Diferencias entre craving y calidad de vida relacionada con la salud en pacientes con dependencia alcohólica con o sin enfermedad dual en tratamiento ambulatorio: estudio descriptivo / Differences between craving and health-related quality of life in patients with alcohol dependence with or without dual pathology in outpatient treatment: A descriptive study

Fundamentos y objetivo: Enfermedad dual es la coexistencia al mismo tiempo de un trastorno adictivo y otro trastorno mental. El objetivo es estimar el craving y la calidad de vida autopercibida en una muestra de pacientes con dependencia alcohólica, con o sin enfermedad dual, que acuden a un centro de tratamiento ambulatorio. Pacientes y método: Estudio transversal de 112 pacientes (56 duales y 56 no duales) diagnosticados de dependencia de alcohol según el DSM-IV-TR. Se determina la presencia de craving mediante la Escala Multidimensional de Craving de Alcohol y la calidad de vida mediante el Cuestionario de Salud SF-36. Resultados: No existen diferencias estadísticamente significativas en el craving entre ambos subgrupos; los duales tienden a referir menor craving de alcohol que los pacientes no duales. Los dualestienen una peor calidad de vida en todas las categorías evaluadas, destacando una peor calidad de vida en las categorías: función social, rol emocional, vitalidad y salud general. El sexo femenino presenta una menor calidad de vida, destacando las categorías de función social y rol emocional. No se detectan diferencias en relación al craving entre los 2 grupos. Conclusiones: Para realizar un correcto abordaje clínico y terapéutico de los pacientes con dependencia alcohólica se debe plantear evaluar el craving y la calidad de vida, puesto que son parámetros importantes para la evaluación del paciente con dependencia alcohólica. Además, el cravinges un parámetro propio de la dependencia alcohólica, no de la dualidad (AU)

Background and objective: Dual diagnosis is the coexistence of an addictive disorder and another mental disorder. The objective is to estimate cravings and self-reported quality of life in a sample of patients with alcoholic dependence, with or without dual pathology, who attend an outpatient treatment centre. Patients and method: A cross-sectional study of 112 patients (56 dual and 56 non-dual), diagnosed with alcohol dependence according to DSM-IV-TR. The presence of cravings is determined by the Multidimensional Alcohol Craving Scale and quality of life through the SF-36 Health Questionnaire. Results: There are no statistically significant differences in cravings in either subgroup; the latter tend to refer to lower alcohol cravings than non-dual patients. The dual patients have a worse quality of life in all categories evaluated, highlighting a worse quality of life in the categories: social function, emotional role, vitality and general health. Females present a lower quality of life emphasising those of social function and emotional role. No differences were detected in relation to cravings between the 2 groups. Conclusions: In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, we should consider focusing on the evaluation of cravings and quality of life. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, it is necessary to consider cravings and quality of life, since these parameters are important for the evaluation of patients with alcohol dependence (AU)

Differences between craving and health-related quality of life in patients with alcohol dependence with or without dual pathology in outpatient treatment: A descriptive study. / Diferencias entre craving y calidad de vida relacionada con la salud en pacientes con dependencia alcohólica con o sin enfermedad dual en tratamiento ambulatorio: estudio descriptivo.

BACKGROUND AND OBJECTIVE: Dual diagnosis is the coexistence of an addictive disorder and another mental disorder. The objective is to estimate cravings and self-reported quality of life in a sample of patients with alcoholic dependence, with or without dual pathology, who attend an outpatient treatment centre. PATIENTS AND METHOD: A cross-sectional study of 112 patients (56 dual and 56 non-dual), diagnosed with alcohol dependence according to DSM-IV-TR. The presence of cravings is determined by the Multidimensional Alcohol Craving Scale and quality of life through the SF-36 Health Questionnaire. RESULTS: There are no statistically significant differences in cravings in either subgroup; the latter tend to refer to lower alcohol cravings than non-dual patients. The dual patients have a worse quality of life in all categories evaluated, highlighting a worse quality of life in the categories: social function, emotional role, vitality and general health. Females present a lower quality of life emphasising those of social function and emotional role. No differences were detected in relation to cravings between the 2 groups. CONCLUSIONS: In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, we should consider focusing on the evaluation of cravings and quality of life. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, it is necessary to consider cravings and quality of life, since these parameters are important for the evaluation of patients with alcohol dependence.

The "Seroquel" Outcomes Study (SOS): Efficacy and tolerability of quetiapine in a long-term, naturalistic study of patients with schizophrenia.

Objective. The "Seroquel" Outcomes Study (SOS) aimed to assess the efficacy and tolerability of quetiapine in patients with schizophrenia in the clinical practice setting. Methods. A 6-month, non-comparative, open-label study in adults with schizophrenia in a standard care setting in Spain. Outpatients received flexibly dosed quetiapine. Efficacy was evaluated using the Brief Psychiatry Rating Scale (BPRS) and the Clinical Global Impression (CGI) scale. BPRS response was defined as≥30% decrease from baseline. Tolerability was assessed using the Simpson-Angus Scale (SAS) and a modified Udvalg for Kliniske Undersogelser (UKU) side-effects scale. Results. A total of 2029 patients enrolled. Significant changes from baseline to Month 6 were recorded for BPRS total and subscale scores (P<0.001). Compared with doses of≥600 mg/day, doses of<400 mg/day were a strong predictor of a lower response rate (OR 0.62; 95% CI: 0.48, 0.82) and higher withdrawal rate (OR 3.3; 95% CI: 2.5, 4.4). Mean change in weight was minimal (+0.4 kg). Somnolence (26.7%), asthenia (12.5%), and constipation (9.8%) were the most common adverse events. Conclusion. Quetiapine was found to improve symptoms of schizophrenia, as indicated by a significant decrease in BPRS scores, and was well tolerated by patients in clinical practice.

Antidepresivos, dolor y cáncer / Antidepressives, pain and cancer

Existe una relación entre estrés, depresión y dolor, relacion que es más evidente en los pacientes oncológicos. Teniendo en cuenta la eficacia de los antidepresivos en el tratamiento de ciertos tipos de dolor crónico y la elevada prevalencia de cuadros depresivos en pacientes oncológicos, consideramos interesante revisar las caracteristicas del dolor crónico, especialmente en estos pacientes, y la relacion entre dolor, cancer y depresión. Por otra parte, la depresión y dolor tienen unas vías comunes que explicarían el mecanismo analgésico de los antidepresivos. Sin embargo, en clínica, la acción antidepresiva y la analgésica son totalmente independientes. En el dolor crónico los antidepresivos más eficaces son los tricíclicos, pero debido a sus efectos indeseables se esta tendiendo al uso de los nuevos antidepresivos duales como la venlafaxina y duloxetina

There is a close relationship between stress, depression, and pain, especially in cancer patients. As the efficacy of antidepressants in some types of chronic pain is well documented and the prevalence of depression is very high in cancer patients, we will review the main features of chronic pain, chronic pain in cancer, and the relationship between pain, cancer, and depression. Depression and pain have common pathways mediating the therapeutic effects of most currently available antidepressants. Clinically, the effect of antidepressants on pain and on affective symptoms is independent. In terms of efficacy, tricyclic antidepressants tend to work better but their side effect profile favor the use of the new dual reuptake inhibitors as venlafaxine or duloxetine

Safety and effectiveness of olanzapine in monotherapy: a multivariate analysis of a naturalistic study.

BACKGROUND: This study investigated safety and effectiveness of olanzapine in monotherapy compared with conventional antipsychotics in treatment of acute inpatients with schizophrenia. METHOD: This was a prospective, comparative, nonrandomized, open-label, multisite, observational study of Spanish inpatients with an acute episode of schizophrenia. Data included safety assessments with an extrapyramidal symptoms (EPS) questionnaire and the report of spontaneous adverse events, plus clinical assessments with the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions-Severity of Illness (CGI-S). A multivariate methodology was used to more adequately determine which factors can influence safety and effectiveness of olanzapine in monotherapy. RESULTS: 339 patients treated with olanzapine in monotherapy (OGm) and 385 patients treated with conventional antipsychotics (CG) were included in the analysis. Treatment-emergent EPS were significantly higher in the CG (p<0.0001). Response rate was significantly higher in the OGm (p=0.005). Logistic regression analyses revealed that the only variable significantly correlated with treatment-emergent EPS and clinical response was treatment strategy, with patients in OGm having 1.5 times the probability of obtaining a clinical response and patients in CG having 5 times the risk of developing EPS. CONCLUSION: In this naturalistic study olanzapine in monotherapy was better-tolerated and at least as effective as conventional antipsychotics.

Safety, effectiveness, and patterns of use of olanzapine in acute schizophrenia: a multivariate analysis of a large naturalistic study in the hospital setting.

BACKGROUND AND OBJECTIVE: This study assessed the safety and effectiveness of the atypical antipsychotic olanzapine for the treatment of inpatients with acute schizophrenia. Furthermore, we evaluated patterns of use of olanzapine and their relationship to safety and effectiveness. PATIENTS AND METHOD: This was a prospective, comparative, nonrandomized, open-label, observational study of 848 patients with schizophrenia (International Classification of Diseases, 10th edition) hospitalized due to an acute psychotic episode. Data were collected during patients' entire hospital stay. Safety of antipsychotic therapy was assessed with an extrapyramidal symptoms questionnaire (based on the Udvalg for Kliniske Undersøgelser scale) and the report of spontaneous adverse events. Clinical status was assessed with the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions-Severity of Illness (CGI-S). A multivariate statistical approach was employed. RESULTS: Patients treated with olanzapine in monotherapy had the lowest risk of developing extrapyramidal symptoms (11.2%), whereas patients treated with conventional antipsychotics had a higher risk (39.0%; p < 0.001). Patients treated with olanzapine in monotherapy (even patients with prominent positive symptoms) displayed a higher rate of response compared with conventional antipsychotics-treated patients (p = .007). CONCLUSIONS: Olanzapine is a safe and effective treatment for patients with acute schizophrenia in the hospital setting, even for patients with prominent positive or agitation symptoms.

Safety, effectiveness, and patterns of use of olanzapine in acute schizophrenia: a multivariate analysis of a large naturalistic study in the hospital setting

FUNDAMENTO Y OBJETIVO: Este estudio evaluó la seguridad y la efectividad del antipsicótico atípico olanzapina en el tratamiento hospitalario de la esquizofrenia, así como los patrones de uso deolanzapina y su relación con la seguridad y la efectividad. PACIENTES Y MÉTODO: Se trató de un estudio prospectivo, comparativo, no aleatorizado, abierto, observacional, de 848 pacientes con esquizofrenia (Clasificación Internacional de Enfermedades, décima edición) hospitalizados a causa de un episodio psicótico agudo. Los datos se recogieron durante la totalidad de su estancia hospitalaria. La seguridad del tratamiento antipsicótico se evaluó mediante un cuestionario de síntomas extrapiramidales basado en la escalaUdvalg for Kliniske Undersøgelser, así como mediante la recogida de efectos adversos autorreferidos por el paciente. La situación clínica se evaluó mediante la Escala Breve de EvaluaciónPsiquiátrica (BPRS) y la escala de Impresión Clínica Global-Severidad de la Enfermedad (CGIS).Se utilizó un método estadístico multivariante. RESULTADOS: Los pacientes tratados con olanzapina en monoterapia mostraron el menor riesgo de desarrollar síntomas extrapiramidales, mientras que los tratados con antipsicóticos convencionales mostraron el mayor riesgo (p < 0,001). Los pacientes tratados con olanzapina en monoterapia(incluso aquellos con síntomas positivos prominentes) demostraron una mayor tasa de respuesta que los tratados con antipsicóticos convencionales (p = 0,007).CONCLUSIONES: La olanzapina constituye un tratamiento seguro y efectivo para pacientes con un episodio agudo de esquizofrenia tratados en el ámbito hospitalario, incluso para aquellos con síntomas positivos o de agitación prominentes

BACKGROUND AND OBJECTIVE: This study assessed the safety and effectiveness of the atypical antipsychoticolanzapine for the treatment of inpatients with acute schizophrenia. Furthermore, we evaluated patterns of use of olanzapine and their relationship to safety and effectiveness. PATIENTS AND METHOD: This was a prospective, comparative, nonrandomized, open-label, observationalstudy of 848 patients with schizophrenia (International Classification of Diseases, 10thedition) hospitalized due to an acute psychotic episode. Data were collected during patients’ entire hospital stay. Safety of antipsychotic therapy was assessed with an extrapyramidal symptoms questionnaire (based on the Udvalg for Kliniske Undersøgelser scale) and the report of spontaneous adverse events. Clinical status was assessed with the Brief Psychiatric Rating Scale(BPRS) and the Clinical Global Impressions-Severity of Illness (CGI-S). A multivariate statistical approach was employed. RESULTS: Patients treated with olanzapine in monotherapy had the lowest risk of developing extrapyramidal symptoms (11.2%), whereas patients treated with conventional antipsychotics had a higher risk (39.0%; p < 0.001). Patients treated with olanzapine in monotherapy (evenpatients with prominent positive symptoms) displayed a higher rate of response compared with conventional antipsychotics-treated patients (p = .007).CONCLUSIONS: Olanzapine is a safe and effective treatment for patients with acute schizophrenia in the hospital setting, even for patients with prominent positive or agitation symptoms

Safety and effectiveness of olanzapine versus conventional antipsychotics in the acute treatment of first-episode schizophrenic inpatients.

OBJECTIVE: To assess the safety and effectiveness of olanzapine compared to typical antipsychotics in the treatment of first-episode schizophrenics in acute psychiatric inpatient wards. METHODS: Data were collected from a prospective, comparative, nonrandomized, open, observational study of 904 inpatients with schizophrenia. One hundred and fifty-eight patients fulfilled the criteria for first-episode schizophrenia, defined as (1) the International Classification of Diseases: Mental and Behavioral Disorders, 10th ed. (ICD-10) diagnosis of schizophrenia, (2) antipsychotic nai;ve, and (3) a course of illness of less than 5 years. Eighty-nine (56.3%) of these patients were assigned to the olanzapine treatment group (OLZ) and 69 (43.7%) to the control group that received treatment with conventional antipsychotics (CON). Safety was evaluated in terms of the spontaneous adverse events reported and a specific questionnaire for extrapyramidal symptoms (EPS). Clinical status was measured by means of the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Severity (CGI-S). Clinical response was defined as the baseline-endpoint decrease in BPRS>40% plus an endpoint BPRS<18 or an endpoint CGI

Safety of olanzapine versus conventional antipsychotics in the treatment of patients with acute schizophrenia. A naturalistic study.

BACKGROUND: Conventional antipsychotics although effective in treating acute psychotic and behavioural symptoms are subject to certain limitations due to the high incidence of side effects associated, mainly extrapyramidal symptoms (EPS), and insufficient response shown in some cases. EPS are a major factor in neuroleptic non compliance and high relapse rates among patients. This study was designed to assess the safety and effectiveness of olanzapine compared to typical antipsychotics drugs in the treatment of schizophrenic inpatients at acute psychiatric in-patient units. METHOD: Data from 904 patients schizophrenic patients (F20 of ICD10, WHO) were collected in this prospective, comparative, non-randomized, open and observational study. Patients were followed during their entire hospital stay. Safety was assessed through the collection of spontaneous adverse events and a specific extrapyramidal symptoms questionnaire (EPS). Clinical status was measured through the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression of Severity (CGI-S), Patient Global Impression of Improvement (PGI) and the Nursing Observational Scale for In-patient Evaluation (NOSIE). RESULTS: A total of 483 patients received olanzapine (olanzapine group, OG), and 421 received typical antipsychotics (control group, CG). Treatment emergent EPS, or worsening of previous EPS were statistically significantly higher in the CG (P=0.001). Responder rate was statistically greater in the OG (P<0.001). Mean change in BPRS-total, BPRS-negative, BPRS-agitation subscales and PGI was significantly higher in the OG (P<0.001). Mean decrease in CGI, BPRS positive and BPRS depression sub-scales was also significantly lower (P< or =0.05). Mean change in the NOSIE scale was similar between both groups. CONCLUSION: Olanzapine has been shown to be better tolerated in comparison with conventional antipsychotics in a large unselected sample of acutely psychotic schizophrenic in-patients. Its effectiveness may be greater than that of conventional antipsychotics.