A Change of Paradigm in the Management of Acute Psychiatric Episodes? A Retrospective Cohort Study on Trajectories of Use of Clinical Resources After the Implementation of Intensive Home-Treatment.

Intensive home treatment (IHT) has shown to be a feasible alternative to hospitalization for the management of acute psychiatric episodes, but there are no real-world studies assessing if patients with a first IHT use it again for the management of their recurrences. The objectives of this retrospective cohort study were to map the use ofacute treatment resources after the implementation of IHT in our territory through the establishment of trajectories of management, and to disentangle if there are profiles of patients who fit better each trajectory. We included the first 1000 episodes admitted to IHT, of which we selected those that corresponded to the first IHT of a patient (index admission). Trajectories after the index admission were: (T-A) absence of use of acute resources, (T-B) only IHT, and (T-C) at least one hospitalization. Follow-up ranged from 6 months to 6 years. We calculated the frequency of each trajectory and performed univariate analyses searching for associations between trajectory and clinical factors. Among those patients with psychiatric history (N = 659), 66.2% followedT-A, 11.2% T-B, and 22.6% T-C. The probability of following T-C was higher for patients with a psychotic disorder (pBonf = 0.018) and with previous hospitalizations (pBonf < 0.0001). Among those patients without psychiatric history (N = 168), 82.7% followed T-A, 6.6% T-B, and 10.7% T-C. The probability of following T-B was higher for those with a higher severity at the index admission (pBonf = 0.028). This study shows that some -or even all- recurrences of some subjects were successfully managed with IHT, providing real-world evidence for its use in acute psychiatric conditions.

Traumatic Events in Dual Disorders: Prevalence and Clinical Characteristics.

Psychological trauma has been identified in substance use disorders (SUD) as a major etiological risk factor. However, detailed and systematic data about the prevalence and types of psychological trauma in dual disorders have been scarce to date. In this study, 150 inpatients were recruited and cross-sectionally screened on their substance use severity, psychological trauma symptoms, comorbidities, and clinical severity. One hundred patients fulfilled criteria for a dual disorder, while 50 patients were diagnosed with only SUD. Ninety-four percent of the whole sample suffered from at least one lifetime traumatic event. The prevalence rates of Posttraumatic Stress Disorder diagnosis for dual disorder and only SUD was around 20% in both groups; however, patients with dual disorder presented more adverse events, more childhood trauma, more dissociative symptoms, and a more severe clinical profile than patients with only SUD. Childhood maltreatment can also serve as a predictor for developing a dual disorder diagnosis and as a risk factor for developing a more complex and severe clinical profile. These data challenge our current clinical practice in the treatment of patients suffering from dual disorder or only SUD diagnosis and favor the incorporation of an additional trauma-focused therapy in this population. This may improve the prognosis and the course of the illness in these patients.

Alcohol Induced Depression: Clinical, Biological and Genetic Features.

BACKGROUND: In clinical practice, there is the need to have clinical and biological markers to identify induced depression. The objective was to investigate clinical, biological and genetic differences between Primary Major Depression (Primary MD) and Alcohol Induced MD (AI-MD). METHODS: Patients, of both genders, were recruited from psychiatric hospitalisation units. The PRISM instrument was used to establish the diagnoses. Data on socio-demographic/family history, clinical scales for depression, anxiety, personality and stressful life events were recorded. A blood test was performed analysing biochemical parameters and a Genome Wide Association Study (GWAS) to identify genetic markers associated with AI-MD. RESULTS: A total of 80 patients were included (47 Primary MD and 33 AI-MD). The AI-MD group presented more medical comorbidities and less family history of depression. There were differences in traumatic life events, with higher scores in the AI-MD (14.21 ± 11.35 vs. 9.30 ± 7.38; p = 0.021). DSM-5 criteria were different between groups with higher prevalence of weight changes and less anhedonia, difficulties in concentration and suicidal thoughts in the AI-MD. None of the genetic variants reached significance beyond multiple testing thresholds; however, some suggestive variants were observed. CONCLUSIONS: This study has found clinical and biological features that may help physicians to identify AI-MD and improve its therapeutic approach.

MDMA interactions with pharmaceuticals and drugs of abuse.

Introduction: MDMA (3,4-methylenedioxymethamphetamine), a synthetic ring-substituted amphetamine, has become one of the most widely used recreational psychostimulant drugs in the world. Among recreational ecstasy/MDMA users, polydrug use is a phenomenon whose common purpose is to experience the synergistic effect of the combined drugs, moderate MDMA effects, prevent potential toxicity, enhance a high or come down from a high from other drugs, or simply to treat existing medical conditions. Thus, MDMA-drug interactions (MDMA-DIs) lead to a higher risk of acute and life-threatening MDMA toxicity.Areas covered: This article provides an overview of the MDMA-DIs with pharmaceuticals and drugs of abuse. In addition, available evidence is summarized along with clinical recommendations. Finally, the increasing importance of MDMA-DIs is highlighted.Expert opinion: There is a reduced number of published MDMA-DIs studies and scarce clinically significant MDMA-DIs documented in the literature. Experimental evidence points out the relevance of MDMA-DI's when MDMA is co-administered with pharmaceuticals that are metabolized by the CYP2D6 due to MDMA inhibitory action and in the case of repeated MDMA administration (MDMA-MDMAIs).

Drug Interactions With New Synthetic Opioids.

Fentanyl, fentanyl analogs, and other new synthetic opioids (NSO) have burst onto the illegal drug market as new psychoactive substances (NPS). They are often sold as heroin to unsuspecting users and produce euphoria through their agonist action on µ- opioid receptors. Their high consumption, often combined with other substances, has led to multiple intoxications during recent years. In some countries, such as the United States, the consumption of opioids, whether for medical or recreational purposes, has become epidemic and is considered a public health problem. Fentanyl analogs are more potent than fentanyl which in turn is 50 times more potent than morphine. Furthermore, some fentanyl analogs have longer duration of action and therefore interactions with other substances and medicines can be more serious. This review is focused on the potentially most frequent interactions of opioid NPS taking into account the drugs present in the reported cases of poly-intoxication, including other illegal drugs of abuse and medication. Substances involved are mainly antidepressants, antihistamines, antipsychotics, benzodiazepines, analgesics, anesthetics, psychostimulants, other opioids, alcohol, and illegal drugs of abuse. The interactions can be produced due to pharmacokinetic and pharmacodynamic mechanisms. Naloxone can be used as an antidote, although required doses might be higher than for traditional opioid intoxications. It is crucial that doctors who habitually prescribe opioids, which are often misused by patients and NPS users, be aware of designer opioids' potentially life-threatening drug-drug interactions in order to prevent new cases of intoxication.

Dual diagnosis in Depression: treatment recommendations. / Patología dual en Depresión: recomendaciones en el tratamiento.

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

La comorbilidad entre los trastornos por uso de sustancias (SUD) y la depresión mayor (DM) es la patología dual más común en el campo de las adicciones a sustancias, con prevalencias que oscilan entre el 12 y el 80% complicando la respuesta al tratamiento y empeorando el pronóstico de los pacientes. Diferenciar entre el diagnóstico de episodios depresivos inducidos y episodios depresivos primarios concurrentes al uso de sustancias es especialmente relevante para el manejo terapéutico. En este artículo se presenta el estado actual de los tratamientos farmacológicos disponibles hasta el momento para la depresión comórbida en pacientes con SUD, teniendo en cuenta la seguridad y el potencial de abuso de los fármacos antidepresivos. Debido a que la comorbilidad de DM y SUD es frecuente y a que estos pacientes presentan mayor gravedad psicopatológica y peor funcionamiento social, es crucial un modelo de tratamiento integrado y no abordar el tratamiento por separado.

Patología dual en Depresión: recomendaciones en el tratamiento / Dual diagnosis in Depression: treatment recommendations

La comorbilidad entre los trastornos por uso de sustancias (SUD) y la depresión mayor (DM) es la patología dual más común en el campo de las adicciones a sustancias, con prevalencias que oscilan entre el 12 y el 80% complicando la respuesta al tratamiento y empeorando el pronóstico de los pacientes. Diferenciar entre el diagnóstico de episodios depresivos inducidos y episodios depresivos primarios concurrentes al uso de sustancias es especialmente relevante para el manejo terapéutico. En este artículo se presenta el estado actual de los tratamientos farmacológicos disponibles hasta el momento para la depresión comórbida en pacientes con SUD, teniendo en cuenta la seguridad y el potencial de abuso de los fármacos antidepresivos. Debido a que la comorbilidad de DM y SUD es frecuente y a que estos pacientes presentan mayor gravedad psicopatológica y peor funcionamiento social, es crucial un modelo de tratamiento integrado y no abordar el tratamiento por separado

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately

Text mining and expert curation to develop a database on psychiatric diseases and their genes.

Database URL: http://www.psygenet.org. PsyGeNET corpus: http://www.psygenet.org/ds/PsyGeNET/results/psygenetCorpus.tar.

Dual Depression: A Sex Perspective.

Mood and substance use disorders (SUDs) are mental conditions that are highly prevalent in the general population. Cooccurrence of major depression and SUD, also known as dual depression, is very common in the field of substance addiction. Sex differences are found in both major depression and SUD. This review, after presenting the state of the art of dual depression as regards prevalence, ethiopathologic mechanisms, and clinical aspects, is focused on dual depression in women. An overview of some potential factors associated with the sex gap in dual depression such as injecting, sexual risk behavior, intimate partner violence, and the reproductive cycle is presented.

Cannabinoides sintéticos / No disponible

Las nuevas sustancias psicoactivas, de las que se describen sus características y clasificación, enmarcan el fenómeno de los cannabinoides sintéticos, que ocupan un lugar central entre ellas. De los cannabinoides sintéticos se revisa su mecanismo de acción, clasificación, efectos y datos de consumo en España. Se concluye que este mercado, con gran número de sustancias, es cambiante y que todavía es limitado el conocimiento científico sobre sus datos epidemiológicos, su farmacocinética, los patrones de distribución en tejidos y órganos, sus interacciones y efectos clínicos. Todo ello hace necesaria la investigación para discernir sobre estas lagunas de conocimiento

The new psychoactive substances, of which its characteristics and classification are introduced, contextualize the phenomenon of synthetic cannabinoids, central among them. The mechanism of action, classification, effects and use data from Spain of synthetic cannabinoids are reviewed. It is concluded that this market, with a large number of substances, is changing and that there is still a limited scientific knowledge about epidemiological data, pharmacokinetics, distribution patterns in tissues and organs, their interactions and clinical effects. More research is needed to discern these knowledge gaps

Benefits of a Secondary Prevention Program in Suicide.

BACKGROUND: The effectiveness of suicide intervention programs has not been assessed with experimental designs. AIM: To determine the risk of suicide reattempts in patients engaged in a secondary prevention program. METHOD: We included 154 patients with suicidal behavior in a quasi-experimental study with a nontreatment concurrent control group. In all, 77 patients with suicidal behavior underwent the Suicide Behavior Prevention Program (SBPP), which includes specialized early assistance during a period of 3-6 months. A matched sample of patients with suicidal behavior (n = 77) was selected without undergoing any specific suicide prevention program. Data on sociodemographics, clinical characteristics, and suicidal behavior were collected at baseline (before SBPP) and at 12 months. RESULTS: After 12 months, SBPP patients showed a 67% lower relative risk of reattempt (χ2 = 11.75, p = .001, RR = 0.33 95% CI = 0.17-0.66). Cox proportional hazards models revealed that patients under SBPP made a new suicidal attempt significantly much later than control patients did (Cox regression = 0.293, 95% CI = 0.138-0.624, p = .001). The effect was even stronger among first attempters. LIMITATIONS: Sampling was naturalistic and patients were not randomized. CONCLUSION: The SBPP was effective in delaying and preventing suicide reattempts at least within the first year after the suicide behavior. In light of our results, implementation of suicide prevention programs is strongly advisable.

Farmacogenética de las reacciones adversas a los antipsicóticos en pacientes con esquizofrenia / Pharmacogenetics of antipsychotic adverse effects in patients with schizophrenia

Esta revisión se centra en los conocimientos actuales en el campo de la farmacogenética que tienen relación con las reacciones adversas a los antipsicóticos en pacientes con esquizofrenia. En el momento actual hay numerosas investigaciones que han intentado determinar variantes genéticas que permitan predecir el riesgo individual de padecer efectos secundarios al tratamiento con antipsicóticos. Múltiples estudios determinan que polimorfismos de las enzimas del citocromo P450 y de los receptores dopaminérgicos pueden estar relacionados con un mayor riesgo de trastornos del movimiento inducidos por antipsicóticos. Por otro lado, tanto el sistema serotoninérgico como la leptina se han relacionado con el control del apetito, y variantes del receptor 5-HT2C y del gen de la leptina pueden estar asociadas al aumento de peso en el contexto del tratamiento con estos fármacos. Estudios centrados en el riesgo de agranulocitosis con clozapina han concluido que variantes del sistema mayor de histocompatibilidad pueden ser responsables de un incremento del riesgo de aparición de esta reacción adversa (AU)

This review focuses on the current knowledge on pharmacogenetics related to adverse reactions to antipsychotics in patients with schizophrenia. Numerous studies have attempted to identify genetic variants that predict individual risk of side effects during antipsychotic treatment. Several of these studies have determined that polymorphisms of cytochrome P450 enzymes and dopamine receptors may be related to an increased risk of movement disorders induced by antipsychotics. On the other hand, the serotonergic and leptin systems can regulate food intake, and polymorphisms in the 5-HT2C and leptin genes have been associated with antipsychotic-induced weight gain. Several studies have investigated the risk of agranulocytosis during clozapine treatment, and concluded that genetic variants of the major histocompatibility complex may be related with and increased risk of agranulocytosis (AU)