Basic quality indicators for clinical care of patients with major depression, schizophrenia, and bipolar disorder.

OBJECTIVE: To identify a set of indicators to monitor the quality of care for patients with major depression, schizophrenia, or bipolar disorder. METHODS: A group of 10 experts selected the most automatically applicable indicators from a total of 98 identified in a previous study. Five online sessions and 5 discussion meetings were performed to select the indicators that met theoretical feasibility criteria automatically. Subsequently, feasibility was tested in a pilot study conducted in two hospitals of the Spanish Health Service. RESULTS: After evaluating its measurement possibilities in the Spanish Health Service, and the fulfillment of all the quality premises defined, 16 indicators were selected. Three were indicators of major depression, 5 of schizophrenia, 3 of bipolar disorder, and 5 indicators common to all three pathologies. They included measures related to patient safety, maintenance and follow-up of treatment, therapeutic adherence, and adequacy of hospital admissions. After the pilot study, 5 indicators demonstrated potential in the automatic generation of results, with 3 of them related to treatments (clozapine in schizophrenia, lithium for bipolar disorder, and valproate in women of childbearing age). CONCLUSIONS: Indicators support the monitoring of the quality of treatment of patients with major depression, schizophrenia, or bipolar disorder. Based on this proposal, each care setting can draw up a balanced scorecard adjusted to its priorities and care objectives, which will allow for comparison between centers.

Lurasidone for the treatment of schizophrenia in adult and paediatric populations.

Schizophrenia is a common debilitating disorder characterized by significant impairments in how reality is perceived, combined with behavioural changes. In this review, we describe the lurasidone development programme for adult and paediatric patients. Both the pharmacokinetic and pharmacodynamic characteristics of lurasidone are revisited. In addition, pivotal clinical studies conducted on both adults and children are summarized. Several clinical cases, which demonstrate the role of lurasidone in real-world practice, are also presented. Current clinical guidelines recommend lurasidone as the first-line treatment in the acute and long-term management of schizophrenia in both adult and paediatric populations.

Fingerprints as Predictors of Schizophrenia: A Deep Learning Study.

BACKGROUND AND HYPOTHESIS: The existing developmental bond between fingerprint generation and growth of the central nervous system points to a potential use of fingerprints as risk markers in schizophrenia. However, the high complexity of fingerprints geometrical patterns may require flexible algorithms capable of characterizing such complexity. STUDY DESIGN: Based on an initial sample of scanned fingerprints from 612 patients with a diagnosis of non-affective psychosis and 844 healthy subjects, we have built deep learning classification algorithms based on convolutional neural networks. Previously, the general architecture of the network was chosen from exploratory fittings carried out with an independent fingerprint dataset from the National Institute of Standards and Technology. The network architecture was then applied for building classification algorithms (patients vs controls) based on single fingers and multi-input models. Unbiased estimates of classification accuracy were obtained by applying a 5-fold cross-validation scheme. STUDY RESULTS: The highest level of accuracy from networks based on single fingers was achieved by the right thumb network (weighted validation accuracy = 68%), while the highest accuracy from the multi-input models was attained by the model that simultaneously used images from the left thumb, index and middle fingers (weighted validation accuracy = 70%). CONCLUSION: Although fitted models were based on data from patients with a well established diagnosis, since fingerprints remain lifelong stable after birth, our results imply that fingerprints may be applied as early predictors of psychosis. Specially, if they are used in high prevalence subpopulations such as those of individuals at high risk for psychosis.

Does Your Loved One With Cognitive Symptoms Need to See a Doctor? Check It Online.

Widespread access to emerging information and communication technologies (ICT) allows its use for the screening of diseases in the general population. At the initiative of the Spanish Confederation of Associations of Families of People with Alzheimer's disease and other dementias (CEAFA), a website (http://www.problemasmemoria.com) has been created that provides information about Alzheimer's disease and includes questionnaires to be completed by family or friends concerned about memory problems of a relative. A cross-sectional, randomized, multicenter study was performed to evaluate feasibility, validity, and user satisfaction with an electronic method of completion vs. the current method of paper-based questionnaires for clinically dementia screening completed by the informants: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Alzheimer's disease-8 screening test (AD8). A total of 111 pairs were recruited by seven memory clinics. Informants completed IQCODE and AD8 questionnaires both in their paper and electronic versions. The correlation between paper and electronic versions was significantly positive for IQCODE (r = 0.98; p < 0.001) and AD8 (r = 0.96; p < 0.001). The execution time did not differ significantly, and participants considered their use equally easy. This study shows that an electronic version of the IQCODE and AD8 questionnaires is suitable for its online use via the internet and achieves the same results as the traditional paper versions.

Huellas dactilares como predictores de la esquizofrenia: un estudio de aprendizaje profundo / Fingerprints as Predictors of Schizophrenia: A Deep Learning Study

El vínculo existente entre la formación de huellas dactilares y el crecimiento del sistema nervioso central apunta a un uso potencial delas huellas dactilares como marcadores de riesgo en la esquizofrenia.Sin embargo, la elevada complejidad de los patrones geométricos delas huellas dactilares requiere algoritmos flexibles capaces de caracterizar dicha complejidad. A partir de una muestra inicial de huellasdactilares escaneadas de 612 pacientes con diagnóstico de psicosisno afectiva y 844 sujetos sanos, hemos construido algoritmos declasificación de aprendizaje profundo basados en redes neuronalesconvolucionales. Previamente, se eligió la arquitectura general de lared a partir de ajustes exploratorios realizados con un conjunto dedatos independiente de huellas dactilares del National Institute ofStandards and Technology. A continuación, la arquitectura de la redse aplicó para construir algoritmos de clasificación (paciente frentea controles) basados en modelos de un solo dedo y en modelos devarios dedos. Se obtuvieron estimaciones de la precisión de la clasificación aplicando un esquema de validación cruzada quíntuple.El mayor nivel de precisión de las redes basadas en un solo dedo loalcanzó la red del pulgar derecho (precisión = 68%), mientras quela mayor precisión de los modelos multientrada la obtuvo el modeloque utilizó simultáneamente imágenes de los dedos pulgar, índice ycorazón izquierdos (precisión = 70%). Aunque los modelos ajustadosse basaron en datos de pacientes con un diagnóstico bien establecido, dado que las huellas dactilares permanecen estables durantetoda la vida después del nacimiento, nuestros resultados implicanque las huellas dactilares pueden aplicarse como predictores tempranos de psicosis. Especialmente, si se utilizan en subpoblacionescon alta prevalencia de esquizofrenia, como las de personas con alto riesgo de psicosis. (AU)

The link between fingerprint generation and central nervous system growth points to a potential use of fingerprints as risk markersin schizophrenia. However, the high complexity of fingerprint geometric patterns requires flexible algorithms capable of characterizing such complexity. From an initial sample of fingerprints scanned from 612 patients diagnosed with non-affective psychosis and844 healthy subjects, we have built deep learning classification algorithms based on convolutional neural networks. Previously, thegeneral network architecture was chosen from exploratory fittingsperformed on an independent fingerprint dataset from the National Institute of Standards and Technology. The network architecturewas then applied for buinding classification algorithms (patientsvs. controls) based on single-finger models and multi-finger models. Classification accuracy estimates were obtained by applyinga 5-fold cross-validation scheme. The highest level of accuracy ofthe single-finger-based networks was achieved by the right thumbnetwork (accuracy = 68%), whereas the highest accuracy of themulti-input models was obtained by the model that simultaneouslyused images of the left thumb, index and middle fingers (accuracy =70%). Although the fitted models were based on data from patientswith a well-established diagnosis, given that fingerprints remainstable throughout life after birth, our results imply that fingerprintscan be applied as early predictors of psychosis. Especially, if usedin subpopulations with high prevalence of schizophrenia, such as those at high risk for psychosis. (AU)

Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association.

INTRODUCTION: Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS: A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS: After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS: Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.

The "CHROME criteria": Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.

OBJECTIVE: Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria. DESIGN: Observational prospective longitudinal study. SETTING: Single nursing home in Las Palmas de Gran Canaria, Spain. PARTICIPANTS: 288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia. INTERVENTION: Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription. MEASUREMENTS: Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107). RESULTS: For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians' diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005). CONCLUSIONS: Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

Conflicto de intereses en psiquiatría / Conflict of interest in Psychiatry

No disponible

Efficacy of a psychoeducational intervention in caregivers of people with intellectual disabilities: A randomized controlled trial (EDUCA-IV trial).

BACKGROUND: People with intellectual disabilities (ID) are usually cared for by their own parents, families or informal caregivers. Caring for a person with ID can have a negative impact on caregivers' mental health (burden, depression, anxiety). The main aim of the EDUCA-IV trial was testing the efficacy of a psychoeducational intervention program (PIP) versus standard practice and to see whether the PIP intervention would reduce the caregiver's burden at post-intervention (4 months) and at follow-up (8 months). METHOD: This was a multi-centre randomised controlled trial including 194 caregivers (96 randomised to PIP, 98 to control condition). PIP intervention consists of 12 weekly group sessions. The control group received treatment as usual. Primary outcomes measured included the Zarit Burden Interview (ZBI). Secondary outcomes were caregivers' mental health (GHQ-28), anxiety (STAI) and depression (CES-D). RESULTS: The decrease of ZBI scores was not significant at 4 months. There was significant decrease in the GHQ scores at 4 and 8 months. CES-D showed relevant results at follow-up. Intention to treat analyses showed similar results. CONCLUSIONS: The PIP intervention seems not to be effective reducing burden, but appears to have a positive result on general mental health. The program was well received and valued by caregivers.

Mental health professionals' attitudes towards mental illness: professional and cultural factors in the INTER NOS study.

BACKGROUND: Research shows that personnel working in mental health facilities may share some of the societal prejudices towards mental illness. This might result in stigmatizing behaviours towards people suffering from mental disorders, undermining the quality of their care. AIMS: To describe and compare attitudes towards mental illness across a sample of professionals working in a wide range of mental health facilities in Spain, Portugal and Italy. METHOD: We administered a survey to personnel including two questionnaires related to stigmatizing attitudes: The Community Attitudes toward the Mentally Ill (CAMI) and the Attribution Questionnaire (AQ-27). Data were compared according to professional category, work setting and country. RESULTS: 34.06% (1525) professionals of the surveyed population responded adequately. Psychologists and social therapists had the most positive attitudes, and nursing assistants the most negative, on most factors of CAMI and AQ-27. Community staff had more positive attitudes than hospital-based professionals in most factors on CAMI and in discriminatory responses on AQ-27. CONCLUSIONS: Globally, mental health professionals showed a positive attitude towards mental illness, but also a relative support to coercive treatments. There are differences in attitudes modulated by professional category and setting. Results can guide preventive strategies, particularly for the hospital-based and nursing staff.

Efectividad de una intervención psicoeducativa en la reducción de la sobrecarga del cuidador informal del paciente con esquizofrenia (EDUCA-III-OSA) / Effectiveness of a psychoeducational intervention in reducing burden in informal caregivers of schizophrenic patients (EDUCA-III-OSA)

Los familiares de pacientes con esquizofrenia o trastorno esquizoafectivo frecuentemente padecen consecuencias negativas derivadas de su labor como cuidadores. El objetivo del estudio EDUCA-III-OSA es evaluar la efectividad de un programa de intervención psicoeducativa (PIP) en la reducción de la sobrecarga del cuidador informal tras la intervención a los 4 meses y 16 meses después. Se llevó a cabo un estudio multicéntrico con diseño cuasi-experimental de grupo único. La variable dependiente principal fue la sobrecarga, medida a través del Inventario de Sobrecarga de Zarit (ZBI) y el Cuestionario de Evaluación de Repercusión Familiar (IEQ). Las variables secundarias fueron la ansiedad (STAI-X), la salud mental del cuidador (GHQ-28) y la depresión (CES-D). 39 cuidadores de 5 centros diferentes participaron en el estudio. Tras la intervención (4 meses), las variables de sobrecarga (d de Cohen = 0.26), depresión (d = 0.42), salud mental (d = 0.76) y ansiedad-estado (d = 0.59) experimentaron una mejora moderada. Esta mejora se vio incrementada a los 16 meses en las variables de sobrecarga (d = 0.56) y ansiedad-estado (d = 0.89), mientras que la variable de salud mental experimentó un descenso (d = 0.39). Tras la aplicación de la intervención psicoeducativa manualizada se produjo una mejoría en el estado psicológico de los cuidadores informales. Estos cambios se mantuvieron un año después

Families of patients with schizophrenia usually experience negative consequences. The aim of the EDUCA-III-OSA study is to test the effectiveness of a psychoeducational intervention program (PIP) to reduce the caregiver burden at post-intervention (4 months) and at follow-up (16 months). A multicentre quasi-experimental study design with a unique group of informal caregivers who received intervention was used. The intervention consisted of 12 weekly group sessions. The primary outcome variable was burden, measured through the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ). Secondary outcome variables were anxiety (STAI-X), mental health (GHQ-28), and depression (CES-D). 39 caregivers from 5 research sites participated in the study. After the intervention (4 months), the variables of burden (Cohen's d = 0.26), depression (d = 0.42), mental health (d = 0.76), and anxiety-state (d = 0.59) showed a moderate decrease. These improvements increased 16 months later in the variables of burden (d = 0.56) and anxiety-state (d = 0.89), while the mental health variable decreased (d = 0.39). After the application of the intervention program a marked improvement in the psychological status of informal caregivers was produced. These changes held one year later

Faux-Pas Test: A Proposal of a Standardized Short Version.

Previous research on theory of mind suggests that people with schizophrenia have difficulties with complex mentalization tasks that involve the integration of cognition and affective mental states. One of the tools most commonly used to assess theory of mind is the Faux-Pas Test. However, it presents two main methodological problems: 1) the lack of a standard scoring system; 2) the different versions are not comparable due to a lack of information on the stories used. These methodological problems make it difficult to draw conclusions about performance on this test by people with schizophrenia. The aim of this study was to develop a reduced version of the Faux-Pas test with adequate psychometric properties. The test was administered to control and clinical groups. Interrater and test-retest reliability were analyzed for each story in order to select the set of 10 stories included in the final reduced version. The shortened version showed good psychometric properties for controls and patients: test-retest reliability of 0.97 and 0.78, inter-rater reliability of 0.95 and 0.87 and Cronbach's alpha of 0.82 and 0.72.

Mapa de la enfermedad de Alzheimer y otras demencias en España. Proyecto MapEA / Map of Alzheimer's disease and other dementias in Spain. MapEA Project

Introducción. En el contexto actual de aumento de la esperanza de vida y progresivo envejecimiento de la población cabe esperar un incremento muy significativo del número de personas con deterioro cognitivo y demencia. No cabe duda que España se enfrenta a un reto de preocupantes dimensiones sociosanitarias en las próximas décadas. El proyecto «Mapa de la enfermedad de Alzheimer y otras demencias en España» pretende analizar el estado actual de las herramientas de planificación y organización, actividades de prevención y detección temprana, proceso asistencial y recursos específicos disponibles en las comunidades autónomas para la atención y el cuidado de las personas con deterioro cognitivo y demencia, con el objeto de identificar las áreas de mejora y emitir recomendaciones. Metodología. El grupo de trabajo estuvo formado por un Comité Asesor nacional de 5 expertos y los correspondientes Comités de Expertos de cada comunidad autónoma constituidos por profesionales del ámbito de la Neurología, Geriatría, Psiquiatría y Atención Primaria así como representantes de Asociaciones de Familiares de personas con Alzheimer y otras demencias. Se llevaron a cabo reuniones de cada comité local en las que se revisó la situación actual de la atención de acuerdo con el cuestionario guía elaborado por el Comité Asesor. Resultados. Los planes específicos disponibles en España están en su mayoría obsoletos o no se han llegado a implantar. En líneas generales no se llevan a cabo actividades de prevención ni de detección temprana. Hay una gran heterogeneidad de rutas asistenciales de acceso al diagnóstico, tratamiento y seguimiento de la enfermedad y no todas las pruebas diagnósticas están disponibles en las diferentes regiones sanitarias. En general, los recursos disponibles se consideran escasos y poco conocidos. Conclusiones. El estudio Mapa de la enfermedad de Alzheimer y otras demencias en España ha permitido detectar los principales puntos susceptibles de cambio y optimización tanto en gestión, organización y coordinación de los recursos como en información y formación de las personas implicadas. Además, el estudio ha revelado que en España se dan las condiciones necesarias de disponibilidad de profesionales implicados y capacitados y de existencia de potenciales recursos diagnósticos y asistenciales para encarar este margen de mejora mediante la aprobación y el desarrollo de un Plan Nacional de Alzheimer, respaldado por un compromiso de voluntades políticas profundo y veraz, y que será el marco idóneo para el desarrollo de estas posibilidades (AU)

Introduction. In the current context of increased life expectancy and progressive aging of the population a very significant increase in the number of people with cognitive impairment and dementia is expected. Consequently, Spain will face an enormous social and health problem in the next decades. The Mapa de la enfermedad de Alzheimer y otras demencias en España project aims to analyse plans, prevention and early diagnosis activities, process of care and resources available across the 17 Spanish regions for the management of cognitive impairment and dementia in order to identify improvement areas, as well as to provide a list of recommendations. Methods. The working group consisted of an Advisory Committee of 5 national experts and a Committee of Experts from each region made up of professionals in the field of Neurology, Geriatrics, Psychiatry, and Primary Care, as well as representatives of Family Associations of People with Alzheimer's and other dementias. The Expert Committee of each region held meetings in which the current situation of care was reviewed. Results. Plans available in Spain for dementia management are mostly obsolete or have not been implemented. Prevention and early detection activities are generally not carried out. There is great variability of care process that patients must follow for the diagnosis, treatment, and follow-up of the disease, and not all diagnostic test are available in different regions. In general, resources are considered scarce and unknown. Conclusions. The Mapa de la enfermedad de Alzheimer y otras demencias en España study has been able to detect the main points that require changing n the management, organisation, and coordination of resources, such as information and training of the personnel involved. Furthermore, the study has revealed that, in Spain, the necessary conditions are in place in Spain, such as the availability and capacity of professionals involved, as well as there being the potential diagnostic and health care resources to address this room for improvement through the approval and development of a National Alzheimer's Plan, supported by a deep and truthful political commitment, which will be the ideal framework for the development of these possibilities (AU)

[Map of Alzheimer's disease and other dementias in Spain. MapEA Project]. / Mapa de la enfermedad de Alzheimer y otras demencias en España. Proyecto MapEA.

INTRODUCTION: In the current context of increased life expectancy and progressive aging of the population a very significant increase in the number of people with cognitive impairment and dementia is expected. Consequently, Spain will face an enormous social and health problem in the next decades. The Mapa de la enfermedad de Alzheimer y otras demencias en España project aims to analyse plans, prevention and early diagnosis activities, process of care and resources available across the 17 Spanish regions for the management of cognitive impairment and dementia in order to identify improvement areas, as well as to provide a list of recommendations. METHODS: The working group consisted of an Advisory Committee of 5 national experts and a Committee of Experts from each region made up of professionals in the field of Neurology, Geriatrics, Psychiatry, and Primary Care, as well as representatives of Family Associations of People with Alzheimer's and other dementias. The Expert Committee of each region held meetings in which the current situation of care was reviewed. RESULTS: Plans available in Spain for dementia management are mostly obsolete or have not been implemented. Prevention and early detection activities are generally not carried out. There is great variability of care process that patients must follow for the diagnosis, treatment, and follow-up of the disease, and not all diagnostic test are available in different regions. In general, resources are considered scarce and unknown. CONCLUSIONS: The Mapa de la enfermedad de Alzheimer y otras demencias en España study has been able to detect the main points that require changing n the management, organisation, and coordination of resources, such as information and training of the personnel involved. Furthermore, the study has revealed that, in Spain, the necessary conditions are in place in Spain, such as the availability and capacity of professionals involved, as well as there being the potential diagnostic and health care resources to address this room for improvement through the approval and development of a National Alzheimer's Plan, supported by a deep and truthful political commitment, which will be the ideal framework for the development of these possibilities.

Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).

BACKGROUND: The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. METHODS: Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. RESULTS: Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 - for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 - for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36, 95% CI: -0.58, -0.15 - for ZBI; -0.39, 95% CI: -0.60, -0.18 - for IEQ). CONCLUSIONS: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. TRIAL REGISTRATION: ( ISRCTN32545295 ).

Estudio de eficacia de una intervención psicoeducativa para la reducción de la sobrecarga del cuidador principal de personas con discapacidad intelectual: análisis de línea base del estudio EDUCA-IV / No disponible

La sobrecarga del cuidador es un aspecto importante en la asistencia a personas con dependencia. Está documentado su impacto sobre la salud tanto del cuidador como de la persona cuidada. Objetivo: estudiar la sobrecarga de cuidadores de personas con discapacidad intelectual y desarrollar una herramienta de intervención, para la prevención o reducción de dicha sobrecarga. La herramienta de intervención (EDUCA-DIS) se basa en la encuesta realizada a 244 familias que cuidan a personas con discapacidad intelectual y en las intervenciones psicoeducativas del programa EDUCA. Métodos: análisis de la línea base del estudio experimental multicéntrico, prospectivo y aleatorizado. Se recogieron datos de 183 cuidadores en 7 centros de atención diurna. La variable principal fue la sobrecarga del cuidador (ZBI). Las variables secundarias fueron el estado de salud mental del cuidador (GHQ-28), el estado de ánimo (CES-D) y el estado de ansiedad (STAI); Se recogieron datos del estado conductual y funcional de la persona cuidada mediante el ICAP. Resultados: El perfil del cuidador principal fue una mujer adulta, que convive con el familiar con un nivel de sobrecarga leve-moderado. Los datos del nivel de distress indicaron que la puntuación más baja está en la subescala de depresión y la más alta en la subescala de ansiedad/ insomnio. El nivel de sobrecarga del cuidador correlacionó negativamente con la capacidad de independencia de la persona atendida, tanto por estado funcional como por la gravedad de problemas de conducta. Conclusiones: el cuidador de la persona con discapacidad presenta síntomas de malestar emocional y es necesario un abordaje de esta problemática asistencial

Caregiver burden is a relevant issue in dependent's assistance. It is well documented its impact in caregiver’s and patient’s health. Aim: EDUCA-IV project study the caregiver burden of mental disability patients and the development of a intervention program to diminish the caregiver burden. The program was based on the surveys of 244 families of patients with intelectual disability and on the previous EDUCA programs. Methods: baseline analyses of a multicentre randomized control trial. Data was obtained from 183 caregivers of 7 daycare centres. Principal outcome was caregiver burden (ZBI-22). Secondary outcomes were mental health (GHQ-28), depression (CES-D), and anxiety (STAI). Behavioural and functionality data of patients were obtained with ICAP questionnaire. Results: Caregiver profile was an adult woman who lives with the patient and shows a low moderate level of burden. GHQ-28 results indicate that caregivers are affected of insomnia/anxiety symptoms. Caregiver burden correlates negatively with the level of independency of patient. Conclusions: Caregivers of intellectual disability patient show burden and psychological distress. It is necessary to act and implement an interventional program

Multidisciplinary consensus on the therapeutic recommendations for iatrogenic hyperprolactinemia secondary to antipsychotics.

Hyperprolactinemia is an underappreciated/unknown adverse effects of antipsychotics. The consequences of hyperprolactinemia compromise therapeutic adherence and can be serious. We present the consensus recommendations made by a group of experts regarding the management of antipsychotic-induced hyperprolactinemia. The current consensus was developed in 3 phases: 1, review of the scientific literature; 2, subsequent round table discussion to attempt to reach a consensus among the experts; and 3, review by all of the authors of the final conclusions until reaching a complete consensus. We include recommendations on the appropriate time to act after hyperprolactinemia detection and discuss the evidence on available options: decreasing the dose of the antipsychotic drug, switching antipsychotics, adding aripiprazole, adding dopaminergic agonists, and other type of treatment. The consensus also included recommendations for some specific populations such as patients with a first psychotic episode and the pediatric-youth population, bipolar disorder, personality disorders and the elderly population.

Sobrecarga y salud mental del cuidador informal del paciente psicogeriátrico institucionalizado (Estudio Resicare) / No disponible

Introducción: El cuidado de personas mayores con enfermedad mental en el domicilio puede generar un importante desgaste psicológico en el cuidador. Este fenómeno se conoce como "sobrecarga". Muchas veces es necesario ingresar al paciente en un recurso residencial psicogeriatrico. El proceso de institucionalización genera nuevas fuentes de estrés, pudiendo generar un nuevo fenómeno de sobrecarga. El objetivo de este estudio es describir y analizar el estado de sobrecarga, depresión, ansiedad, salud psíquica y conflictividad con el centro de los familiares tras el ingreso del paciente. Material y métodos: estudio observacional multicéntrico transversal realizado en 10 centros residenciales psicogeriátricos de España. Se evaluó a los familiares (n=66) con escalas autoadministradas: Escala de sobrecarga de Zarit (ZBI), Escala de sobrecarga para familiares con parientes ingresados en residencias (CBS-FNH), la Escala Hospitalaria de Ansiedad y Depresión (HADS), el Cuestionario de Salud General (GHQ-28) y la Escala de aspectos de mejora en la atención en centros residenciales (NHHS). Resultados: la muestra presentaba sobrecarga leve (ZBI-22 = 48.58;17.85 y CBS-FNH = 14.27; 7.12), distrés psicológico (GHQ-28 = 28.68; 14.74). Los cuidadores cuyos familiares llevaban más tiempo ingresados y recibian más atención del centro presentaron menor clínica. La gravedad psicopatológica del paciente y la conflictividad en la toma de decisión del ingreso se correlacionaron con mayores niveles de malestar en el cuidador. Conclusiones: A pesar del ingreso del paciente, los cuidadores mantienen niveles de sobrecarga y de distrés psicológico. Es necesaria una mayor atención por parte de los servicios residenciales en los momentos iniciales del ingreso

Introduction: The care of elderly people with mental illness at home can produce psychological distress to the informal caregiver. This phenomena has been defined as "caregiver burden". Institutionalize the patient in a psychogeriatric nursing-home becomes necessary. This process can generate new fonts of distress, and burden. The aim of this study is to describe and analyze the estate of burden, depression, anxiety, mental health and hassles with the care center. Material and methods: transversal multicenter observational study performed in 10 psycho-geriatric nursing homes in Spain. Caregivers (n= 66) were assessed with autoadministrated scales: Zarit burden interview (ZBI-22), Caregiver burden scale for family caregivers with relatives in nursing homes (CBS-FNH), Hospitalary anxiety and depression scale (HADS), General Health Questionnaire (GHQ-28) and Caregiving hassles scale (NHHS). Results: the sample showed moderate burden (ZBI-22 = 48.58;17.85 y CBS-FNH = 14.27; 7.12), psychological distress (GHQ-28 = 28.68; 14.74). Caregivers whose family members had more time hospitalized and received more attention had lower clinical scores. Pathological severity of the patient and conflict in decision making correlated directly with higher levels of caregiver distress. Conclusions: Despite the admission of the patient, caregivers maintain levels of burden and psychological distress. Greater attention from residential services in the initial moments of admission is required

Consenso español sobre los riesgos y detección de la hiperprolactinemia iatrogénica por antipsicóticos / Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia

Introducción. La hiperprolactinemia iatrogénica (HPRLi) se ha descrito con más frecuencia con algunos antipsicóticos, dependiendo de su capacidad de bloqueo de los receptores de dopamina D2. Existe gran heterogeneidad de la práctica clínica y posiblemente falta de concienciación sobre este problema entre los médicos. Dada la elevada frecuencia con la que los pacientes con enfermedad mental grave reciben antipsicóticos de forma prolongada, se precisa vigilar posibles riesgos en su salud física. La HPRLi y sus síntomas pueden pasar desapercibidos si no se investigan rutinariamente. Metodología. Se realiza una revisión profunda de la literatura para elaborar un consenso multidisciplinario con psiquiatras junto a otros especialistas (de Endocrinología, Medicina Interna y Oncología) con el fin de consensuar los riesgos clínicos y los métodos de detección más adecuados de la HPRLi de acuerdo con los distintos niveles de evidencia científica (I-IV). Resultados. Los síntomas a corto plazo incluyen amenorrea, galactorrea y disfunción sexual (descenso del deseo y disfunción eréctil por hipogonadismo secundario). A medio-largo plazo y relacionado con la disminución de estrógenos, se pueden inducir baja masa ósea (osteopenia y osteoporosis), hipogonadismo, menopausia precoz, incremento del riesgo de algunos tipos de cáncer (mama y endometrio), aumento del riesgo cardiovascular, alteraciones en la inmunidad, dislipidemia y disfunción cognitiva, entre otros. La petición de niveles de PRL debería realizarse al inicio del tratamiento en todos los pacientes que reciben antipsicóticos, aunque no se observen síntomas precoces (amenorrea, galactorrea) por el riesgo de subestimar otros síntomas que pueden aparecen a medio plazo. Se aconseja determinar también niveles de FSL, LH, testosterona y vitamina D. Se recomienda explorar rutinariamente la función sexual, ya que puede ser un síntoma mal tolerado que podría conducir al abandono del tratamiento. Se propone un especial cuidado en niños y adolescentes, así como en pacientes con PRL > 50 ng/ml (intensidad moderada), revisando periódicamente si existe hipogonadismo o disfunción sexual. En los pacientes con PRL > 150 ng/ml debe descartarse siempre un prolactinoma radiológicamente y se debe prestar especial atención a posibles antecedentes de cáncer de mama o endometrio. Se aconseja realizar densitometrías en varones >50 años y en mujeres con amenorrea > 6 meses o menopausia precoz para detectar osteoporosis y evitar riesgo de fracturas por fragilidad (AU)

Introduction. Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination. Methodology. An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV). Results. Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50 ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150 ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea > 6 months, or early menopause to avoid fracture risk (AU)