Rural residence and health-related quality of life in a sample of Spain perimenopausal women.

BACKGROUND: The prevalence and severity of perimenopausal symptoms are typically associated with multiple factors, including demographic characteristics. The sociodemographic characteristics of women living in rural areas differ from those residing in urban areas, and it has been suggested that these differences could potentially influence the prevalence of symptoms experienced during perimenopause. OBJECTIVES: To evaluate if perimenopausal women living in Spanish rural areas have a higher prevalence of perimenopausal symptoms and assess their influence on health-related quality of life. METHODS: A cross-sectional study was conducted in a sample of 270 perimenopausal women residing in rural and urban areas. The participants completed the Cervantes Scale Short Version and Beck Depression Inventory 2. RESULTS: Perimenopausal women in rural areas reported a higher incidence of perimenopausal symptoms and a lower perception of health-related quality of life compared to those in urban areas, as evidenced by higher scores on the total Cervantes Scale Short Version scale (33.2 (±16.2) vs. 26.4 (±18.1), p = .001). No differences in the Beck Depression Inventory 2 score were detected. CONCLUSIONS: Perimenopausal women residing in rural areas of Spain reported a higher prevalence of perimenopausal symptoms and experienced a poorer Health-Related Quality of Life compared to those living in urban areas of Spain.

Processing speed mediates the relationship between DDR1 and psychosocial functioning in euthymic patients with bipolar disorder presenting psychotic symptoms.

The DDR1 locus is associated with the diagnosis of schizophrenia and with processing speed in patients with schizophrenia and first-episode psychosis. Here, we investigated whether DDR1 variants are associated with bipolar disorder (BD) features. First, we performed a case‒control association study comparing DDR1 variants between patients with BD and healthy controls. Second, we performed linear regression analyses to assess the associations of DDR1 variants with neurocognitive domains and psychosocial functioning. Third, we conducted a mediation analysis to explore whether neurocognitive impairment mediated the association between DDR1 variants and psychosocial functioning in patients with BD. Finally, we studied the association between DDR1 variants and white matter microstructure. We did not find any statistically significant associations in the case‒control association study; however, we found that the combined genotypes rs1264323AA-rs2267641AC/CC were associated with worse neurocognitive performance in patients with BD with psychotic symptoms. In addition, the combined genotypes rs1264323AA-rs2267641AC/CC were associated with worse psychosocial functioning through processing speed. We did not find correlations between white matter microstructure abnormalities and the neurocognitive domains associated with the combined genotypes rs1264323AA-rs2267641AC/CC. Overall, the results suggest that DDR1 may be a marker of worse neurocognitive performance and psychosocial functioning in patients with BD, specifically those with psychotic symptoms.

Differential Cellular Interactome in Schizophrenia and Bipolar Disorder-Discriminatory Biomarker Role.

Schizophrenia (SCH) and bipolar disorder (BD) are two of the most important psychiatric pathologies due to their high population incidence and disabling power, but they also present, mainly in their debut, high clinical similarities that make their discrimination difficult. In this work, the differential oxidative stress, present in both disorders, is shown as a concatenator of the systemic alterations-both plasma and erythrocyte, and even at the level of peripheral blood mononuclear cells (PBMC)-in which, for the first time, the different affectations that both disorders cause at the level of the cellular interactome were observed. A marked erythrocyte antioxidant imbalance only present in SCH generalizes to oxidative damage at the plasma level and shows a clear impact on cellular involvement. From the alteration of protein synthesis to the induction of death by apoptosis, including proteasomal damage, mitochondrial imbalance, and autophagic alteration, all the data show a greater cellular affectation in SCH than in BD, which could be linked to increased oxidative stress. Thus, patients with SCH in our study show increased endoplasmic reticulum (ER)stress that induces increased proteasomal activity and a multifactorial response to misfolded proteins (UPR), which, together with altered mitochondrial activity, generating free radicals and leading to insufficient energy production, is associated with defective autophagy and ultimately leads the cell to a high apoptotic predisposition. In BD, however, oxidative damage is much milder and without significant activation of survival mechanisms or inhibition of apoptosis. These clear differences identified at the molecular and cellular level between the two disorders, resulting from progressive afflictions in which oxidative stress can be both a cause and a consequence, significantly improve the understanding of both disorders to date and are essential for the development of targeted and preventive treatments.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Are older adults also at higher psychological risk from COVID-19?

OBJECTIVE: Given the lack of information on the psychological impact of COVID-19 on people aged ≥60, we aimed to describe their psychological responses to this pandemic and lockdown situation and compare them with those under 60 years of age. METHODS: Secondary analysis of a larger online cross-sectional study designed to determine the psychological impact of the COVID-19 pandemic and lockdown across Spain. We analyzed a total of 1690 respondents aged ≥60 years and compared them with 13,363 respondents under 60 years of age. We employed the Depression, Anxiety, and Stress Scale and the Impact of Event Scale to evaluate psychological responses. RESULTS: In all, 52.6% of women and 34.3% of men were found to be probable cases of any emotional distress (p < 0.001). In both sexes, the most common psychological response was avoidance behavior (34.7% and 23.8%, respectively), followed by depression (28.5 and 14.2%). Older women and men were considered probable cases of any emotional distress less often than younger ones (women: 52.6% vs. 72.3%, p < 0.001; men: 34.3% vs. 50.6%, p < 0.001). Finally, the results of the binary logistic regression showed that only depressive and stress responses are psychological factors associated with age group [age ≥ 60 years, O.R. = 0.617 (95% CI = 0.501 - 0.759) and 0.437 (95% CI = 0.334 - 0.573), respectively]. CONCLUSION: Contrary to our hypothesis and despite the high percentage of emotional distress we found in older adults, especially women, they are actually at lower risk of developing depressive and stress consequences from COVID-19 and lockdown than those under 60 years of age. That said, we believe our results highlight the need for expert guidance in this age group, especially older women living alone.

Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality. METHODS: We evaluated 538 patients with MDD (mean age [standard deviation] = 43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA). RESULTS: Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p = 0.007), significantly younger (41.20 vs. 51.77 years; p < 0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p < 0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p = 0.001; 127.90 vs. 109.97, p = 0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (ß = 0.489, p = 0.000; odds ratio [95% confidence intervals] = 1.631 [1.266-2.102]). We propose a cut-off value of NLR = 1.30 (sensitivity = 75% and specificity = 35%). CONCLUSIONS: Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.

Prevention of recurrent suicidal behavior: case management and psychoeducation / Prevención de las conductas suicidas recurrentes: manejo de casos y psicoeducación

Background: Development of effective programs for suicide prevention is a global priority. This study evaluated the differential effectiveness of the combination of several strategies to prevent repetition of suicide attempts. Methods: Participants were patients who entered the Emergency Department after a non-fatal suicide attempt. A total of 163 participants (68.1% females, mean age = 41.39) met the inclusion criteria and were spread across three groups: One group received a passive strategy consisting of preventive information, a second group received the passive strategy combined with an active component of case management (MAC), and a third group received the passive strategy, case management and a psychoeducational programme (PSyMAC). Randomization of participants was not possible. The study included assessments at the beginning, and follow-ups every six months up to 30 months. Results: The study showed no significant differences between groups in the number of re-attempts. Logistic regression showed a positive effect for MAC. Conclusions: The present study showed that the use of case management could be a promising strategy, but more research is needed

Antecedentes: el desarrollo de programas efectivos para la prevención del suicidio es una prioridad global. Este estudio ha evaluado la efectividad diferencial de la combinación de diversas estrategias para la prevención de la repetición de los intentos suicidas. Método: los participantes del estudio son pacientes que acudieron al Servicio de Urgencias tras un intento de suicidio. Un total de 163 participantes (68,1% mujeres, edad media = 41,39 años) cumplieron los criterios de inclusión y fueron repartidos en tres grupos: un grupo recibió una estrategia pasiva de información preventiva, un segundo grupo recibió la estrategia pasiva combinada con un componente activo de manejo de casos (MAC) y un tercer grupo recibió la estrategia pasiva, el manejo de casos y un programa psicoeducativo (PSyMAC). La aleatorización de los participantes no fue posible. El estudio incluyó evaluaciones al inicio y seguimientos cada seis meses hasta los 30 meses. Resultado: el estudio no mostró diferencias significativas entre grupos en el número de reintentos. La regresión logística mostró un efecto positivo para el MAC. Conclusiones: el presente estudio muestra que el uso del manejo de casos puede ser una estrategia prometedora, pero se requiere de más investigación

Prevention of recurrent suicidal behavior: Case management and psychoeducation.

BACKGROUND: Development of effective programs for suicide prevention is a global priority. This study evaluated the differential effectiveness of the combination of several strategies to prevent repetition of suicide attempts. METHODS: Participants were patients who entered the Emergency Department after a non-fatal suicide attempt. A total of 163 participants (68.1% females, mean age = 41.39) met the inclusion criteria and were spread across three groups: One group received a passive strategy consisting of preventive information, a second group received the passive strategy combined with an active component of case management (MAC), and a third group received the passive strategy, case management and a psychoeducational programme (PSyMAC). Randomization of participants was not possible. The study included assessments at the beginning, and follow-ups every six months up to 30 months. RESULTS: The study showed no significant differences between groups in the number of re-attempts. Logistic regression showed a positive effect for MAC. CONCLUSIONS: The present study showed that the use of case management could be a promising strategy, but more research is needed.

Factors associated with tobacco consumption in patients with depression. / Factores asociados con consumo de tabaco en pacientes con depresión.

Smoking and depression are related in a bidirectional way: smoking is the primary avoidable cause of illness and death in patients with depression, and depression is one of the most consistent risk factors for smoking. The main objective of this study is to investigate the relationship between smoking and depression, analyzing sociodemographic and clinical variables such as severity of symptoms, subtype of affective disorder, and its impact on suicidal behavior in the clinical population.A sample of 201 patients, over 18 years of age [mean age (SD) = 53.76 (10.36) years; women = 132 (65.7%)], with a history of depressive episode (unipolar or bipolar) or dysthymia (ICD 10 criteria) was studied.Current smoking prevalence was 43.2% and life-time prevalence 61.2%. No statistically significant differences in smoking prevalence between men and women were found (X2 = 3.896, p = 0.143). The average age of onset was 17.81 (5.60) years. There was a tendency towards a linear association between number of cigarettes/day consumed and severity of depression according to the Hamilton Depression Scale (HDRS) in current smokers (Pearson's R = 0.298, p = 0.050). Multinomial logistic regression analysis showed that current tobacco consumption was associated with higher HDRS scores, with each additional point on the HDRS increasing the likelihood of smoking by 0.062 [p = 0.032; OR (95% CI) = 1.064 (1.005-1.125)].Our results showed that depressed patients present higher prevalence of current smoking than the general population, also suggesting a relationship between severity of consumption and severity of depressive symptoms.

Tabaquismo y depresión se relacionan de forma bidireccional: el tabaquismo es la primera causa evitable de enfermedad y muerte en pacientes con depresión, y la depresión constituye uno de los factores de riesgo de tabaquismo más consistentes. El principal objetivo del presente trabajo es profundizar en la relación entre tabaquismo y depresión, analizando variables socio-demográficas y clínicas como la gravedad de los síntomas, el subtipo de trastorno afectivo, y su impacto en las conductas suicidas en población clínica.Se estudió una muestra de 201 pacientes, mayores de 18 años [edad media (SD) = 53,76 (10,36) años; mujeres = 132 (65,7%)], con historia de episodio depresivo (unipolar o bipolar) o distimia (criterios CIE 10).La prevalencia de tabaquismo actual fue 43,2% y la prevalencia vida 61,2%, no existiendo diferencias estadísticamente significativas entre hombres y mujeres (X2 = 3,896; p = 0,143). La edad media de inicio fue 17,81 (5,60) años. Se observó tendencia a asociación lineal entre número de cigarrillos/día consumidos y gravedad de la depresión según la Escala de Hamilton para la Depresión (HDRS) en los consumidores actuales de tabaco (R de Pearson = 0,298; p = 0,050). El análisis de regresión logística multinomial puso de manifiesto que el consumo actual de tabaco se asocia con puntuaciones más elevadas en la HDRS, de modo que cada incremento de un punto en dicha escala, la posibilidad de fumar aumenta en 0,062 [p = 0,032; OR (95% CI) = 1,064 (1,005-1,125)].Nuestros resultados muestran que los pacientes deprimidos presentan mayor prevalencia de consumo actual de tabaco que la población general, sugiriendo además una relación entre gravedad de consumo y gravedad de los síntomas de depresión.

Factors associated with tobacco consumptionin patients with depression / Factores asociados con consumo de tabacoen pacientes con depresión

Smoking and depression are related in a bidirectional way: smoking is the primary avoidable cause of illness and death in patients with depression, and depression is one of the most consistent risk factors for smoking. The main objective of this study is to investigate the relationship between smoking and depression, analyzing sociodemographic and clinical variables such as severity of symptoms, subtype of affective disorder, and its impact on suicidal behavior in the clinical population. A sample of 201 patients, over 18 years of age [mean age (SD) = 53.76 (10.36) years; women = 132 (65.7%)], with a history of depressive episode (unipolar or bipolar) or dysthymia (ICD 10 criteria) was studied. Current smoking prevalence was 43.2% and life-time prevalence 61.2%. No statistically significant differences in smoking prevalence between men and women were found (X2 = 3.896, p = 0.143). The average age of onset was 17.81 (5.60) years. There was a tendency towards a linear association between number of cigarettes/day consumed and severity of depression according to the Hamilton Depression Scale (HDRS) in current smokers (Pearson’s R = 0.298, p = 0.050). Multinomial logistic regression analysis showed that current tobacco consumption was associated with higher HDRS scores, with each additional point on the HDRS increasing the likelihood of smoking by 0.062 [p = 0.032; OR (95% CI) = 1.064 (1.005-1.125)].Our results showed that depressed patients present higher prevalence of current smoking than the general population, also suggesting a relationship between severity of consumption and severity of depressive symptoms

Tabaquismo y depresión se relacionan de forma bidireccional: el tabaquismo es la primera causa evitable de enfermedad y muerte en pacientes con depresión, y la depresión constituye uno de los factores de riesgo de tabaquismo más consistentes. El principal objetivo del presente trabajo es profundizar en la relación entre tabaquismo y depresión, analizando variables socio-demográficas y clínicas como la gravedad de los síntomas, el subtipo de trastorno afectivo, y su impacto en las conductas suicidas en población clínica. Se estudió una muestra de 201 pacientes, mayores de 18 años [edad media (SD) = 53,76 (10,36) años; mujeres = 132 (65,7%)], con historia de episodio depresivo (unipolar o bipolar) o distimia (criterios CIE 10). La prevalencia de tabaquismo actual fue 43,2% y la prevalencia vida 61,2%, no existiendo diferencias estadísticamente significativas entre hombres y mujeres (X2 = 3,896; p = 0,143). La edad media de inicio fue 17,81 (5,60) años. Se observó tendencia a asociación lineal entre número de cigarrillos/día consumidos y gravedad de la depresión según la Escala de Hamilton para la Depresión (HDRS) en los consumidores actuales de tabaco (R de Pearson = 0,298; p = 0,050). El análisis de regresión logística multinomial puso de manifiesto que el consumo actual de tabaco se asocia con puntuaciones más elevadas en la HDRS, de modo que cada incremento de un punto en dicha escala, la posibilidad de fumar aumenta en 0,062 [p = 0,032; OR (95% CI) = 1,064 (1,005-1,125)]. Nuestros resultados muestran que los pacientes deprimidos presentan mayor prevalencia de consumo actual de tabaco que la población general, sugiriendo además una relación entre gravedad de consumo y gravedad de los síntomas de depresión

Obstetric Phenotypes in the Heterogeneity of Schizophrenia.

Schizophrenia is a complex mental disorder with genetic and environmental components. Obstetric complications (OCs) are one of the most common environmental risk factors described. However, despite being different in timing and outcome, OCs are usually described as a homogeneous entity. In the present study, we evaluate the presence of different patterns of OCs evaluated with the Lewis-Murray Scale in chronic schizophrenia patients (n = 101) and their association with a crude marker of the intrauterine environment such as weight at birth.OCs related with abnormal fetal growth (p < 0.001) and OCs during gestation (p = 0.003) were associated with lower birth weight. However, difficulties in delivery, complications in pregnancy, and OCs all together (as a set) were not associated with weight at birth.Our results infer that OCs cannot be taken as a homogeneous group. Different patterns of OCs result in different birth weights, which is associated with specific metabolic, cognitive, and brain structure outcomes.

Functional recovery in patients with schizophrenia: recommendations from a panel of experts.

BACKGROUND: The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. METHODS: After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. RESULTS: After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). CONCLUSIONS: Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.

Eficacia, eficiencia y efectividad en el tratamiento multidimensional de la esquizofrenia: proyecto Rethinking / Effectiveness, efficiency and efficacy in the multidimensional treatment of schizophrenia: rethinking project

La esquizofrenia es un síndrome clínicamente heterogéneo que afecta a múltiples dimensiones vitales del individuo. Su tratamiento requiere un abordaje multidimensional en el que se deberían tener en cuenta la eficacia (la capacidad de una intervención para obtener el resultado pretendido en condiciones ideales), la efectividad (el grado en que se obtiene el efecto pretendido en condiciones de la práctica clínica habitual) y la eficiencia (el valor de la intervención con respecto al coste para el individuo o la sociedad). En una primera fase, un grupo de 90 expertos nacionales de todos los ámbitos, desde una perspectiva multidimensional y multidisciplinar de la enfermedad, definieron los conceptos de eficacia, efectividad y eficiencia en torno a 7 dimensiones clave: síntomas; comorbilidades; recaídas y adherencia; conciencia de enfermedad y experiencia subjetiva; cognición; calidad de vida, autonomía y capacidad funcional, e inclusión. Las principales conclusiones de esta fase se presentan en este trabajo (AU)

Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients’ life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein (AU)

Effectiveness, efficiency and efficacy in the multidimensional treatment of schizophrenia: Rethinking project. / Eficacia, eficiencia y efectividad en el tratamiento multidimensional de la esquizofrenia: proyecto Rethinking.

Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients' life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein.

Tabaco y rendimiento cognitivo en pacientes con esquizofrenia: diseño del estudio COGNICO / Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study

Las personas con esquizofrenia constituyen una parte sustancial de las personas que todavía fuman. La hipótesis de la automedicación en relación al rendimiento cognitivo mantiene que los pacientes fuman para mejorar su déficit cognitivo basándose en los efectos estimulantes de la nicotina. El objetivo de este artículo es describir la metodología del estudio COGNICO. Estudio cuasiexperimental, observacional, prospectivo, multicéntrico y con seguimiento a 3, 6, 12 y 18 meses. Fue llevado a cabo en tres ciudades del norte de España (Oviedo, Ourense y Santiago de Compostela). Se reclutaron 81pacientes con esquizofrenia fumadores (edad media de 43,35 años (DT=8,83). 72,8% varones). Se asignaron a 3 grupos: a) control: pacientes fumadores; b) pacientes que dejan de fumar mediante parches de nicotina; c) pacientes que dejan de fumar mediante vareniclina. Como medida primaria se aplicó la batería neuropsicológica MATRICS. Además, se llevó a cabo una evaluación comprehensiva de los pacientes, que incluía el número de cigarrillos por día, la dependencia física y psicológica a la nicotina y el CO expirado. También se realizó una evaluación clínica general (PANSS, HDRS, ICG, C-SSRS) así como un seguimiento de las medidas antropométricas y los signos vitales. Se pretende identificar la relación entre el patrón de consumo de tabaco y el rendimiento cognitivo mediante la comparación de las puntuaciones en la batería neuropsicológica MATRICS durante los períodos de seguimiento

People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorders

Gender differences in addiction severity. / Diferencias de género en la gravedad de la adicción.

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

Se ha descrito que el género es un factor que condiciona los trastornos por uso de sustancias (TUS). Sin embargo, hay pocos estudios que hayan evaluado esas diferencias de género de manera global, estandarizada y en una muestra amplia de pacientes con TUS. Nuestro objetivo es analizar el rol del género en la gravedad de la adicción a través de los diversos dominios de vida mediante el Addiction Severity Index-6 (ASI-6). Se llevó a cabo un estudio naturalístico, multicéntrico y prospectivo con una muestra compuesta por 221 pacientes con TUS (80,1% hombres). Los participantes fueron entrevistados con el ASI-6. Los resultados han mostrado que las Puntuaciones Sumarias Recientes (PSRs) son similares entre hombres y mujeres a excepción de las correspondientes a Salud mental y Pareja- Problemas, donde las mujeres presentan mayor gravedad (p = 0,017 y p = 0,013, respectivamente). Por otra parte, se han encontrado diferencias estadísticamente significativas en diversos aspectos concretos de las áreas contempladas por el ASI-6, que indican que los hombres presentan más problemas en cuanto a salud física, cuestiones legales y uso de alcohol y drogas, y la mujeres en salud mental, red social y la valoración subjetiva sobre las consecuencias del TUS y la necesidad de tratamiento. Estos resultados deben tenerse en cuenta a la hora de implementar una mejora en la identificación, prevención y tratamiento de los TUS.

Diferencias de género en la gravedad de la adicción / Gender differences in addiction severity

Se ha descrito que el género es un factor que condiciona los trastornos por uso de sustancias (TUS). Sin embargo, hay pocos estudios que hayan evaluado esas diferencias de género de manera global, estandarizada y en una muestra amplia de pacientes con TUS. Nuestro objetivo es analizar el rol del género en la gravedad de la adicción a través de los diversos dominios de vida mediante el Addiction Severity Index-6 (ASI-6). Se llevó a cabo un estudio naturalístico, multicéntrico y prospectivo con una muestra compuesta por 221 pacientes con TUS (80,1% hombres). Los participantes fueron entrevistados con el ASI-6. Los resultados han mostrado que las Puntuaciones Sumarias Recientes (PSRs) son similares entre hombres y mujeres a excepción de las correspondientes a Salud mental y Pareja- Problemas, donde las mujeres presentan mayor gravedad (p = 0,017 y p = 0,013, respectivamente). Por otra parte, se han encontrado diferencias estadísticamente significativas en diversos aspectos concretos de las áreas contempladas por el ASI-6, que indican que los hombres presentan más problemas en cuanto a salud física, cuestiones legales y uso de alcohol y drogas, y la mujeres en salud mental, red social y la valoración subjetiva sobre las consecuencias del TUS y la necesidad de tratamiento. Estos resultados deben tenerse en cuenta a la hora de implementar una mejora en la identificación, prevención y tratamiento de los TUS

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD

Predictors of posttreatment drinking outcomes in patients with alcohol dependence.

AIM: This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors. METHODS: A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment. RESULTS: Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes. CONCLUSIONS: The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.

Protocolo de estudio de un programa para la prevención de la recurrencia del comportamiento suicida basado en el manejo de casos (PSyMAC) / Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)

Introducción. La prevención del comportamiento suicida es una prioridad en la salud pública de la Unión Europea. La tentativa suicida previa es el mejor predictor de riesgo de futuras tentativas suicidas y de suicidio consumado. El principal objetivo de este artículo es describir el protocolo de un estudio controlado diseñado para prevenir la recurrencia de comportamientos suicidas que propone el manejo de casos, e incluye un programa psicoeducativo, en comparación con la intervención clínica habitual (PSyMAC). Métodos. Se monitorizó con un protocolo que incluye variables sociodemográficas y evaluación psiquiátrica y psicosocial a los pacientes que, desde enero de 2011 a junio de 2013, acudieron al Servicio de Urgencias del Hospital Universitario Central de Asturias, tras haber realizado una tentativa suicida. Los pacientes se asignaron de manera aleatoria a un grupo que recibía una atención continuada basada en el manejo de casos incluyendo participación periódica en un programa psicoeducativo (grupo experimental) o a un grupo control que recibía los cuidados clínicos habituales. El objetivo principal es determinar si el período de tiempo hasta la recurrencia del comportamiento suicida es significativamente diferente en el grupo experimental y en el grupo control. Conclusión. El PSyMAC propone intervenciones de bajo coste y fácilmente adaptables al entorno clínico habitual que pueden ayudar a suplir la carencia de protocolos específicos de actuación y de programas preventivos de comportamiento suicida existente en nuestro país. La evaluación de resultados del PSyMAC permitirá determinar su efectividad real en el manejo y reducción del riesgo de suicidio (AU)

Introduction. Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). Methods. Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. Conclusion. SyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk (AU)

[Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)]. / Protocolo de estudio de un programa para la prevención de la recurrencia del comportamiento suicida basado en el manejo de casos (PSyMAC).

INTRODUCTION: Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). METHODS: Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. CONCLUSION: PSyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk.