; df=2.8; p=0.000). Treatment was well-tolerated and no serious side-effects were observed. CONCLUSIONS: In this naturalistic study in patients with severe agitation, 20-mg oral olanzapine was effective, rapid and safe.

Olanzapina bucodispersable en la agitación psicótica severa / Olanzapine orally-disintegrating tablet in severe psychotic agitation: a naturalistic study

Introducción. El objetivo de este estudio fue determinar la efectividad y seguridad de la olanzapina en pacientes con agitación severa. Método. Estudio naturalístico y abierto en 80 pacientes psicóticos con agitación psicomotriz severa que fueron atendidos en el servicio de urgencias de psiquiatría. Los pacientes recibieron 20 mg de olanzapina bucodispersable o el tratamiento convencional dependiendo de la preferencia del psiquiatra que los evaluó. La eficacia se determinó mediante los componentes de excitación de la escala de evaluación de los síntomas positivos y negativos (PANSS-EC), la escala de evaluación agitación-calma (ACES) y variables pragmáticas (necesidad de segunda intervención farmacológica y necesidad de contención física). Resultados. El 60% de los pacientes completaron el estudio de 6 h de duración. Ambos grupos mostraron una reducción significativa en la media de la puntuación PANSSEC. El grupo tratado con olanzapina mostró una mejoría estadísticamente significativa: PANSS-EC (F=122,9; gl=2,4; p=0,000), ACES (F=68,2; gl=2,8; p=0,000). El tratamiento fue bien tolerado y no se observaron efectos secundarios severos. Conclusiones. Según este estudio naturalístico en pacientes con agitación psicótica severa la administración de 20 mg de olanzapina oral fue efectiva, rápida y segura

Introduction. This study was conducted to determine effectiveness and safety of olanzapine in patients with severe agitation. Method. A naturalistic, open-label study in 80 acutely agitated psychotic patients visited in our psychiatric emergency department. Patients received either a 20-mg olanzapine orally-disintegrating tablet or conventional treatment depending on attending psychiatrist's preference. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation- Calmness Evaluation Scale (ACES) and pragmatic variables (second pharmacological intervention and need for physical restraints). Results: 60 % patients completed a 6 hour trial. Both groups showed a significant reduction in mean PANSS-EC score. The olanzapine-treated group showed statistically significant improvements: PANSS-EC (F=122.9; df=2.4; p=0.000), ACES (F=68.2; df=2.8; p=0.000). Treatment was well-tolerated and no serious side-effects were observed. Conclusions. In this naturalistic study in patients with severe agitation, 20-mg oral olanzapine was effective, rapid and safe