Anaesthesia in electroconvulsive therapy. Special conditions / Anestesia en terapia electroconvulsiva. Condiciones especiales

OBJECTIVES: Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS: We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS: We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS: We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases

OBJETIVOS: La terapia electroconvulsiva (TEC) es una de las principales técnicas disponibles para el tratamiento de enfermedades mentales tan graves como la esquizofrenia y la depresión resistente al tratamiento farmacológico. La evaluación preanestésica adecuada en pacientes con diversos trastornos mentales o enfermedades no difiere sustancialmente de la de otros pacientes antes de recibir anestesia para un procedimiento quirúrgico. La presente revisión tiene como objetivo proponer pautas para lograr mayor nivel de seguridad y efectividad durante la TEC en las situaciones más frecuentes, de acuerdo con la bibliografía actual. MÉTODOS: Se realizó una búsqueda sobre el papel de la anestesia en la TEC en las bases de datos Ovid MEDLINE, PubMed y Scientific Electronic Library Online (SciELO), con especial hincapié en las poblaciones que reciben este tipo de terapia. La búsqueda se realizó entre 1978 y diciembre de 2016. RESULTADOS: Se incluyeron los 96 artículos que contenían las recomendaciones más importantes para la preparación de esta guía. CONCLUSIONES: Proponemos estas pautas para lograr mayor nivel de seguridad y efectividad durante la TEC en condiciones especiales. También resumimos la actitud más importante que debe tener en cuenta el anestesiólogo en estos casos

Anaesthesia in electroconvulsive therapy. Special conditions.

OBJECTIVES: Electroconvulsive therapy (ECT) is one of the main techniques available for the treatment of such serious mental illnesses as schizophrenia and drug-resistant depression. The pre-anaesthetic assessment appropriate for patients with various mental disorders or pathologies does not differ substantially from that of any patient prior to undergoing anaesthesia for a surgical procedure. The present review aims to propose guidelines to achieve a higher level of safety and effectiveness during ECT in the most frequent situations, in accordance with the current literature. METHODS: We conducted a search on the role of anaesthesia in ECT in the Ovid MEDLINE, PubMed, and SciELO (Scientific Electronic Library Online) databases, with special attention to the populations undergoing this type of therapy. The search was carried out between 1978 and December 2016. RESULTS: We included the 96 articles that contained the most important recommendations for the preparation of this guide. CONCLUSIONS: We propose these guidelines in order to achieve a higher level of safety and effectiveness during ECT in special conditions. We also summarize the most important attitude to be taken into account by the anaesthesiologist in these cases.

Patrón de uso de clozapina en España. Variabilidad e infraprescripción / Pattern of use of clozapine in Spain. Variability and under-prescription

Introducción: Los datos internacionales disponibles sobre uso de clozapina recogen en general una baja prescripción, infradosificación y retraso en el inicio del tratamiento, y han originado diversas iniciativas para mejorar su uso y disminuir la llamativa variabilidad. No disponemos de estudios que valoren estos aspectos en población española, por lo que nos hemos planteado una primera y modesta aproximación a través de 4 muestras territoriales. Nuestra hipótesis es que, al igual que las referencias comentadas, en nuestro país el consumo de clozapina podría ser bajo y variable. Nuestro objetivo, en caso de confirmarse la hipótesis, sería iniciar una reflexión sobre posibles estrategias a plantear. Material y métodos: Los autores han accedido a datos de consumo de clozapina en Cataluña, Castilla y León, País Vasco y un Área de Madrid (el Área de Gestión Clínica PSM del Hospital 12 de Octubre). Resultados: Los pacientes con diagnóstico de esquizofrenia en tratamiento en los territorios estudiados oscilan en torno al 0,3%; los tratamientos con clozapina/10.000 habitantes entre el 33% y 57%; y los pacientes diagnosticados como esquizofrenia en tratamiento con clozapina suponen entre el 13,7% y 18,6% de los tratados. El coeficiente de variación entre centros y prescriptores es frecuentemente superior al 50%. Conclusiones: Aunque por debajo de las cifras indicadas por la literatura, los datos globales de prescripción de clozapina en los territorios que hemos estudiado no son tan bajos como los recogidos en otros trabajos internacionales, y se sitúan en el rango de países de nuestro entorno. Sin embargo, la variabilidad en la prescripción es muy importante, aparentemente no justificada; y aumenta a medida que analizamos zonas menores, hasta una gran heterogeneidad de la prescripción individual

Introduction: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. Material and methods: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). Results: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. Conclusions: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription

Pattern of use of clozapine in Spain. Variability and under-prescription. / Patrón de uso de clozapina en España. Variabilidad e infraprescripción.

INTRODUCTION: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. MATERIAL AND METHODS: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). RESULTS: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. CONCLUSIONS: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription.

Guía práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con un trastorno mental grave y un trastorno por uso de sustancias / A clinical guideline for the pharmacological and psychological treatment of adult patients with a serious mental disorder and substance use disorder

Objetivos: El objetivo principal de esta Guía es recoger recomendaciones concretas basadas en los resultados de la literatura científica para tratar a pacientes con un trastorno mental grave y un consumo de sustancias atendidos en centros de tratamiento hospitalarios y ambulatorios. Incluye: 1) Recomendaciones farmacológicas y psicológicas para el tratamiento de los pacientes con un un trastorno depresivo mayor y un trastorno por uso de sustancias (cocaína, cannabis, alcohol, nicotina). 2) Recomendaciones farmacológicas y psicológicas para el tratamiento de los pacientes con trastorno del espectro esquizofrénico y un trastorno por uso de sustancias (cocaína, cannabis, alcohol, nicotina). 3) Recomendaciones farmacológicas y psicológicas para el tratamiento de los pacientes con un un trastorno de ansiedad y un trastorno por uso de sustancias (cocaína, cannabis, alcohol, nicotina). 4) Recomendaciones farmacológicas y psicológicas para el tratamiento de los pacientes con un un trastorno bipolar y un trastorno por uso de sustancias (cocaína, cannabis, alcohol, nicotina). 5) Recomendaciones farmacológicas y psicológicas para el tratamiento de los pacientes con un un trastorno por déficit de atención e hiperactividad y un trastorno por uso de sustancias (cocaína, cannabis, alcohol, nicotina).

Estudio retrospectivo del tratamiento y uso de consultas en un grupo clínico de pacientes con trastorno delirante / A descriptive retrospective study of the treatment and outpatient service use in a clinical group of delusional disorder patients

Introducción: Las diferencias de género en la asistencia a consultas por trastorno delirante han sido escasamente estudiadas. Además, el trastorno delirante es tradicionalmente considerado como un trastorno resistente al tratamiento. Material y métodos: Se llevó a cabo un estudio retrospectivo longitudinal que incluyó 78 pacientes con trastorno delirante (DSM-IV-TR) que ingresaron consecutivamente en nuestro centro en un período de 10 años. Se realizó un seguimiento de los pacientes durante un a˜no con el objetivo de describir variables demográficas y clínicas y comparar la efectividad terapéutica. En este estudio, debido a su naturaleza no intervencionista, se realizó un análisis de las medidas de efectividad indirecta. La muestra se dividió en 3 grupos según el tratamiento antipsicótico recibido en el primer ingreso. Resultados: Veintitrés pacientes recibieron risperidona inyectable de acción prolongada (RILD), 30 risperidona oral y 25 otros antipsicóticos atípicos orales. Las mujeres con trastorno delirante presentaron un inicio más tardío del trastorno y requirieron un mayor tiempo de hospitalización. No se encontraron diferencias estadísticamente significativas entre los 3 grupos de tratamiento con respecto a los datos demográficos, al funcionamiento social y personal, así como a la psicopatología en el ingreso. En el seguimiento durante un año el grupo RILD mostró un mayor porcentaje de permanencia al final del período evaluado. Además, el grupo RILD requirió con menor frecuencia un tratamiento con antidepresivos y benzodiazepinas. Conclusiones: Concluimos que el tratamiento con RILD podría disminuir las pérdidas en el seguimiento del trastorno delirante en comparación con otros antipsicóticos atípicos (AU)

Introduction: Gender differences in attendance rates for appointments in delusional disorder have been poorly studied. Furthermore, delusional disorder is traditionally considered a treatment-resistant disorder. Material and methods: We conducted a longitudinal retrospective study with a one-year followup, including 78 delusional disorder patients (DSM-IV-TR), consecutively admitted over a period of 10 years. We performed a follow-up for one year in order to describe demographic and clinical variables, and to compare the therapeutic effectiveness. In this study, due to the non-interventional nature of this study, indirect measures were used to measure treatment effectiveness. The sample was divided into three groups according to the antipsychotic received at the first admission. Results: Twenty-three patients received Risperidone Long-Acting Injection (RILD), 30 oral risperidone, and 25 patients received other oral atypical antipsychotics. Delusional disorder women had a later age at onset and needed a longer duration of hospitalization. No statistically significant differences were found between the three treatment groups as regards demographic data, social and personal functioning, and psychopathology at admission. The RILD group showed higher maintenance rates at the end of the follow-up period. Furthermore, the RILD group required treatment with antidepressants and benzodiazepines less often. Conclusions: We concluded that treatment with RLAI may increase maintenance rates at followup in DD patients when compared with other oral atypical antipsychotics (AU)

Delphi consensus on the physical health of patients with schizophrenia: evaluation of the recommendations of the Spanish Societies of Psychiatry and Biological Psychiatry by a panel of experts.

INTRODUCTION: Available data from scientific literature show that patients with schizophrenia have higher rates of physical comorbidity and excess mortality due to other physical pathologies. The growing interest to investigate and improve the health of these patients has led a group of Spanish experts to publish in 2008 a "Consensus on physical health of patients with schizophrenia from the Spanish Societies of Psychiatry and Biological Psychiatry" (2008 Consensus). These recommendations imply a significant change to the present model of medical attention. OBJECTIVE: To gauge the level of agreement of a group of expert psychiatrists on the clinical criteria and recommendations collected from the scientific literature and the 2008 Consensus on the physical health of patients with schizophrenia. METHOD: The process involved four phases: 1) Scientific Committee established to manage the study and to define the 66-item questionnaire; 2) Panel of 15 experts in psychiatry is established; 3) Submission of questionnaire to the Expert Panel in two consecutive rounds, with an intermediate processing and sharing of results; 4) Evaluation of results, discussion and conclusions between Scientific Committee and Expert Panel. RESULTS: All items, as set by the Scientific Committee and aligned with the recommendations published in the 2008 Consensus, achieved consensus on agreement from the Expert Panel, except 5 items, for which most of the answers were placed in the indeterminate position rate. CONCLUSIONS: The expert criteria shown in this study indicate a global agreement with regard to clinical criteria on the physical health of patients with schizophrenia, as well as with the present recommendations to improve the health of patients having, or at risk to have, other concomitant pathologies. The need to incorporate new intervention guidelines that facilitate a better control and improvement of the physical health of patients with schizophrenia must be disseminated in the psychiatric providers' collectives.