Prevalencia de enfermedad psiquiátrica entre los suicidios consumados en la provincia de Badajoz en el periodo 2015-2017 / Prevalence of psychiatric pathology among completed suicides in the province of Badajoz in the period 2015-2017

Se realiza un estudio en 157 sujetos que durante el periodo establecido entre el 1 de julio de 2015 y el 31 de diciembre de 2017 cometieron un suicidio consumado en la provincia de Badajoz, para investigar qué porcentaje de los suicidios consumados tenían antecedentes de enfermedad mental. Los resultados indican que existe una menor relación de la esperable entre el acto suicida y la presencia de antecedentes personales psiquiátricos, ya que estos solo aparecen en dos quintas partes de la muestra. Si existen estos, el diagnóstico más frecuente es el de trastorno depresivo y el tratamiento con mayor frecuencia, antidepresivos. Estos datos contrastan con otros recogidos en la literatura que hablan de porcentajes mucho más altos de enfermedad psiquiátrica en sujetos que cometen suicidio. (AU)

A study is carried out in 157 subjects who during the period established between July 01, 2015 and December 31, 2017 committed a consummated suicide in the province of Badajoz to investigate what percentage of consummated suicides had a history of mental pathology. The results indicate that there is a lower-than-expected relationship between the suicidal act and the presence of a personal psychiatric history, as these only appear in two-fifths of the sample. If they do exist, the most frequent diagnosis is depressive disorder and the most frequent treatment is antidepressants. These data contrast with other data collected in the literature that report much higher percentages of psychiatric pathology in subjects who commit suicide. (AU)

Substance use and course of bipolar disorder in an inpatient sample.

INTRODUCTION: Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription. METHODS: The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects. RESULTS: Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them. CONCLUSIONS: The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years.

Uso de sustancias y curso del trastorno bipolar en una muestra de pacientes hospitalizados / Substance use and course of bipolar disorder in an inpatient sample

Introducción. Los pacientes con trastorno bipolar (TB) presentan un consumo de sustancias comórbido con elevada frecuencia. Nuestro estudio pretende establecer una relación entre el consumo de sustancias y el TB, en cuanto a una mayor dificultad diagnóstica, un peor pronóstico y cambios en la prescripción farmacológica. Métodos. La muestra estuvo compuesta por 394 sujetos que a lo largo de veinte años fueron hospitalizados con un diagnóstico de TB en la unidad de agudos de Psiquiatría de un hospital general (10,6% del total de 3704 pacientes ingresados). Las historias clínicas fueron analizadas para obtener datos demográficos, clínicos y relativos al grupo familiar de los sujetos. Resultados. Se obtuvieron datos completos de 319 pacientes. De ellos 165 (51,7%) presentaban antecedentes personales de consumo de sustancias (abuso/dependencia). Este fue más frecuente en hombres (79,7% vs. 34,2%), en menores de 65 años (58,4% vs. 16,7%) y en el TB tipo I respecto al II (55% vs. 35%). Los pacientes consumidores de sustancias presentaban una edad de inicio de la enfermedad más precoz así como más dificultades diagnósticas. Respecto al tratamiento, recibían al alta más estabilizadores del estado de ánimo y más antipsicóticos, así como dosis más elevadas de la mayoría de ellos. Conclusiones. Los casos de patología dual fueron detectados en más de la mitad de la muestra, siendo los más graves y con peor pronóstico, presentando además un debut más temprano de la enfermedad. La asociación TB / consumo de sustancias fue más frecuente en hombres y en menores de 65 años

Introduction. Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription. Methods. The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects. Results. Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them. Conclusions. The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features.

OBJECTIVE: Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied. METHODS: Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment. RESULTS: When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients. DISCUSSION: The results support the association between blunted cortisol response and bulimic features.

Fluoxetine, topiramate, and combination of both to stabilize eating behavior before bariatric surgery.

INTRODUCTION: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). MATERIAL AND METHODS: We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). RESULTS: Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. CONCLUSIONS: The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery.

Fluoxetina, topiramato y combinación de ambos en el control de la conducta alimentaria antes de la cirugía bariátrica / Fluoxetine, topiramate, and combination of both to stabilize eating behavior before bariatric surgery

Introducción. El tratamiento farmacológico de la obesidad está dirigido principalmente a la pérdida de peso, mantenimiento de la pérdida de peso y la reducción del riesgo (reducción de la grasa corporal, factores de riesgo cardiovasculares y la incidencia de diabetes mellitus). Entre los fármacos que han sido evaluados para bajar de peso están los antidepresivos (fluoxetina) y antiepilépticos (topiramato). Material y Métodos. Se analiza la conducta alimentaria y la pérdida de peso en una muestra de pacientes con obesidad mórbida antes de la cirugía bariátrica. Aquellos pacientes que sufrían trastornos alimentarios se agruparon en tres grupos: un grupo recibió 40 mg de fluoxetina/día (Grupo A); topiramato 200 mg/día (Grupo B) y el otro fluoxetina 40 mg y 200 mg de topiramato (Grupo C). Resultados. Los pacientes tratados con fluoxetina más topiramato perdieron más peso a los 3 y 6 meses antes de la cirugía. Conclusiones. El uso de psicofármacos (fluoxetina y topiramato) en pacientes obesos mórbidos con trastornos de la alimentación puede representar una ayuda para el manejo de la conducta alimentaria antes de la cirugía bariátrica

Introduction. Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). Material and Methods. We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). Results. Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. Conclusions. The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery