Síndrome de secreción inadecuada de hormona antidiurética, hiponatremia y antipsicóticos. Revisión de la literatura a propósito de un caso / Syndrome of inappropriate antidiuretic hormone secretion, hyponatraemia and antipsychotics. Review of the evidence and case report

Introducción. La hiponatremia es un efecto secundario asociado al uso de psicofármacos, entre ellos, los antipsicóticos. El síndrome de secreción inadecuada de hormona antidiurética y la polidipsia se han postulado como mecanismos etiopatogénicos subyacentes. Asimismo, se propone que exista una afectación biológica en la esquizofrenia que promueva la hiponatremia. Caso clínico. Presentamos a una paciente de 45 años con diagnóstico de esquizofrenia que comienza con un síndrome de secreción inadecuada de hormona antidiurética probablemente secundario a palmitato de paliperidona. Discusión. A partir de este caso, realizamos una revisión de la literatura disponible y planteamos la interrelación de la hiponatremia, el síndrome de secreción inadecuada de hormona antidiurética, la polidipsia, la propia psicosis y otros mecanismos etiopatogénicos. Conclusiones. La hiponatremia es una complicación importante e impredecible, de la que desconocemos su fisiopatología exacta en pacientes psicóticos. Son necesarios más estudios que esclarezcan su patogenia y determinen la necesidad de seguimiento analítico de pacientes que reciben tratamiento antipsicótico, sobre todo aquellos con diagnóstico de esquizofrenia (AU)

Introduction. Hyponatraemia is an adverse drug reaction to psychotropic medication, among them the antipsychotics. Syndrome of inappropriate antidiuretic hormone secretion and polydipsia have been suggested as aetiopathogenic mechanisms. Moreover, it has been postulated that there is a biological dysfunction in schizophrenia that induces hyponatraemia. Case report. A case is presented on a 45-year old woman with schizophrenia who has an syndrome of inappropriate antidiuretic hormone secretion, which was suspected of being due to paliperidone palmitate. Discussion. A review was made of the available published evidence and proposed the relationship between hyponatraemia, syndrome of inappropriate antidiuretic hormone secretion, polydipsia, the psychosis itself, and other aetiopathogenic mechanisms. Conclusions. Hyponatraemia is an important and unpredictable complication, for which its pathophysiology remains unknown. Further studies are needed to establish its pathogenic mechanisms and to determine the need of analytical monitoring in patients who are on treatment with antipsychotics, especially those with schizophrenia (AU)

Chemsex. An emergent phenomenon. / Chemsex. Un fenómeno emergente.

Letter to the editor.

Carta al editor.

An approach to the new psychoactive drugs phenomenon / Una aproximación al fenómeno de las nuevas drogas psicoactivas

Abstract Background. The new psychoactive drugs (NPD) are those that represent a danger to public health and are not prohibited by conventions on international narcotics. The concept also includes new contexts and new routes of consumption as well as novel ways of distribution, notably Internet. The risks associated with NPD consumption are largely unknown to users and to health care providers. Objective. To integrate the existing evidence regarding the main NPD in terms of description, epidemiology, psychopharmacology, medical complications and psychoactive effects. Method. To review relevant and updated clinical information on NPD obtained from specialized books and indexed scientific journals (PubMed/Medline, Google Scholar, Scopus), as well as official documents edited by international organizations dedicated to the epidemiologic analysis of drug abuse and Internet websites and forums managed by psychoactive substance users. Results. Aspects of clinical and pharmacological interest are described comprehensively, together with epidemiological data and risks associated to the consumption of the most relevant NPD: synthetic cannabinoids, synthetic cathinones, NBOMe series, indoleamines, piperazines, hallucinogenic mushrooms (Psilocybe SP.), synthetic opioids, plant products (khat, kratom, Salvia divinorum, ayahuasca) and dissociative anesthetics. Discussion and conclusion. The emergence of the NPD is a phenomenon on the rise with important consequences for public health. Learning about new trends in drug consumption and its potential risks should be essential for the medical professional. New research is needed in order to understand the phenomenon of the NPD and its pharmacological, clinical and legal implications.

Resumen Antecedentes. Las nuevas drogas psicoactivas (NDP) son aquellas que, aun cuando representan un peligro para la salud pública, no están prohibidas por los acuerdos internacionales sobre narcóticos. La noción incluye también nuevos contextos de usos, nuevas formas de administración y nuevas vías de distribución, entre las que destaca Internet. Los riesgos asociados al consumo de NDP son en gran medida desconocidos por los usuarios y el personal de salud. Objetivo. Integrar la información existente sobre las principales NDP en cuanto a su descripción, psicofarmacología, epidemiología, efectos psicoactivos y complicaciones médicas descritas. Método. Revisión de la información actualizada de relevancia clínica sobre las NDP obtenida de libros especializados y revistas científicas indexadas (PubMed/Medline, Google Scholar, Scopus); de documentos oficiales de organismos internacionales dedicados a la epidemiología del consumo de drogas, y de portales y foros en Internet gestionados por usuarios de sustancias psicoactivas. Resultados. Se describen de manera detallada aspectos de interés clínico y farmacológico, así como datos epidemiológicos y riesgos asociados al consumo de las NDP más relevantes: cannabinoides sintéticos, catinonas sintéticas, serie de los NBOMe, indolaminas, piperazinas, hongos alucinógenos (Psilocybe sp.), opioides sintéticos, productos vegetales (khat, kratom, Salvia divinorum, ayahuasca) y anestésicos disociativos. Discusión y conclusión. El surgimiento de las NDP es un fenómeno en auge con importantes consecuencias en la salud pública. Se hace imprescindible para el profesional médico conocer las nuevas tendencias en el consumo y los riesgos potenciales del mismo. Son necesarias también nuevas investigaciones para comprender el fenómeno de las NDP y sus implicaciones farmacológicas, clínicas y legales.

Chemsex. Un fenómeno emergente / Chemsex. An emergent phenomenon

No disponible

Mefedrona y chemsex. Análisis descriptivo de una muestra de pacientes en Madrid / Mephedrone and chemsex. A descriptive analysis of a sample of patients in Madrid

Introducción: El término chemsex hace referencia al uso intencionado de drogas psicoactivas para mantener relaciones sexuales, generalmente entre hombres que tienen sexo con hombres, en sesiones de varias horas o días y con múltiples parejas. Mefedrona es una de las sustancias más comúnmente utilizadas, generalmente en combinación con γ-hidroxibutirato, metanfetamina o inhibidores de la 5-fosfodiesterasa, entre otras. En este fenómeno destaca el uso de aplicaciones geosociales para dispositivos móviles, que facilitan tanto el contacto con otros compañeros sexuales como la adquisición de drogas. Esta práctica ha sido descrita en algunos países europeos. Objetivos: Describir las características de una muestra de pacientes con trastorno por consumo de mefedrona utilizada en el contexto de chemsex, atendidos en un centro de drogodependencias de Madrid. Método: Se recogieron datos demográficos, características del consumo, otras sustancias acompañantes, uso de aplicaciones geosociales y comorbilidad médica y psiquiátrica. Resultados: El policonsumo de sustancias se observó en un 100% de los pacientes, siendo muy frecuente la asociación con cocaína y GHB (67%). El uso de aplicaciones geosociales era mayoritario (73,3%) así como la actividad sexual en grupo (73,3 %). El 93% de los pacientes presentaba infección por VIH. Un 60% presentaba trastornos psiquiátricos, siendo los más prevalentes el trastorno adaptativo mixto y el trastorno depresivo. Conclusiones: El uso de mefedrona en el contexto del chemsex en España y su impacto a nivel sanitario es una realidad de la que aún no se tienen estimaciones precisas. Se proponen medidas destinadas a la prevención, reducción de daños y asistencia médica, entre las que se encuentran intervenciones a través de aplicaciones digitales para móviles y la formación de profesionales, así como desarrollo de estudios dirigidos a un conocimiento más exhaustivo del fenómeno

Introduction: The term chemsex refers to sex intentionally had under the influence of psychoactive drugs, usually among men who have sex with men, in sessions lasting several hours or days and with multiple sexual partners. Mephedrone is one of the most commonly used substances, usually in combination with γ-hydroxybutyrate, methamphetamine or phosphodiesterase type 5 inhibitors, among others. The use of mobile geosocial applications stand out, facilitating both contact with other sexual-partners and the acquisition of drugs. This practice has been described in some European countries. Objectives: To describe the characteristics of a sample of patients with mephedrone use disorder used in the context of chemsex, treated at a drug dependence clinic in Madrid. Method: Demographics, consumption patterns, other accompanying substances, use of geo-social applications and comorbid medical and psychiatric disease data were described. Results: Polydrug use was observed in 100% of patients, with a very frequent association of mephedrone, cocaine and GHB (67%). Most patients used geo-social applications (73.3%) and engaged on group sexual activity (73.3%). 93% of patients were HIV-positive. 60% had psychiatric disorders, the most prevalent of these being adjustment and depressive disorders. Conclusions: Mephedrone use during chemsex in Spain and its impact on health status is a reality that has not yet been accurately estimated. Measures for prevention, harm reduction and health care are proposed, such as interventions through geosocial applications, training of professionals, and the need for further research in order to gain more comprehensive knowledge of this phenomenon

Severe Psychosis, Drug Dependence, and Hepatitis C Related to Slamming Mephedrone.

Background. Synthetic cathinones (SCs), also known as "bath salts," are ß-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion. Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described.

Uso combinado de desvenlafaxina y terapia electro-convulsiva / No disponible

No disponible

[Vegetables as new psychoactive drugs: a narrative review]. / Vegetales como nuevas drogas psicoactivas: una revisión narrativa.

There is growing interest in plants with psychoactive effects among consumers with different levels of experience. This has generated a need for updated knowledge among medical professionals and other health workers. These plants, which may be used in shamanic healing ceremonies or rituals or just for traditional purposes, have emerged in the Western world as new psychoactive drugs; largely thanks to the ease of purchase, sale, cultivation and exchange of information that the Internet offers. This review summarizes the current knowledge about the most important psychoactive plants, either by their mention in Internet forums or harm-reduction portals or by their allusion in scientific texts.

Existe un interés creciente en los vegetales con efectos psicoactivos por parte de consumidores, con diferentes niveles de experiencia. Esto ha generado una necesidad de actualización de conocimientos del lado de los profesionales médicos y de otros responsables de la salud pública. Se trata, por lo general, de plantas de uso en ceremonias chamánicas con intención curativa, en rituales o simplemente de uso tradicional que han dado el salto al mundo occidental como nuevas drogas psicoactivas, en gran medida gracias a la facilidad de compra, venta, cultivo e intercambio de información que ofrece Internet. Recopilamos en este texto los vegetales con propiedades psicoactivas más relevantes, tanto por su frecuente mención en foros de usuarios o en portales destinados a la reducción de daños en el consumo de drogas, como por su aparición en textos científicos.

New Psychoactive Drugs.

Carta al editor.

El síntoma en el cuerpo. Psicosis monosintomática e hipocondría: a propósito de dos casos / The symptom in the body. Monosymptomatic psychosis and hypochondriasis: A report of two cases

No disponible

Nuevas Drogas Psicoactivas / New Psychoactive Drugs

No disponible

Platelet monoamine oxidase activity in obsessive-compulsive disorder.

Response to SSRIs suggests the implication of the serotonergic system in obsessive-compulsive disorder (OCD). However, biological studies on serotonergic function in OCD have yielded contradictory results. Platelet monoamine oxidase (MAO) activity has been proposed as an index of cerebral serotonin activity. The aim of this study was to examine platelet MAO activity in 29 OCD patients and 29 healthy controls matched by age, sex and tobacco use. We also explored the relationship between platelet MAO activity and aggressive obsessions in OCD patients. There were no differences in platelet MAO activity between OCD patients and healthy controls. We found a significant correlation between platelet MAO activity and Y-BOCS scores in the group of patients with Y-BOCS scores >15. OCD patients with aggressive obsessions had significantly lower levels of platelet MAO activity than patients without aggressive obsessions. Our results suggest that platelet MAO activity may be a marker of OCD severity, and that low platelet MAO activity may be associated with aggressive obsessions in OCD patients.

Association between obsessive-compulsive disorder and a variable number of tandem repeats polymorphism in intron 2 of the serotonin transporter gene.

BACKGROUND: Pharmacological studies indicate a dysregulation of the serotonergic system in obsessive-compulsive disorder (OCD). A variable number tandem repeats (VNTR) polymorphism with three alleles (Stin2.9, Stin2.10, Stin2.12) has been described in intron 2 of the serotonin transporter (5-HTT) gene. This polymorphism has been associated with unipolar depression, bipolar disorder, schizophrenia, and anxiety disorders including OCD. METHODS: The association between OCD and the polymorphism is examined in 97 OCD patients, 578 psychiatric controls and 406 healthy controls, all Spanish Caucasians. RESULTS: Genotype frequencies for the polymorphism were significantly different in OCD patients, psychiatric patients and controls. There was a significant excess of 12/12 and 12/10 genotypes in OCD patients compared to psychiatric patients and controls. CONCLUSIONS: Our results indicate a possible association between the Stin2.12 allele of the VNTR polymorphism and OCD.

Perceived quality of life in obsessive-compulsive disorder: related factors.

BACKGROUND: Obsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres. METHODS: We measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamilton's depression scale and the SF-36 self-administered global QOL perception scale. RESULTS: We found a correlation among Hamilton's scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamilton's scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health. CONCLUSION: Quality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status.