Circadian Disruption and Mental Health: The Chronotherapeutic Potential of Microbiome-Based and Dietary Strategies.

Mental illness is alarmingly on the rise, and circadian disruptions linked to a modern lifestyle may largely explain this trend. Impaired circadian rhythms are associated with mental disorders. The evening chronotype, which is linked to circadian misalignment, is a risk factor for severe psychiatric symptoms and psychiatric metabolic comorbidities. Resynchronization of circadian rhythms commonly improves psychiatric symptoms. Furthermore, evidence indicates that preventing circadian misalignment may help reduce the risk of psychiatric disorders and the impact of neuro-immuno-metabolic disturbances in psychiatry. The gut microbiota exhibits diurnal rhythmicity, as largely governed by meal timing, which regulates the host's circadian rhythms. Temporal circadian regulation of feeding has emerged as a promising chronotherapeutic strategy to prevent and/or help with the treatment of mental illnesses, largely through the modulation of gut microbiota. Here, we provide an overview of the link between circadian disruption and mental illness. We summarize the connection between gut microbiota and circadian rhythms, supporting the idea that gut microbiota modulation may aid in preventing circadian misalignment and in the resynchronization of disrupted circadian rhythms. We describe diurnal microbiome rhythmicity and its related factors, highlighting the role of meal timing. Lastly, we emphasize the necessity and rationale for further research to develop effective and safe microbiome and dietary strategies based on chrononutrition to combat mental illness.

Cognitive and behavioral profiles in children with autism spectrum disorder with and without Attention-Deficit/hyperactivity disorder.

BACKGROUND: Understanding the developmental trajectories of children with autism spectrum disorder (ASD) with and without comorbid ADHD is relevant to tailor care plans. This prospective study assessed, for the first time, cognitive, emotional, behavioral, and learning outcomes in adolescence of children with ASD-ADHD and in those with ASD+ADHD in childhood. Possible predictors of severity of ASD core symptoms in adolescence were also evaluated. METHODS: Forty-five adolescents without intellectual disability, 26 diagnosed in childhood with ASD-ADHD and 19 with ASD+ADHD, were evaluated at baseline (mean age: 8.6 ± 1.3) and at 5-year follow-up (mean age: 12.9 ± 0.9). Parents and teachers completed questionnaires on executive functions, theory of mind (ToM), emotional/behavioral difficulties (EBD), and learning style at both time points.. RESULTS: Overall different developmental trajectories for the two groups were found. In general, deficits in metacognition processes, ToM skills, EBD, and learning abilities were more pronounced in the ASD+ group. Over time, the ASD+ADHD group, but not the ASD-ADHD, tended to improve in EBD and metacognition but their level of development continued to be lower compared with ASD+ADHD. EBD in childhood were significant predictors of autism core symptoms of adolescents. CONCLUSIONS: Our findings highlight the importance of an early identification of comorbid ADHD symptoms in ASD to offer treatment strategies based on specific developmental trajectories.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles.

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Exploring developmental trajectories throughout adolescence of children with autism spectrum disorder without intellectual disability.

Characterizing the developmental trajectories of children with autism spectrum disorder (ASD) throughout adolescence and across different domains of functioning offers opportunities to improve long-term outcomes. This prospective study explored, for the first time, the evolution of children with ASD-without intellectual disability (ID) in terms of socio-adaptative skills, learning behaviors, executive functioning (EF), and internalizing/externalizing problems, compared to typically developing (TD) peers. Forty-five children with ASD-without ID and 37 matched TD children (aged 7-11) were assessed at baseline and after 5 years. Parents and teachers completed measures on theory of mind (ToM), socialization, daily living skills, learning style, EF, and emotional/behavioural difficulties at both time points. On all the domains assessed, the ASD group performed significantly worse than the TD group, both in childhood and adolescence. Specific changes were noted between baseline and follow-up assessment on adaptive skills, prosocial behavior, emotional control, inhibit, working memory and monitoring. Group membership (ASD/TD) was influenced by peer relationships and inhibit EF variables. These findings have implications for clinical and school settings.

A Feasibility Study of Patients with Major Depression and Substance Use Disorders: Vortioxetine as Maintenance Treatment.

Background: Limited studies have evaluated the effectiveness of vortioxetine in real-world settings, and none of them has involved patients with dual depression (major depressive disorder [MDD] and substance use disorder [SUD]). The objective of the study was to describe the effectiveness of vortioxetine in clinical practice and determine its effect on affective symptoms, cognitive function, quality of life, and substance use in patients with MDD and SUD. Methods: Post-authorization, retrospective, multicenter, descriptive, and observational study in 80 patients with MDD and SUD receiving a maintenance treatment with vortioxetine for six months between January 2017 and April 2021. Results: Compared with baseline, scores significantly decreased after 3 and 6 months of treatment in the Montgomery-Åsberg Depression Rating Scale total (from 28.9 to 17.7 and 12.0), and global functional impairment of the Sheehan Disability Inventory (from 26.3 to 19.1 and 16.7). The number of correct answers in the symbol digit modalities test significantly improved during vortioxetine treatment (from 40.4 to 43.8 and 48.4). Regarding the clinical global impression scale, the score for disease severity significantly decreased from 3.8 to 3.0 and 2.4. Compared with baseline, there was a significant reduction in consumption of practically all substances, especially of alcohol, cannabis, and cocaine. Conclusion: Vortioxetine was effective in clinical practice for alleviating depressive symptoms and functional impairment, and in improving cognitive and executive functions and disease severity in patients with MDD and SUD. Moreover, the treatment with vortioxetine favored a reduction in substance use and the severity of the SUDs.

Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review.

LAY ABSTRACT: This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.

Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder.

The depressive disorder coexists in a high prevalence with a substance-related disorder, which is asso- ciated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientific sup- port. The existing evidence suggest that the currently avail- able anti-depressive drugs are of minor efficacy in this group of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanism of action. The aim of this study was to describe the clinical develop- ment of a series of patients affected by this comorbidity un- der treatment with tianeptine under usual clinical practices.

Efectividad de tianeptina en pacientescon depresión mayor y trastorno poruso de sustancias / Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder

Introducción: La depresión coexiste frecuentemente conlos trastornos por uso de sustancias (TUS), lo que conllevaun peor pronóstico. Existe una importante falta de evidenciasobre las intervenciones terapéuticas más efectivas para estacomorbilidad. Los estudios existentes sugieren que los antidepresivos disponibles actualmente son poco eficaces paraestos pacientes. La disponibilidad terapéutica de antidepresivos con mecanismos neurobiológicos diferentes podría seruna alternativa. El objetivo es describir la evolución de ungrupo de pacientes con esta comorbilidad que han realizadotratamiento con tianeptina en condiciones de práctica clínica habitual en consultas de deshabituación.Metodología. Se diseñó un estudio postautorización,multicéntrico, retrospectivo y observacional de práctica clínica habitual. Se revisaron las historias clínicas de los 100últimos pacientes diagnosticados de depresión mayor y TUS,tratados con tianeptina durante al menos 3 meses. Se evaluaron en tres ocasiones (inicial, intermedia y final a los 3meses) las siguientes escalas: Escala de Evaluación para laDepresión de Hamilton (HDRS), Escala de Impresión ClínicaGlobal (ICG) y Escala de Gravedad de la Adicción (SDS).Resultados. La mayoría de los pacientes fueron tratadoscon una combinación de psicofármacos y psicoterapia. Alfinal del seguimiento 70 pacientes (70 %) obtuvieron unaremisión clínica según la escala HDRS y 76 pacientes (76 %)se clasificaron con mucha o moderada mejoría según ICG.Respecto al consumo, los descensos más destacados se produjeron en los trastornos por uso de alcohol y cocaína.Conclusión. Tianeptina, en monoterapia o en combinación, puede ser un tratamiento de utilidad para pacientescon depresión dual de forma conjunta con otras medidasterapéuticas que traten de forma integrada estos pacientescomplejos. (AU)

Introduction: The depressive disorder coexists in a highprevalence with a substance-related disorder, which is associated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientificsupport. The existing evidence suggest that the currentlyavailable anti-depressive drugs are of minor efficacy in thisgroup of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanismof action. The aim of this study was to describe the clinicaldevelopment of a series of patients affected by this comorbidity under treatment with tianeptine under usual clinicalpractices.Methods. Study design corresponds to a post-authorization, observational, retrospective, multicentric, study underusual clinical practice study. The clinical history of the lastconsecutive 100 patients diagnosed of major depressive andsubstance-related disorders under treatment with tianeptinefor at least 3 months was reviewed. The following scales wereevaluated in 3 times (basal, intermediate, final): HDRS, ICGand SDS. Results. Most patients were treated by a combinationof anti-depressive drugs together with psychotherapy. Atthe end of follow-up, 70 % patients had a clinical remissionin accordance with HDRS and 76 % of them had a mild orsignificant improvement in ICG. Regarding the use of substances, the most remarkable decreases were obtained in theconsumption of alcohol, and cocaine.Conclusion. Tianeptine could be a useful drug for thetreatment of patients with dual diagnosis of depression andsubstance-related disorder, together with other therapeuticinterventions. (AU)

Treatment Needs and Service Delivery for Patients with Dual Disorders During the COVID-19 Pandemic: Findings From the WADD Survey.

OBJECTIVE: The COVID-19 pandemic has posed a great challenge for the existing health systems. The restrictions imposed across countries on the movement of people and the realignment of health care services in response to the pandemic are likely to negatively affect the health status and delivery of mental health services to persons with dual disorders (PWDD). Methods: An online survey was conducted among mental health professionals involved in providing care to PWDD to better understand the problems encountered and identify potential solutions in providing continued treatment for PWDD during the COVID-19 pandemic. Results: The findings confirmed significant disruption in the delivery of treatment services for PWDD during the COVID-19 pandemic. Dissatisfaction with personal protective equipment, inadequate COVID-19 testing services at treatment facility, and lack of guidelines on providing continued treatment services to PWDD by national authorities or professional bodies were identified as the likely reasons for this disruption. Conclusions: These concerns in turn need to be addressed by the policy-makers, hospital management staff, and other stakeholders. Specifically, there should be a focus on developing and disseminating guidelines to assist mental health professionals in setting-up and providing continued treatment services to PWDD via tele-psychiatry and other novel digital strategies.

Subgroups of Children with Autism Spectrum Disorder without Intellectual Disability: A Longitudinal Examination of Executive and Socio-Adaptive Behaviors in Adolescence.

Within the autistic spectrum, there is remarkable variability in the etiology, presentation, and treatment response. This prospective study was designed to identify, through cluster analysis, subgroups of individuals with ASD without intellectual disability (ID) based on the severity of the core symptoms in childhood. The secondary aim was to explore whether these subgroups and a group with typical development (TD) differ in cognitive, adaptive, and social aspects measured in adolescence. The sample at baseline was comprised of 52 children with ASD without ID and 37 children with TD, aged 7-11. Among the ASD group, three clusters were identified. Cluster 1 (40%), 'high severity', presented high symptom severity on the DSM-5 criteria and the Social Communication Questionnaire. Cluster 2 (34%) showed 'moderate severity' on most of the scores. Cluster 3 (25%) corresponded to 'low severity', showing moderate social impairment and low restrictive, repetitive patterns of behavior, interests and activities. At 5-year follow-up, 45 adolescents with ASD without ID and 27 adolescents with TD were assessed. All clusters had significantly more difficulties in EF, ToM, socialization and adaptive behavior compared to TD. Social and adaptive trajectories between the ASD subgroups were relatively different; Cluster 3 showed poorer socialization and daily living skills than the other two subgroups. These findings highlight the importance of fully assessing social, cognitive, and adaptive profiles to develop care plans tailored to specific needs.

Developmental outcomes in adolescence of children with autism spectrum disorder without intellectual disability: A systematic review of prospective studies.

Individuals with Autism Spectrum Disorder (ASD) without intellectual disability (ID) represent approximately two-thirds of the ASD population. Here we focused on prospective research assessing different areas of functioning of children with ASD, without ID, until adolescence. Based on a pre-registered protocol (PROSPERO CRD42020189029), a systematic review of prospective studies (published between 01.01.2010 and 01.01.2020) was conducted. Twenty-eight studies met eligibility criteria. Findings indicated that ASD diagnosis and the Intelligence Quotient were highly stable over time across studies. Executive Functioning, Theory of Mind and Central Coherence processes tended to improve, although deficits remained when compared to typically developed controls. Adaptive difficulties and psychiatric comorbidity were relatively stable over time. We discuss potential implications of the findings for clinicians and educators and suggest recommendations for future research.

Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study.

BACKGROUND: As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems. OBJECTIVE: The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs. METHODS: A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices. RESULTS: The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units. CONCLUSIONS: This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/26214.

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. OBJECTIVES: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. METHODS: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. RESULTS: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. CONCLUSIONS: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver's quality of life.

Professional perception of clozapine use in patients with dual psychosis.

INTRODUCTION: Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication. MATERIAL AND METHODS: A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease. RESULTS: The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual disorder. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%). CONCLUSIONS: In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus.

Percepción de los profesionales sobre el uso de la clozapina en pacientes con psicosis dual / Professional perception of clozapine use in patients with dual psychosis

INTRODUCCIÓN. Los pacientes con trastornos psicóticos presentan con frecuencia trastornos por uso de sustancias y otras adicciones. El objetivo de este estudio fue conocer la situación actual del tratamiento de estos pacientes con el foco puesto en la clozapina, que ha sido propuesta en la mayoría de los consensos como antipsicótico de primera elección en esta indicación. MATERIAL Y MÉTODOS. Se elaboró una encuesta con 14 preguntas sobre aspectos relacionados con el tratamiento y manejo de la patología dual, haciendo hincapié en el papel de la clozapina en esta enfermedad. RESULTADOS: La encuesta fue respondida por 199 exper-tos en enfermedades mentales (90,5% médicos y 9,5% psicólogos). Un 88,4% de los encuestados tenía posibilidad de prescribir la clozapina, pero la mayoría (89,4%) la administraba a pacientes con esquizofrenia resistente sin considerar una patología dual. Solo un 30,8% planteó el uso de la clozapina a pacientes con psicosis dual. La infrautilización de la clozapina en estos pacientes se atribuyó principalmente a los controles del plan de farmacovigilancia, incluido el recuento leucocitario frecuente (57,1%), y a la falta de formación sobre el fármaco (35,6%). Las principales medidas propuestas para incrementar su uso son tener que hacer menos controles hemáticos (29,3%), mayor formación (27,8%) y tener menos problemas administrativos (25,1%). CONCLUSIONES: Para mejorar el tratamiento de los pacientes con psicosis dual es necesario simplificar la terapia e incrementar la formación de los profesionales sobre el uso de antipsicóticos atípicos, especialmente la clozapina, considerada como el fármaco de elección en los principales consensos de expertos

INTRODUCTION: Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication. MATERIAL AND METHODS: A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease. RESULTS: The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual dis-order. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%). CONCLUSIONS: In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus

Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD.

BACKGROUND: Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors. METHODS: Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses). RESULTS: The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals. CONCLUSIONS: The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.

Correction to: Once­Monthly Long­Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co­occurring Substance Use Disorders: A Multicentre, Observational Study.

A randomized, 1-year follow-up study comparing LAI aripiprazole with LAI paliperidone in patients with psychosis, mostly schizophrenia, and SUD reported a large effect of the change from baseline in the CGI severity score, from 5.9 to 2.4 for LAI aripiprazole and from 5.7 to 2.6 for LAI risperidone [29].

Once-Monthly Long-Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co-occurring Substance Use Disorders: A Multicentre, Observational Study.

AIM: To evaluate the efficacy and impact of long-acting injectable (LAI) aripiprazole in patients with schizophrenia with a coexisting substance use disorder (SUD). PATIENTS AND METHODS: A multicenter, observational, descriptive and retrospective study was conducted in patients with a DSM-5 diagnosis of schizophrenia who had a coexisting SUD and were treated with LAI-aripiprazole. Disease severity was evaluated with the Clinical Global Impression (CGI) severity scale for schizophrenia, daily functioning and disability were evaluated with the World Health Organisation Disability Assessment Scale (WHODAS-2.0), and the severity of the addiction was evaluated with the Severity of Dependence Scale (SDS). RESULTS: The sample included 40 patients. Overall, after 6 months of treatment with LAI-aripiprazole at a dose of 400 mg/4 weeks in 77.5% of the patients, we observed significant improvement in the psychopathological symptoms, with a reduction of over 30% in the scores of the five CGI-severity scales. The WHODAS-2.0 mean (standard deviation) score was also significantly reduced from 57.6 (8.2) to 42.3 (4.3) points (p < 0.001). Regarding SUDs, after 6 months of treatment, substance use was stopped in 5 of the 9 patients with cocaine use disorder and in 3 of the 16 patients with alcohol abuse disorder. A significant reduction in the severity of the dependence was observed only in the subgroups of participants with cocaine and alcohol use disorders. CONCLUSION: Our study suggests that once-monthly LAI-aripiprazole retains its antipsychotic efficacy in patients with schizophrenia and a coexisting SUD and could be useful for the management of cocaine or alcohol use disorders in this population.

La transición del adolescente con trastorno por déficit de atención con hiperactividad: Implicaciones para el tratamiento del adulto / Transition of adolescents with attention deficit/hyperactivity disorder. Implications for treatment of adults

El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo crónico, complejo y multifactorial asociado con elevadas tasas de concurrencia con otros trastornos psiquiátricos, junto con problemas y repercusiones en diferentes áreas del funcionamiento del individuo. El TDAH no es exclusivo de la edad infanto-juvenil, estimándose una persistencia del 40-60% en la edad adulta, de modo que entre 2.5 y 5% de adultos continúan presentando este trastorno. La adolescencia es una etapa en la que se producen grandes y continuos cambios y que se asocia con una menor adherencia al tratamiento, una mayor vulnerabilidad a la aparición de problemas académicos, más conductas de riesgo, el inicio en el consumo de sustancias y la aparición de otros trastornos comórbidos. Se produce también la transición a los servicios o unidades de adultos, siendo necesaria una mayor coordinación entre los servicios infanto-juveniles y de adultos para asegurar una continuidad de la intervención en una etapa d e la vida en la que el paciente es especialmente vulnerable. Como en el caso de los niños y adolescentes, el tratamiento recomendado en el adulto con TDAH es el abordaje multimodal y multidisciplinar, que combina la medicación con estrategias psicológicas o psicosociales, como la psicoeducación, la terapia cognitivo conductual o el coaching, adaptadas a las necesidades individuales de cada paciente. Los fármacos psicoestimulantes son considerados de primera elección en adultos por las guías clínicas.

Attention deficit hyperactivity disorder (ADHD) is a chronic, complex and multifactorial neurodevelopmental disorder associated with high rates of concurrent psychiatric disorders, along with problems and complications on different areas of individual functioning. ADHD is not exclusively a childhood disorder, 40-60% persisting into adulthood with an estimated prevalence of 2.5-5%. Adolescence is a stage where great and continuous changes occur, associated with a lower adherence to treatment, a greater vulnerability to the emergence of academic problems, more risk-behaviors, the onset of substance use and higher rates of other comorbid disorders. The transition to adult services or units also occurs at this stage, requiring greater coordination between child/adolescent and adult services to ensure continuity of care in a phase of life in which the patient is particularly vulnerable. As in the case of children and adolescents, the recommended treatment for adults with ADHD is the multimodal and multidisciplinary approach, that combines medication with psychological or psychosocial strategies, such as psycho-education, cognitive behavioral therapy or coaching, adapted to the individual needs of each patient. Clinical guidelines recommend psycho-stimulant drugs as first-line treatments for adult patients with ADHD.

[Transition of adolescents with attention deficit/hyperactivity disorder. Implications for treatment of adults]. / La transición del adolescente con trastorno por déficit de atención con hiperactividad. Implicaciones en el tratamiento en el adulto.

Attention deficit hyperactivity disorder (ADHD) is a chronic, complex and multifactorial neurodevelopmental disorder associated with high rates of concurrent psychiatric disorders, along with problems and complications on different areas of individual functioning. ADHD is not exclusively a childhood disorder, 40-60% persisting into adulthood with an estimated prevalence of 2.5-5%. Adolescence is a stage where great and continuous changes occur, associated with a lower adherence to treatment, a greater vulnerability to the emergence of academic problems, more risk-behaviors, the onset of substance use and higher rates of other comorbid disorders. The transition to adult services or units also occurs at this stage, requiring greater coordination between child/adolescent and adult services to ensure continuity of care in a phase of life in which the patient is particularly vulnerable. As in the case of children and adolescents, the recommended treatment for adults with ADHD is the multimodal and multidisciplinary approach, that combines medication with psychological or psychosocial strategies, such as psycho-education, cognitive behavioral therapy or coaching, adapted to the individual needs of each patient. Clinical guidelines recommend psycho-stimulant drugs as first-line treatments for adult patients with ADHD.

El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo crónico, complejo y multifactorial asociado con elevadas tasas de concurrencia con otros trastornos psiquiátricos, junto con problemas y repercusiones en diferentes áreas del funcionamiento del individuo. El TDAH no es exclusivo de la edad infanto-juvenil, estimándose una persistencia del 40-60% en la edad adulta, de modo que entre 2.5 y 5% de adultos continúan presentando este trastorno. La adolescencia es una etapa en la que se producen grandes y continuos cambios y que se asocia con una menor adherencia al tratamiento, una mayor vulnerabilidad a la aparición de problemas académicos, más conductas de riesgo, el inicio en el consumo de sustancias y la aparición de otros trastornos comórbidos. Se produce también la transición a los servicios o unidades de adultos, siendo necesaria una mayor coordinación entre los servicios infanto-juveniles y de adultos para asegurar una continuidad de la intervención en una etapa d e la vida en la que el paciente es especialmente vulnerable. Como en el caso de los niños y adolescentes, el tratamiento recomendado en el adulto con TDAH es el abordaje multimodal y multidisciplinar, que combina la medicación con estrategias psicológicas o psicosociales, como la psicoeducación, la terapia cognitivo conductual o el coaching, adaptadas a las necesidades individuales de cada paciente. Los fármacos psicoestimulantes son considerados de primera elección en adultos por las guías clínicas.