Síntomas maníacos en encefalitis autoinmune por anticuerpos contra mGluR5: a propósito de un caso / Maniac symptoms in autoimmune encephalitis due to mGluR5 antibodies: Presentation of a case

La encefalitis autoinmune es una entidad heterogénea en cuanto a su presentación clínica y pronóstico. Es frecuente que este cuadro presente síntomas psiquiátricos por lo que es habitual la intervención de los servicios de psiquiatría tanto en el proceso diagnóstico como en el manejo sintomático. El curso de la enfermedad suele ser agudo o rápidamente progresivo motivo por el cual es esencial la detección precoz de esta enfermedad con el fin de realizar las exploraciones complementarias y el tratamiento etiológico. Describimos el caso de un varón de 49 años, sin antecedentes psiquiátricos que presenta sintomatología maniforme en urgencias pero que a las pocas horas de ingresar en la unidad de agudos presenta disminución del nivel de consciencia y fiebre. Las exploraciones complementarias permiten orientarlo como encefalitis autoinmune por anticuerpos contra el receptor metabotrópico de glutamato 5. La psiquiatría de interconsulta participa en el manejo sintomático del paciente

Autoimmune encephalitis is a heterogeneous entity in terms of its symptoms and prognosis. As the clinical presentation frequently includes psychiatric symptoms, the intervention of psychiatric services is usual in the diagnostic process, as well as in the management of the symptoms. The course of the disease is usually acute or rapidly progressive, making the early detection of this disease essential in patients in order to perform the complementary tests and to treat the origin. The case is presented of a 49 year-old man, with no psychiatric history, who presents with maniac symptoms in the emergency room. A few hours after being admitted to the inpatient unit he presents with decrease in consciousness level and fever. Complementary tests led to the diagnosis of autoimmune encephalitis with antibodies against the metabotropic receptor of glutamate 5. The psychiatric approach for symptomatic treatment was made by joint consultation

Controversias sobre los niveles plasmáticos de clozapina: revisión a propósito de un caso / Controversies regarding plasmatic levels of clozapine: review and a case report

La clozapina es el fármaco de primera elección en el manejo de la esquizofrenia resistente al tratamiento, y no existe ninguna alternativa terapéutica que haya demostrado mayor eficacia en estos pacientes. Por ello es importante optimizar el tratamiento con clozapina en la esquizofrenia resistente. Una de las herramientas clínicas de las que se dispone es la monitorización de los niveles plasmáticos del fármaco, ya que permite asegurar que el paciente está dentro del rango terapéutico y disminuye el riesgo de efectos adversos. La evidencia disponible concluye en establecer un límite inferior alrededor de los 350 ng/ml. Sin embargo, la cuestión del límite superior del intervalo es más compleja y no existe un acuerdo sobre la concentración sanguínea de clozapina que se asocia a toxicidad. Presentamos un caso clínico de un paciente con esquizofrenia resistente en tratamiento con clozapina, en el cual la monitorización de niveles plasmáticos pudo influir en las decisiones terapéuticas (AU)

Clozapine should be considered as first-line treatment in individuals with a diagnosed treatment-resistant schizophrenia. Despite alternative treatments and augmentation strategies available, there is no consistent evidence that none of these options produce substantive clinical gains when clozapine-treated patients demonstrate a suboptimal clinical response. It is therefore important that we optimize clozapine treatment in these patients. One of the clinical tools to assist in this has been therapeutic drug monitoring of plasmatic levels, because it provides drug concentrations associated with highest probability of response and a low risk of side effects. A number of studies have addressed the therapeutic range of clozapine's plasmatic level, and reviews of this topic have generally agreed that the lower threshold is around 350 ng/ml. In contrast, the issue of an upper threshold is more complex and there is no agreed for an upper limit associated with clozapine toxicity. We report a case of a patient with the diagnosis of treatment-resistant schizophrenia treated with clozapine in which we think that therapeutic drug monitoring of clozapine plasmatic could influence treatment decisions (AU)

The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies.

Patients with severe mental illness have higher prevalences of cardiovascular risk factors (CRF). The objective is to determine whether interventions to modify lifestyles in these patients reduce anthropometric and analytical parameters related to CRF in comparison to routine clinical practice. Systematic review of controlled clinical trials with lifestyle intervention in Medline, Cochrane Library, Embase, PsycINFO and CINALH. Change in body mass index, waist circumference, cholesterol, triglycerides and blood sugar. Meta-analyses were performed using random effects models to estimate the weighted mean difference. Heterogeneity was determined using i(2) statistical and subgroups analyses. 26 studies were selected. Lifestyle interventions decrease anthropometric and analytical parameters at 3 months follow up. At 6 and 12 months, the differences between the intervention and control groups were maintained, although with less precision. More studies with larger samples and long-term follow-up are needed.

¿Toman los pacientes deprimidos el tratamiento prescrito? Estudio descriptivo sobre el cumplimiento del tratamiento antidepresivo / Do depressed patients comply with treatments prescribed? A cross-sectional study of adherence to the antidepressant treatment

Introducción. El cumplimiento del tratamiento antidepresivo es un aspecto importante en la evolución de los trastornos depresivos. El mal cumplimiento se ha asociado a una peor evolución, a un mayor número de recaídas y mayor coste económico. El objetivo de este estudio es describir el cumplimiento del tratamiento antidepresivo en una muestra de pacientes de atención primaria (AP) con diagnóstico de depresión durante el año 2007. Método. Se realizó un muestreo aleatorio de pacientes con diagnóstico de depresión y tratamiento con antidepresivos atendidos en dos equipos de (AP) y se revisaron las historias clínicas. En ellas consta el número de recetas prescritas y el número de recetas recogidas en la farmacia. Se calculó la diferencia entre recetas prescritas y recogidas. Una diferencia de + 2 se consideró un buen cumplimiento. Se mostraron los resultados en porcentajes y se realizaron comparaciones Ji cuadrado, t-student y ANOVA cuando procedía. Resultados. La muestra estaba compuesta de 212 pacientes. La edad media era de 63,2 años (DE =15,27). El 66,5% estaba en tratamiento con un antidepresivo y el 24,1% con dos. El porcentaje de pacientes no cumplidores era del 33,96% [IC 95% (27,35-40,57)]. Los pacientes cumplidores presentaban un menor porcentaje de tratamiento con otros fármacos crónicos. En los cumplidores el porcentaje de mujeres era superior que en el de no cumplidores (p = 0,015). No había diferencias en el cumplimiento en los pacientes atendidos en el centro de salud mental. Conclusiones. Un tercio de los pacientes en tratamiento farmacológico antidepresivo no eran cumplidores puesto que no lo retiraban de forma adecuada de las farmacias. Es necesario desarrollar estrategias de mejora de la adherencia terapéutica de los pacientes (AU)

Introduction. Compliance with antidepressant treatment is a very relevant factor in the outcome of depressive disorders. Poor compliance has been associated with worse outcome, increased rate of relapses and greater cost. This study has aimed to describe adherence to antidepressant treatment in a sample of primary care patients with a diagnosis of depression in 2007. Methods. Randomized sampling was made of patients with depression and antidepressant treatment attended in two primary care teams. Their medical records were reviewed to obtain the total number of prescriptions given to patients and the total number of prescriptions dispensed in the pharmacies. The difference between prescriptions written and collected was calculated. A difference of ± 2 was considered as good compliance. Results are shown as percentages. Comparisons were made with the chi-square, Student’s T and ANOVA tests, where appropriate. Results. The simple was made up of 212 patients. Mean age was 63.2 years (SD 15.27). In the sample, 66.5% were treated with only one antidepressant and 24.1% with two. The percentage of non-compliance was 33.96% (95% CI: 25.35–40.57). Treatment-adherent patients have a lower percentage of long-term treatment with other drugs. The percentage of treatment-adherent women was higher than non-adherent (p=0.015). No differences were found in compliance among patients treated in the mental health center. Conclusions. One third of patients on antidepressant drug treatment were non-compliers because the drugs were not picked up properly from the pharmacies. We need to develop strategies to improve the therapeutic adherence of patients (AU)

[Do depressed patients comply with treatments prescribed?: a cross-sectional study of adherence to the antidepressant treatment]. / ¿Toman los pacientes deprimidosel tratamiento prescrito? Estudiodescriptivo sobre el cumplimientodel tratamiento antidepresivo.

INTRODUCTION. Compliance with antidepressant treatment is a very relevant factor in the outcome of depressive disorders. Poor compliance has been associated with worse outcome, increased rate of relapses and greater cost. This study has aimed to describe adherence to antidepressant treatment in a sample of primary care patients with a diagnosis of depression in 2007. METHODS. Randomized sampling was made of patients with depression and antidepressant treatment attended in two primary care teams. Their medical records were reviewed to obtain the total number of prescriptions given to patients and the total number of prescriptions dispensed in the pharmacies. The difference between prescriptions written and collected was calculated. A difference of ± 2 was considered as good compliance. Results are shown as percentages. Comparisons were made with the chi-square, Student's T and ANOVA tests, where appropriate. RESULTS. The simple was made up of 212 patients. Mean age was 63.2 years (SD 15.27). In the sample, 66.5% were treated with only one antidepressant and 24.1% with two. The percentage of non-compliance was 33.96% (95% CI: 25.35­40.57). Treatment-adherent patients have a lower percentage of long-term treatment with other drugs. The percentage of treatment-adherent women was higher than non-adherent (p=0.015). No differences were found in compliance among patients treated in the mental health center. CONCLUSIONS. One third of patients on antidepressant drug treatment were non-compliers because the drugs were not picked up properly from the pharmacies. We need to develop strategies to improve the therapeutic adherence of patients.