Evaluación de un Programa Intensivode Prevención de Reintento de Suicidio (PIPRS) en un Área de Salud de 430.000 personas / Evaluation of an Intensive-Reattempt-Prevention Programme based on problem solving therapy in a catchment area of 430.000 people in Madrid, Spain

Introducción. La prevención del suicidio es objetivo prioritario en salud mental. Tener un antecedente de intento de suicidio se considera factor de alto riesgo para la repetición. Este estudio persigue evaluar la efectividad de un programa de prevención de reintentos de suicidio en un área sanitaria de 430.000 habitantes. Metodología. Se realizó un estudio de seguimiento de 12 meses con todas (871) las personas que entre el 1 de enero de 2013 y el 31 de diciembre de 2015 habían realizado intentos de suicidio y solicitaron atención en salud mental del área. De estas, 292 recibieron tratamiento en un Programa Intensivo de Prevención de Reintentos de Suicidio (PIPRS) mediante terapia breve de solución de problemas y enfoque de gestión de caso y se compararon con 357 pacientes que recibieron tratamiento convencional (Treatment as usual, TAU). Resultados. Repitieron intento de suicidio el 9,0% en el PIPRS frente al 23,3% del TAU (Prueba exacta de Fisher p<0,001) y un NNT=7, IC 95% (5-11). El análisis multivariante de Regresión de Cox mostró que el grupo que recibió TAU tenía una HR= 2,68, IC 95% (1,65-4,35) respecto al grupo PIPRS. La ventaja del PIPRS se mantuvo al controlar por las características no homogéneas de los grupos. Conclusiones. La aplicación de un programa de prevención mediante psicoterapia breve y enfoque de gestión de caso, tras un intento de suicidio, reduce y retrasa en el tiempo la repetición de intentos durante el año siguiente. Destaca un esfuerzo clínico (NNT=7) muy rentable.(AU)

Background. Suicide prevention is a primary goal of mental health care and a past history of suicide attempts is considered a high-risk factor for subsequent attempts. This study aims to evaluate the effectiveness of an intensive suicide-reattempt-prevention program (ISRPP) in a health catchment area of 430.000 inhabitants. Methods. A 12-month follow-up study was conducted with all individuals who, between 1 January 2013 and 31 December 2015, had attempted suicide and sought mental health care in the area. Out of a total of 871 patients treated, 292 received treatment as part of ISRPP using short-term problem-solving therapy and a case management approach. Results were compared to those of 357 patients who received treatment as usual (TAU). Results. Attempted suicide was repeated by 9,0% in the ISRPP group, compared to 23,3% in the TAU (Fisher’s exact test p<0,001). The number needed to treat (NNT) was=7; 95% CI 95% (5-11). A multivariate Cox regression analysis showed that the TAU group had a hazard ratio (HR)=2,68; 95% CI (1,65-4,35) compared to the ISRPP group. The advantage of ISRPP was maintained when controlling for the non-homogeneous characteristics of the groups. Conclusions. Applied after a suicide attempt, an intensive prevention programme based on brief cognitive behavioural therapy (CBT) and case management reduces and delays repeat suicide attempts at one-year follow-up. The clinical effort is remarkable (NNT=7).(AU)

Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience.

AIMS: To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. METHOD: Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. RESULTS: During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. CONCLUSIONS: Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. SHORT SUMMARY: Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

El tratamiento grupal de adolescentes con trastornos graves de la personalidad: Una aproximación contextual / Group therapy for adolescents with severe personality disorders: a contextual approach

El presente trabajo se centra en los trastornos mentales graves en la adolescencia, y más específicamente en los trastornos de personalidad. La Terapia Dialéctico Conductual (DBT) es uno de los tratamientos con más evidencia para adolescentes con este tipo de trastornos. Entre las terapias contextuales, la DBT se centra en la reducción de los trastornos de conducta graves, haciendo énfasis en el entrenamiento de habilidades. La relación terapéutica es uno de los componentes clave para tratar la patología de personalidad en adolescentes. Asimismo, la combinación con otras terapias contextuales, como la Psicoterapia Analítica Funcional (PAF), permite un mayor efecto de la DBT. El objetivo de este artículo es mostrar cómo la PAF, combinada con estrategias de otras psicoterapias contextuales, supone una mejora clínica en adolescentes con trastornos de personalidad graves. En este artículo se describe la intervención clínica ambulatoria realizada con cuatro adolescentes de entre 13 y 17 años de edad, diagnosticadas de enfermedad mental grave y con criterios de trastornos de personalidad. Los principales síntomas evaluados fueron la impulsividad, los intentos de suicidio, las autolesiones, la auto y heteroagresividad, los síntomas psicóticos y los problemas del yo. El instrumento de medida utilizado fue el Inventario Clínico para Adolescentes de Millon (MACI). Tras una intervención de cuatro meses, se observó un descenso en las escalas clínicas significativas del MACI. También se encontró una mejoría en cognición, tendencias suicidas, regulación emocional y experiencia del yo (AU)

The present work focuses on severe mental disorders in adolescence; and more specifically on personality disorders. Dialectical Behavioral Therapy (DBT) has proven effective in teenagers with these disorders. Among contextual therapies, DBT aims to reduce serious behaviour disorders, emphasizing skills training. The therapeutic relationship is one of the key components of successful treatment of personality pathology in adolescents. DBT has a greater effect combined with other contextual therapies, such as Functional Analytic Psychotherapy (FAP). The purpose of this paper is to show how FAP, in combination with the latest technical advances in other contextual therapies, brings about clinical improvement in adolescents with severe personality disorders. Four teenagers, between 13 and 17 years old, diagnosed with a severe mental disorder and meeting some criteria for personality disorders, received treatment in an outpatient setting. The main symptoms evaluated were: high impulsivity, suicide attempts, self-injury, self and heteroagressivity, psychotic symptoms, and problems of the self. Patients were assessed with the Millon Adolescent Clinical Inventory (MACI). After a four-month intervention, a decrease in the MACI Clinical scales was observed. We also found an improvement in cognition, suicidal tendencies, emotional regulation, and experience of self (AU)

The Modulation of the Startle Reflex as Predictor of Alcohol Use Disorders in a Sample of Heavy Drinkers: A 4-Year Follow-Up Study.

BACKGROUND: Previous studies demonstrated that patients with alcohol use disorders (AUDs) show altered startle reflex responses to alcohol-related stimuli. However, there is little information about the role of these altered responses in the development of AUDs. This study examined the startle reflex response to different visual stimuli and the role of these patterns in the development of AUDs in a 4-year follow-up. METHODS: Two hundred and thirty-nine (nondependent) heavy-drinking participants were selected. In the baseline period, the startle reflex responses to alcohol-related, aversive, appetitive, and neutral pictures were assessed. Startle reflex responses to these pictures were used as predictive variables. Status drinking (alcohol dependence and nondependence) assessed at 4-year follow-up was used as outcome measure. RESULTS: At the 4-year follow-up assessment, 46% of participants fulfilled DSM-IV alcohol abuse or dependence criteria. Alcohol dependence status was predicted by an attenuated startle reflex response to alcohol-related and aversive pictures. CONCLUSIONS: This study revealed that an attenuated modulation of startle reflex response to alcohol-related and aversive stimuli could be used as a clinical marker to predict the development of AUDs in participants with previous alcohol consumption.

The Addiction-Related Protein ANKK1 is Differentially Expressed During the Cell Cycle in Neural Precursors.

TaqIA is a polymorphism associated with addictions and dopamine-related traits. It is located in the ankyrin repeat and kinase domain containing 1 gene (ANKK1) nearby the gene for the dopamine D2 receptor (D2R). Since ANKK1 function is unknown, TaqIA-associated traits have been explained only by differences in D2R. Here we report ANKK1 studies in mouse and human brain using quantitative real-time PCR, Western blot, immunohistochemistry, and flow cytometry. ANKK1 mRNA and protein isoforms vary along neurodevelopment in the human and mouse brain. In mouse adult brain ANKK1 is located in astrocytes, nuclei of postmitotic neurons and neural precursors from neurogenic niches. In both embryos and adults, nuclei of neural precursors show significant variation of ANKK1 intensity. We demonstrate a correlation between ANKK1 and the cell cycle. Cell synchronization experiments showed a significant increment of ANKK1-kinase in mitotic cells while ANKK1-kinase overexpression affects G1 and M phase that were found to be modulated by ANKK1 alleles and apomorphine treatment. Furthermore, during embryonic neurogenesis ANKK1 was expressed in slow-dividing neuroblasts and rapidly dividing precursors which are mitotic cells. These results suggest a role of ANKK1 during the cell cycle in neural precursors thus providing biological support to brain structure involvement in the TaqIA-associated phenotypes.

Cognitive impairments in patients with first episode psychosis: The relationship between neurophysiological and neuropsychological assessments.

Cognitive deficits in schizophrenia have been widely reported. Neurophysiological and neuropsychological assessments have been conducted to study these impairments. Event-related potentials (ERPs) are relevant markers of cognitive deficits in schizophrenia, and reductions in specific ERP components have been found. The MATRICS Consensus Cognitive Battery (MCCB) was developed to obtain a consensus battery for the assessment of cognitive deficits in schizophrenia. Here, we aimed to study modulations of several ERP components in first episode psychosis (FEP). We also examined neuropsychological deficits using the MCCB, and correlations between ERP and MCCB impairments. Thirty-eight FEP patients were compared to thirty-eight healthy controls. The following ERP components were examined: P1, N1, MMN, P2, early-P3 and late-P3. We used an auditory three-stimulus oddball paradigm, with standard (60%), target (20%) and distractor (20%) stimuli. FEP patients showed significantly lower amplitudes of P2, early-P3 and late-P3 components. FEP patients also showed significant deficits in all the MCCB cognitive domains. Finally, correlational analyses found strong associations between amplitudes of P2, early-P3 and late-P3 components and MCCB tests for attention and speed of processing. These findings indicate that deficits in late auditory ERP components are present in FEP, whereas early components are preserved. These reductions in late ERP components were related to attentional deficits in FEP as assessed by MCCB. These findings indicate that MCCB is a valid battery for studying cognitive impairments in the initial stages of schizophrenia, and highlight the utility of converging neurophysiological and neuropsychological measures to examine attentional impairments in schizophrenia.

Tratamiento cognitivo-conductual de fobia específica en la infancia: estudio de caso / Cognitive-behavioral treatment of specific phobia in childhood: A case study

Presentamos el caso de un adolescente de 12 años de edad derivado a salud mental infanto-juvenil. El paciente presentaba rasgos ansiosos predominando el diagnóstico de fobias específicas que afectaban a su vida diaria. OBJETIVOS: Reducción del número de preocupaciones, disminución de la activación psicofisiológica, crítica de las expectativas irracionales y eliminación de las respuestas de evitación y escape. Evaluación: Entre otras escalas, se utilizó la versión española de la Escala de Ansiedad Infantil de Spence (SCAS), y el Cuestionario de Miedos para Niños-Revisado (FSSC-R). Intervención: Adaptación grupal del Brief-Coping-Cat (BCC) y exposición en vivo individual. RESULTADOS: Hubo una reducción de la sintomatología ansiosa y el paciente pudo exponerse a sus miedos hasta reducir completamente la ansiedad. Resaltamos la importancia de las técnicas de violación de expectativas y la focalización en estímulos positivos como factores de cambio asociados a la exposición. CONCLUSIONES: El presente trabajo pone de manifiesto la eficacia de la adaptación grupal de la BCC, así como la importancia de emplear técnicas que maximicen la eficacia de la exposición en población infanto-juvenil

This article presents the case of a 12-year old adolescent referred to a child and adolescent mental health centre. The patient presented with anxious traits, leading to a primary diagnosis of specific phobias, which impaired his daily living. OBJECTIVES: To achieve a reduction in the patient's number of concerns and psychophysiological arousal, to challenge unrealistic expectations and to eliminate avoidance and escape behaviours. Assessment: Among others, the Spanish version of the Spence Children's Anxiety Scale (SCAS) and the Fear Survey Schedule for Children-Revised (FSSC-R), were used. Intervention: Group adaptation of the Brief Coping Cat (BCC) and individual in vivo exposure. RESULTS: Overall anxious symptoms were reduced and the patient successfully exposed himself to his fears until anxiety completely disappeared. We highlight the importance of expectancy violation and positive stimuli techniques as change factors associated with exposure. CONCLUSIONS: This article underscores the effectiveness of adapting the BCC to a group treatment format and the importance of optimising exposure techniques that may work for children and adolescents

Sensory Gating Deficits in First-Episode Psychosis: Evidence From Neurophysiology, Psychophysiology, and Neuropsychology.

Sensory gating deficits are commonly found in patients with schizophrenia. However, there is still scarce research on this issue. Thirty-eight patients with first-episode psychosis (FEP) were compared to thirty-eight controls. A condition-test paradigm of event-related potentials (ERP), prepulse inhibition (PPI), and some specific tasks of the MATRICS Consensus Cognitive Battery (MCCB) were used (i.e., TMT, BACS-SC, and Fluency for processing speed and CPT-IP for attention and vigilance). The ERP components measured were P50, N1, and P2. The PPI intervals examined were 30, 60, and 120 msec. Regarding the MCCB, processing speed and attention/vigilance cognitive domains were selected. FEP patients showed significant deficits in N1 and P2 components, at 30 and 60 PPI levels and in all the MCCB subtests selected. We obtained significant relationships in N1 with PPI-60, and with one MCCB subtest for processing speed. In addition, this same subtest showed significant association with P2. Therefore, sensory gating functioning is widely impaired since the very early stages of schizophrenia.

The Addiction-Related Gene Ankk1 is Oppositely Regulated by D1R- and D2R-Like Dopamine Receptors.

The ankyrin repeat and kinase domain containing 1 (ANKK1) TaqIA polymorphism has been extensively studied as a marker of the gene for dopamine receptor D2 (DRD2) in addictions and other dopamine-associated traits. In vitro mRNA and protein studies have shown a potential connection between ANKK1 and the dopaminergic system functioning. Here, we have investigated whether Ankk1 expression in the brain is regulated by treatment with dopaminergic agonists. We used quantitative RT-PCR of total brain and Western blots of specific brain areas to study Ankk1 in murine brain after dopaminergic treatments. We found that Ankk1 mRNA was upregulated after activation of D1R-like dopamine receptors with SKF38393 (2.660 ± 1.035-fold; t: 4.066, df: 11, P = 0.002) and apomorphine (2.043 ± 0.595-fold; t: 3.782, df: 8, P = 0.005). The D2R-like agonist quinelorane has no effect upon Ankk1 mRNA (1.004 ± 0.580-fold; t: 0.015, df: 10, P = 0.9885). In contrast, mice treatment with the D2R-like agonists 7-OH-DPAT and aripiprazole caused a significant Ankk1 mRNA downregulation (0.606 ± 0.057-fold; t: 2.786, df: 10, P = 0.02 and 0.588 ± 0.130-fold; t: 2.394, df: 11, P = 0.036, respectively). With respect the Ankk1 proteins profile, no effects were found after SKF38393 (t: 0.54, df: 2, P = 0.643) and Quinelorane (t: 0.286, df: 8, P = 0.782) treatments. In contrast, the D2R-like agonist 7-OH-DPAT (±) caused a significant increment of Ankk1 in the striatum (t: 2.718, df: 7; P = 0.03) when compared to the prefrontal cortex. The activation of D1R-like and D2-R-like leads to opposite transcriptional regulation of Ankk1 by specific pathways.

Are negative symptoms really related to cognition in schizophrenia?

Previous studies have generally found a relationship between negative and cognitive symptoms in schizophrenia. The present study investigated the relationship between the 5 PANSS factors of a recent consensus model developed by NIMH researchers, and cognitive performance as assessed with the MATRICS Consensus Cognitive Battery (MCCB) in 80 patients with schizophrenia using correlation and regression analyses. The PANSS Cognitive factor showed a small to moderate significant association with MCCB Speed of processing, Working memory, Verbal learning, the Neurocognitive composite score, and the Overall composite score. Notably, however, no relationship was found between the PANSS Negative factor and any of the MCCB scores. The Positive, Excited and Depressed factors also did not show associations with the MCCB. These results highlight the need for refined assessment instruments and support the relative independence of cognition from other domains of psychopathology, including negative symptoms, in patients with schizophrenia.

Stress induced by the socially evaluated cold-pressor test cause equivalent deficiencies of sensory gating in male subjects with schizophrenia and healthy controls.

It is known that patients with schizophrenia show a deficiency in the prepulse inhibition reflex (PPI). These patients display abnormalities in autonomic nervous system and hypothalamic-pituitary-adrenal function and may have an altered sensitivity to stress. To date, no studies have been carried out to determine the effect of acute stress on the PPI. We investigated whether there was a differential response in reactivity to acute stress caused by the socially evaluated cold-pressor test (SECPT) in a sample of 58 chronic male patients with schizophrenia and 28 healthy control subjects. PPI, salivary cortisol and heart rate (HR) were measured. The patients were evaluated in two sessions (with and without the SECPT) 72 h apart and basal measurements were carried out and 30 min post-startle probe. We found an increase in salivary cortisol levels and the HR with SECPT condition in both groups and a significantly lower PPI% in patients with schizophrenia. The most relevant findings of this study are that the impairment of the PPI is increased by stress. Stress-induced increase in cortisol in both groups, mainly in healthy control group which allows us to hypothesize that at least such deterioration may be due to the hypercortisolemia caused by the SECPT.

Clinical and Demographic Characteristics of Binge Drinkers Associated with Lack of Efficacy of Brief Intervention and Medical Advice.

UNLABELLED: Brief Counseling Intervention (BCI) and Medical advice (MA) are psychotherapeutic approaches used for the treatment of binge drinkers in Primary Care. Although binge drinking is a common pattern of alcohol misuse in Europe and in the US, no studies have evaluated those subjects who do not respond to Brief Counseling Interventions or Medical Advice. OBJECTIVE: To determine the clinical and demographic characteristics of binge drinkers in whom BCI or MA are not effective in reducing harmful alcohol use. METHODS: This is a secondary analysis of data from a randomized alcohol brief intervention trial with a 12-month follow-up period. A total of 674 subjects (89%) participated right through to the end of the study. The primary outcome measure was change in harmful alcohol use from baseline to 12 months. RESULTS: The strongest baseline predictors of harmful alcohol use during follow-up were educational status, young adults, and high number of cigarettes smoked, present family history of alcoholism, treatment condition and number of drinks per episode of binge drinking. CONCLUSIONS: Binge drinkers are a heterogeneous group that responds to brief intervention or MA but in a subgroup of them these interventions fail to prevent harmful alcohol use. Other interventions should be implemented for these subjects.

La Intervención Breve (IB) y el Consejo Médico simple (CM) son intervenciones psicoterapéuticas usadas para el tratamiento del consumo de alcohol por atracones en Atención Primaria. A pesar de la frecuencia de este patrón de abuso en Europa y en los Estados Unidos, ningún estudio ha evaluado las características de los sujetos que no responden a esas dos técnicas. Objetivo. Determinar las características demográficas y clínicas de los bebedores por atracones en los que la IB y el CM no son efectivos para la reducción del consumo perjudicial de alcohol. Métodos. Se trata de un análisis secundario de los datos obtenidos en un ensayo aleatorizado de intervención breve en alcohol con un período de seguimiento de 12 meses. Un total de 674 sujetos (89%) participaron durante todo el estudio hasta el final. La variable principal fue el cambio en el uso perjudicial de alcohol tras 12 meses de seguimiento. Resultados. Para ambos grupos de tratamiento las variables que predecían la continuidad en el consumo perjudicial tras el seguimiento eran: bajo nivel educativo, ser jóvenes, el número de cigarrillos fumados, la historia familiar de alcoholismo y la gravedad del consumo de alcohol basalmente. Conclusiones. Las características clínicas y sociodemográficas de los sujetos con un patrón de consumo de alcohol por atracones atendidos en Atención primaria influyen en el pronóstico de las Intervenciones breves y del Consejo Médico.

Utilidad clínica e implicaciones económicas de la terapia electroconvulsiva de continuación/mantenimiento en un hospital público del Sistema Nacional de Salud español: serie de casos / Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series

Introducción: La terapia electroconvulsiva de continuación/mantenimiento ha demostrado su eficacia en la prevención de recaídas tanto en cuadros afectivos como psicóticos. Sin embargo, existen pocos estudios sobre variables de gestión clínica, costes asociados y calidad percibida. Material y métodos: Se presenta una serie de 8 casos incluidos en el Programa de terapia electroconvulsiva de Continuación/Mantenimiento del Servicio de Psiquiatría del Hospital Universitario 12 de Octubre durante los primeros 18 meses de su funcionamiento. Para cada paciente se compararon variables clínicas (Escala de Impresión Clínica Global-Mejoría Global, días de ingreso, visitas a Urgencias, ingresos urgentes) antes y después de su inclusión en el programa, así como costes asociados y calidad percibida. Resultados: Tras su inclusión en el programa, el 50,0% de los pacientes refirió encontrarse «mucho mejor», y el 37,5% «moderadamente mejor» en la Escala de Impresión Clínica Global-Mejoría Global. Además, una vez incluidos en el programa de terapia electroconvulsiva de continuación/mantenimiento, los pacientes tuvieron un total de 349 días de ingreso, 3 visitas a Urgencias y 2 ingresos urgentes, frente a los 690 días de ingreso (p = 0,012), 26 visitas a Urgencias (p = 0,011) y 22 ingresos urgentes (p = 0,010) en el mismo periodo, antes de su inclusión en el programa. Los costes directos asociados por estancia/día tras su inclusión en el programa se redujeron al 50,6% del coste previo, y los costes asociados a visitas a Urgencias disminuyeron al 11,5% del coste previo. Respecto a la calidad percibida, un 87,5% de los pacientes evaluaron la atención y tratamiento recibido como «muy satisfactorio», y un 12,5% como «satisfactorio». Conclusiones: El programa de terapia electroconvulsiva de continuación/mantenimiento estudiado ha demostrado utilidad clínica, repercusión económica favorable, así como una elevada calidad percibida (AU)

Introduction: Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables. Material and methods: A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality. Results: After inclusion in the program, 50.0% of patients reported feeling «much better» and 37.5% «moderately better» in the Clinical Global Impression-Improvement Scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy program, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with Emergency Department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of patients assessed the care and treatment received as being «very satisfactory», and 12.5% as «satisfactory». Conclusions: This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality (AU)

Changes on the Modulation of the Startle Reflex in Alcohol-Dependent Patients after 12 Weeks of a Cognitive-Behavioral Intervention.

AIMS: Little is known about changes in the modulation of the startle reflex when patients go through an alcohol-dependence treatment in an outpatient facility. In the current study, the affective modulation of the cue-related startle reflex has been used to evaluate changes in the emotional processing of alcohol-related stimuli that occurred after a standard cognitive-behavioral intervention, and to assess the outcome of this intervention. We hypothesized a 'normalization' of the startle inhibition for the alcohol-related cues during the period of treatment. We also assumed that higher startle inhibition at baseline elicited by alcohol cues would predict the relapse on alcohol consumption during treatment. PARTICIPANTS: A total of 98 alcohol-dependent subjects were included who fulfilled DSM-IV criteria for alcohol dependence. A control group of 72 subjects was selected to match demographic characteristics. MEASUREMENTS: All patients received a standard cognitive-behavioral therapy once a week throughout the study period. FINDINGS: Results show that the startle response differed significantly after 12 weeks of treatment for alcohol-related, neutral and aversive stimuli between alcohol-dependent patients and controls. Low startle responses at baseline to alcohol cues predicted relapse. CONCLUSIONS: These results may indicate that the startle reflex is referred to enduring and permanent processes of cue reactivity, and that the emotional processing of alcohol-associated cues assessed with the affect-modulated startle reflex is less altered by interventions attempting to influence explicit cognitions. Furthermore, lower values of the baseline startle reflex elicited by alcohol-associated stimuli were associated with higher probability of relapse on alcohol use.

Startle-response based tasks and laboratory measures of impulsivity in abstinent alcoholic patients.

AIMS: It is well known that impulsivity is a risk factor for the development of Addictive Disorders, and more specifically Alcohol Use Disorders (AUD). Recently, the Startle-Response Based Tasks (SRBT) and its different forms of plasticity have been found to be impaired in the alcoholic population. This is the first study to explore the correlation between impulsivity laboratory tasks and the SRBT test, in order to determine whether impulsivity and startle response (SR) could be related and in turn, explain their association with Alcohol Dependence (AD). SUBJECTS: 40 men, who met DSM-IV criteria for AD and had been abstinent for at least one month. Impulsivity was assessed using three laboratory tests: Continuous Performance Test (CPT), Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). Patients also underwent the SR test. They were compared to 40 matched controls. RESULTS: Impulsivity laboratory measures tasks (SST and commissions of the CPT) correlated positively with the magnitude of SR (P < 0.05) and with habituation (P < 0.05). Scores on DRL6 correlated negatively with the magnitude of SR (P < 0.05). This was not found in the control group. CONCLUSIONS: The fact that impulsivity laboratory measures and the SR are correlated in patients but not in controls, could imply the existence of a common link for these two measures in alcoholic patients. Our findings support the hypothesis of the existence of two different vulnerability pathways for the development of AUD: anxiety and disinhibitory behaviour.

Cannabis abuse effects on prepulse inhibition in patients with first episode psychosis in schizophrenia.

Deficits in prepulse inhibition (PPI) and cannabis abuse are consistently found in schizophrenia. The authors studied PPI deficits in first episode psychosis (FEP) with schizophrenia and cannabis abuse influence. Thirty-five patients with FEP and 22 control subjects were examined. Patients were divided into cannabis use disorder (CUD) (N=21) and non-CUD (N=14). Startle measures were as follows: PPI at 30, 60, and 120 msec. Patients with CUD and patients without CUD showed lower PPI at 30 msec than control subjects. At 60 msec, patients with CUD obtained higher %PPI than patients without CUD, and patients without CUD obtained lower levels than control subjects. These findings show that cannabis abuse may improve PPI in patients with FEP at some levels.

Clinical usefulness and economic implications of continuation/maintenance electroconvulsive therapy in a Spanish National Health System public hospital: A case series.

INTRODUCTION: Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there is a limited nubber of studies that investigate clinical management, associated costs, and perceived quality variables. MATERIAL AND METHODS: A series of 8 cases included during the first 18 months of the Continuation/Maintenance Electroconvulsive Therapy Program of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (Clinical Global Impression-Improvement Scale, length of hospitalization, number of Emergency Department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy program were compared for each patient, as well as associated costs and perceived quality. RESULTS: After inclusion in the program, 50.0% of patients reported feeling « much better ¼ and 37.5% « moderately better ¼ in the Clinical Global Impression-Improvement Scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy program, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalization (P = .012), 26 Emergency Department visits (P = .011) and 22 urgent admissions (P = .010) during the same period before inclusion in the program. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with Emergency Department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of patients assessed the care and treatment received as being « very satisfactory ¼, and 12.5% as « satisfactory ¼. CONCLUSIONS: This continuation/maintenance electroconvulsive therapy program has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality.

Factors associated with hospitalization after suicide spectrum behaviors: results from a multicenter study in Spain.

The objective of this study was to identify factors associated with hospital admission after suicide spectrum behaviors. Patients' characteristics, the nature of the suicidal behavior, admission rates between centers, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in 3 Spanish cities. The intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors, and psychiatric diagnosis of schizophrenia, mood, or personality disorder were independently associated with being admitted. There was a 3-fold between-center difference in the rate of hospitalization. Widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.

Características clínicas y demográficas de bebedores "por atracones" que se relacionan con una falta de eficacia de la intervención breve y el consejo médico / Clinical and Demographic Characteristics of Binge Drinkers Associated with Lack of Efficacy of Brief Intervention and Medical Advice

La Intervención Breve (IB) y el Consejo Médico simple (CM) son intervenciones psicoterapéuticas usadas para el tratamiento del consumo de alcohol por atracones en Atención Primaria. A pesar de la frecuencia de este patrón de abuso en Europa y en los Estados Unidos, ningún estudio ha evaluado las características de los sujetos que no responden a esas dos técnicas. Objetivo:. determinar las características demográficas y clínicas de los bebedores por atracones en los que la IB y el CM no son efectivos para la reducción del consumo perjudicial de alcohol. Métodos:. Se trata de un análisis secundario de los datos obtenidos en un ensayo aleatorizado de intervención breve en alcohol con un período de seguimiento de 12 meses. Un total de 674 sujetos (89%) participaron durante todo el estudio hasta el final. La variable principal fue el cambio en el uso perjudicial de alcohol tras 12 meses de seguimiento. Resultados:. Para ambos grupos de tratamiento las variables que predecían la continuidad en el consumo perjudicial tras el seguimiento eran: bajo nivel educativo, ser jóvenes, el número de cigarrillos fumados, la historia familiar de alcoholismo y la gravedad del consumo de alcohol basalmente. Conclusiones:. Las características clínicas y sociodemográficas de los sujetos con un patrón de consumo de alcohol por atracones atendidos en Atención primaria influyen en el pronóstico de las Intervenciones breves y del Consejo Médico

Brief Counseling Intervention (BCI) and Medical advice (MA) are psychotherapeutic approaches used for the treatment of binge drinkers in Primary Care. Although binge drinking is a common pattern of alcohol misuse in Europe and in the US, no studies have evaluated those subjects who do not respond to Brief Counseling Interventions or Medical Advice. Objective: To determine the clinical and demographic characteristics of binge drinkers in whom BCI or MA are not effective in reducing harmful alcohol use. Methods: This is a secondary analysis of data from a randomized alcohol brief intervention trial with a 12-month follow-up period. A total of 674 subjects (89%) participated right through to the end of the study. The primary outcome measure was change in harmful alcohol use from baseline to 12 months. Results:. The strongest baseline predictors of harmful alcohol use during follow-up were educational status, young adults, and high number of cigarettes smoked, present family history of alcoholism, treatment condition and number of drinks per episode of binge drinking. Conclusions:. Binge drinkers are a heterogeneous group that responds to brief intervention or MA but in a subgroup of them these interventions fail to prevent harmful alcohol use. Other interventions should be implemented for these subjects