Cyclosporine A plus low-dose steroid treatment in COVID-19 improves clinical outcomes in patients with moderate to severe disease: A pilot study.

BACKGROUND: COVID-19 pandemic causes high global morbidity and mortality and better medical treatments to reduce mortality are needed. OBJECTIVE: To determine the added benefit of cyclosporine A (CsA), to low-dose steroid treatment, in patients with COVID-19. METHODS: Open-label, non randomized pilot study of patients with confirmed infection of SARS-CoV-2 hospitalized from April to May 2020 at a single centre in Puebla, Mexico. Patients were assigned to receive either steroids or CsA plus steroids. Pneumonia severity was assessed by clinical, laboratory, and lung tomography. The death rate was evaluated at 28 days. RESULTS: A total of 209 adult patients were studied, 105 received CsA plus steroids (age 55.3 ± 13.3; 69% men), and 104 steroids alone (age 54.06 ± 13.8; 61% men). All patients received clarithromycin, enoxaparin and methylprednisolone or prednisone up to 10 days. Patient's death was associated with hypertension (RR = 3.5) and diabetes (RR = 2.3). Mortality was 22 and 35% for CsA and control groups (P = 0.02), respectively, for all patients, and 24 and 48.5% for patients with moderate to severe disease (P = 0.001). Higher cumulative clinical improvement was seen for the CsA group (Nelson Aalen curve, P = 0.001, log-rank test) in moderate to severe patients. The Cox proportional hazard analysis showed the highest HR improvement value of 2.15 (1.39-3.34, 95%CI, P = 0.0005) for CsA treatment in moderate to severe patients, and HR = 1.95 (1.35-2.83, 95%CI, P = 0.0003) for all patients. CONCLUSION: CsA used as an adjuvant to steroid treatment for COVID-19 patients showed to improve outcomes and reduce mortality, mainly in those with moderate to severe disease. Further investigation through controlled clinical trials is warranted.

De la calle a su país: una reflexión sobre el papel facilitador de las nuevas tecnologías / For the street to her country: a reflection onthe facilitating role of new technologies

Se presenta el caso de una paciente inmigrante ingresada en la Unidad de Agudos de Psiquiatría con un trastorno amnésico alcohólico, deficiente dominio del castellano y nulo apoyo social, en el que las nuevas tecnologías y la informatización en la asistencia sanitaria resultan determinantes para una resolución satisfactoria

We present a case of an inmigrant inpatient diagnosed of alcoholic amnestic disorder, with deficient use of Spanish languaje and lack of social support, in which new technologies and computerization in health care are determining for satisfactory outcome

Comorbilidad psiquiátrica y alteraciones de la conducta alimentaria en pacientes con obesidad mórbida candidatos a cirugía bariátrica / Tittle

Nuestros objetivos fueron evaluar las alteraciones psicopatológicas y de la conducta alimentaria de pacientes con obesidad mórbida derivados para evaluación previa a cirugía bariátrica. Se incluyeron 145 pacientes derivados de forma consecutiva para valoración psiquiátrica previa a la realización de cirugía bariátrica. Como grupo control se valoraron 65 pacientes con obesidad, igualmente derivados desde endocrinología de forma consecutiva por otros motivos de consulta (alteraciones de la conducta alimentaria y trastornos mentales comórbidos). Se realizó una entrevista clínica y se aplicaron varias escalas de psicopatología y de evaluación de la conducta alimentaria: escala de depresión de Beck (BDI), escala de ansiedad de Beck (BAI), inventario de obsesiones-compulsiones de Maudsley (MOCI), escala de impulsividad de Barrat (BIS), inventario de trastornos de la alimentación (EDI), test de actitudes hacia la comida (EAT), test de bulimia de Edimburgo (BITE) y cuestionario sobre la figura corporal (BSQ). Un 44,4% de los pacientes valorados para cirugía presentaba un diagnóstico psiquiátrico comórbido en el eje I del DSM-IV, fundamentalmente distimia (19,4%). Un 15,3% presentó un diagnóstico de trastorno de personalidad. Un 40% requirió el uso de psicofármacos, habitualmente antidepresivos. Respecto a la conducta alimentaria, un 16,6% presentaba atracones, un 4% criterios de bulimia nerviosa y casi un 14% criterios de trastorno de la conducta alimentaria no especificado, fundamentalmente el denominado trastorno por atracones. Aunque el grupo control presentaba mayor comorbilidad psiquiátrica y más trastornos de la ideación autolítica o en la mayoría de las escalas que medían psicopatología, insatisfacción corporal o conducta alimentaria. Los pacientes candidatos a un programa de cirugía bariátrica presentan una elevada comorbilidad psiquiátrica, fundamentalmente trastornos del humor, y severas alteraciones de la conducta alimentaria e insatisfacción corporal que justifican la presencia de una evaluación psiquiátrica previa a la cirugía

Our objectives were to evaluate psychopathological and eating disorders in morbid obese candidates to bariatric surgery. We evaluated 145 out-patients who were admitted to a psychiatric evaluation consecutively previous to surgical procedure. The control group was constituted by 65 out-patients with diagnosis of obesity referred from unit of endocrinology who were admitted to a psychiatric evaluation because mental or eating disorders. We used a clinical interview, we evaluated psychiatric comorbidity, and we applied the next scales: Beck depression inventory (BDI), Beck anxiety inventory (BAI), Maudsley obssesive-compulsive interview (MOCI), Barrat impulsiveness scale (BIS), eating disorder inventory (EDI), eating attitudes test (EAT), bulimic investigation test Edinburg (BITE), and body shape questionnaire (BSQ). Between morbid obese candidates to surgery, 44.4% had a diagnosis of mental disorder, mainly dysthimia (19.4%), additionaly 15.3% had a personality disorder. Between candidates to surgery, 16.6% had binge eating, 4% fulfilled criteria of bulimia nervosa and about 14% fulfilled criteria of eating disorders not otherwise specified, mainly the binge eating disorder. Control group had more pychiatric comorbidity and eating disorders, but they showed similar scores in majority of scales to evaluate psychopathology and eating disorders. The patients candidates to bariatric surgery had a elevated psychiatric comorbidity, mainly mood disorders, and elevated scores in core items of eating disorders scales and body dissatisfaction. These findings provide evidence to the need of a psychiatric evaluation among bariatric surgery candidates

Diferencias clínicas entre pacientes obesos mórbidos con y sin atracones / Clinical differences between morbid obese patients with and without binge eating

Introducción. Nuestro objetivo fue evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria. Material y métodos. Se estudiaron a 210 pacientes con obesidad mórbida derivados de forma consecutiva a una consulta de psiquiatría en un hospital general por diferentes motivos. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicaron una serie de escalas de psicopatología y de conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en dos grupos: pacientes con conductas de atracones según las definiciones de la CIE-10 y el DSM-IV y aquellos sin estas conductas. En el primer grupo se incluyeron 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 pacientes con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones frente a 145 sin atracones). Resultados. Los pacientes con atracones tenían más psicopatología, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales debidas a su obesidad y presentaba mayor obsesividad sobre el peso y la comida. Conclusiones. Por tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente del diagnóstico de trastorno de la conducta alimentaria presente) y diferenciado del resto de los obesos mórbidos por la existencia de mayor psicopatología fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal

Introduction. Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. Methods. We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). Results. Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. Conclusions. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction

[Clinical differences between morbid obese patients with and without binge eating]. / Deferencias clinicas entre pacientes obesos mórbidos con y sin atracones.

INTRODUCTION: Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. METHODS: We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). RESULTS: Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. CONCLUSIONS. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction.

Ingresos de inmigrantes en una unidad de hospitalización psiquiátrica breve / Income of immigrants in a brief psiquiatric hospitalization unit

La inmigración constituye un fenómeno complejo, con implicaciones en el ámbito sanitario. En España, en los últimos años, se ha asistido a un incremento importante de las cifras de inmigrantes. Este trabajo se propone estudiar las características de la población inmigrante que ingresó en una Unidad de Agudos de Psiquiatría en un período de 2 años. Se produjeron 44 ingresos, que correspondieron a 33 pacientes. Los ingresos de inmigrantes supusieron el 5,38% de los ingresos totales en la unidad en el periodo estudiado. Casi la mitad se encontraba en situación ilegal y el 42,4% de los pacientes eran considerados portadores de problemática social. La tercera parte de los pacientes provenía de Marruecos, con un perfil diferente al del resto de nacionalidades: con mayor predominio de los cuadros psicóticos, frecuentemente de etiología tóxica y un mayor desconocimiento del idioma. En la tercera parte de los casos existía un consumo perjudicial de alcohol

Immigration is a complex phenomenon with implications in health systems. In spain, in the last years, there has been an important increase in the number of inmigrants. This study aims to analyze the characteristics of inmigrants in a two-year period. There were 44 admissions). Almost half of the patients were illegal residents in Spain and 42,4% were considered as having social problems. One third of the patients came from Morocco, with a differentiated profile respect to other contries of origin: with more psychotic episodes, frequently of toxic origin and a worse knowledge of spanish. One third of patients were alcohol abusers

[Treatment of Tourette syndrome and its comorbidity: experience with 17 cases]. / Tratamiento del síndrome de Tourette y su comorbilidad: presentación de 17 casos.

INTRODUCTION: Clinical characteristics and comorbid disorders of Tourette syndrome (TS) are reviewed along with a presentation of our experience with 17 cases. MATERIAL AND METHODS: We carried out a retrospective study of pediatric patients with TS admitted from 1998 to 2004 in Fundación Hospital Alcorcón. RESULTS: Seventeen patients were obtained, 16 of whom were men and there was only 1 woman. Present age ranged from 7 to 17 years old. Most frequent comorbid disorders were attention deficit disorder (ADD) in 9 patients, (53%), obsessive-compulsive disorder in 8 (48%) and anxiety in 7 (41%). Learning disorders were found in 7 patients (41%), 5 of whom have concurrent ADD and 1 severe obsessive compulsive disorder. Psychopharmacological treatment was withdrew in the 2 cases treated with halloperidol due to the presence of severe extrapyramidal symptoms (EPS) and in 3 of the 7 cases treated with pimozide (one of them was withdrawn due to EPS). No EPS was found with atypical neuroleptics, but sedation and weight gain was common. Methylphenidate was administered to 7 patients without an increase in tics. CONCLUSIONS: In our sample the most common comorbid disorders were ADD, obsessive-compulsive disorders, anxiety and learning disorders. Atypical neuroleptics were better tolerated than classic ones, although the incidence of side effects is elevated. Methylphenidate was not associated with tic worsening.

Tratamiento del síndrome de Tourette y su comorbilidad: presentación de 17 casos / Treatment of Tourette syndrome and its comorbidity: experience with 17 cases

Introducción. Presentamos las características clínicas y trastornos comórbidos asociados y evaluamos los resultados de los tratamientos farmacológicos empleados en 17 pacientes con síndrome de Tourette (ST). Material y métodos. Revisión retrospectiva de los pacientes pediátricos diagnosticados de ST en nuestro hospital entre 1998 y 2004. Resultados. De los 17 pacientes, 16 son varones y sólo 1 mujer, con edades actuales comprendidas entre 7 y 17 años. Los trastornos comórbidos más frecuentes fueron el trastorno por deficit de atención con hiperactividad (TDAH) en 9 pacientes (53 Ofo), conductas obsesivo-compulsivas en 8 (48 %) Y ansiedad en 7 (41 %). Presentaban problemas de aprendizaje 7 (41 %), de los cuales 5 asociaban un TDAH y 1 un trastorno obsesivo-compulsivo (TOC) severo. Encontramos efectos farmacológicos adversos severos que obligaron a la retirada de la medicación en los 2 casos tratados con haloperidol (ambos de tipo extrapiramidal) y en 3 de los 7 (43 %) de los tratados con pimozida (1 de ellos de tipo extrapiramidal). No ocurrieron efectos extrapiramidales con los neurolépticos atípicos, pero fueron frecuentes la sedación y el aumento de peso. Siete pacientes fueron tratados con metilfenidato, sin empeoramiento de los tics. Conclusiones. En nuestra serie los trastornos comórbidos más frecuentes fueron el TDAH, conductas obsesivo-compulsivas, ansiedad y dificultades en el aprendizaje. Los neurolépticos atípicos fueron mejor tolerados que los clásicos, aunque la incidencia de efectos adversos es también elevada. El metilfenidato no se ha asociado a empeoramiento de los tics

Introduction. Clinical characteristics and comorbid disorders of Tourette syndrome (TS) are reviewed along with a presentation of our experience with 17 cases. Material and methods. We carried out a retrospective study of pediatric patients with TS admitted from 1998 to 2004 in Fundación Hospital Alcorcón. Results. Seventeen patients were obtained, 16 of whom were men and there was only 1 woman. Present age ranged fram 7 to 17 years old. Most frequent comorbid disorders were attention deficit disorder (ADD) in 9 patients, (53 %), obsessive-compulsive disorder in 8 (48 %) and anxiety in 7 (41 %). Learning disorders were found in 7 patients (41 %), 5 of whom have concurrent ADD and 1 severe obsessive compulsive disorder. Psychopharmacological treatment was withdrew in the 2 cases treated with halloperidol due to the presence of severe extrapyramidal symptoms (EPS) and in 3 of the 7 cases treated with pimozide (one of them was withdrawn due to EPS). No EPS was found with atypical neuraleptics, but sedation and weight gain was common. Methylphenidate was administered to 7 patients without an increase in tics. Conclusions. In our sample the most common comorbid disorders were ADD, obsessive-compulsive disorders, anxiety and learning disorders. Atypical neuroleptics were better tolerated than classic ones, although the incidence of side effects is elevated. Methylphenidate was not associated with tic worsening

Fobia a tragar: presentación clínica de una serie de nueve casos / Chocking phobia: clinical presentation of nines cases

Introducción: La fobia a tragar es un miedo a tragar sólidos y/o líquidos que suele responder a tratamiento conductual. Metodología: estudiamos nueve casos de fobia a tragar tratados ambulatoriamente. Se describen edad, sexo, historia familiar, comorbilidad, y datos sobre tratamiento y evolución, entre otros. Resultados: un 55% eran mujeres, edad media 25 años. El 33% tenía antecedentes familiares psiquiátricos,88% tenía comorbilidad con trastorno de pánico, patología obsesivo-compulsiva o personalidad evitativa. Los tratamientos eficaces fueron terapia cognitivo-conductual (n = 9), clomipramina (n = 2), paroxetina (n = 2) y benzodiacepinas (n = 5). Conclusión: la fobia a tragar tiene una alta comorbilidad con trastornos ansiosos, lo que condiciona el abordaje terapéutico

Introduction: Choking (swallowing) phobia is a fear of swallowing food and/or fluids that usually respondsto behaviour therapy.Methods: Nine cases attending an out patient clinic and suffering from choking phobia are retrospectively studied. Age, sex, family history, comorbidity, treatment strategies and outcome data are described. Results: Fifty-five percent of patients were female, mean age 25 years. A total of 33% had psychiatric family history, 88% had comorbidity with panic disorder, obsessive-compulsive disease or avoidant personality. Effective treatments were cognitive-behavioural therapy (n = 9), clomipramine (n = 2), paroxetine (n = 2) and benzodiazepines (n = 5). Conclusion: Swallowing (choking) phobia has a high comorbidity rate with anxious disorders, suggesting certain treatment strategies

Uso de recursos hospitalarios tras un programa de tratamiento de alcoholismo en un hospital general / Hospital resource use after an alcoholism treatment program in a general hospital

Objetivo: El objetivo de nuestro estudio fue evaluar el uso de recursos sanitarios en un hospital general tras un programa ambulatorio de tratamiento del alcoholismo en el mismo hospital. Material y métodos: Se incluyó a 145 pacientes que iniciaron el tratamiento de forma consecutiva. Se estableció una comparación del uso de consultas externas de otras especialidades del hospital, días de ingresos hospitalarios y visitas a urgencias, entre los pacientes que permanecían en tratamiento a los 6 meses de iniciarlo y aquellos que no permanecían ese tiempo. Se calculó un índice de uso de cada recurso considerando el tiempo de seguimiento de cada paciente. Resultados: Los pacientes que permanecieron en tratamiento de deshabituación 6 meses presentaron un descenso en el uso de urgencias y en los días de ingreso hospitalario tanto respecto a antes del tratamiento como al compararlos con los pacientes que no permanecieron los 6 meses. No hubo diferencias en el uso de consultas externas entre grupos. Conclusiones: Los programas de deshabituación producen beneficio al reducir la utilización de algunos recursos sanitarios

Aim: The aim of this study was to evaluate resource use in a general hospital after an outpatient alcoholism treatment program. Material and methods: One hundred forty-five consecutive patients who started the treatment program were included. The use of outpatient care in other hospital departments, days of hospitalization, and the use of the emergency room were compared among patients who remained in the treatment program 6 months after starting and those who did not. A medical care index for outpatient, inpatient and emergency use was calculated, taking into consideration each patient's period of follow-up. Results: Days of hospitalization and emergency room use were reduced in patients who remained in the alcoholism treatment program for 6 months in comparison with the subgroup without 6 months of retention. No differences were found in the use of outpatient care between the two groups. Conclusions: In view of these results, alcohol treatment programs reduce some resource use

Consumo de sustancias psicoactivas en pacientes con trastorno de pánico / Psychoactive drugs use in patients with panic disorder

Introducción. Los objetivos de este estudio fueron evaluar la prevalencia del consumo de drogas en pacientes ambulatorios con trastorno de pánico, su repercusión sobre la evolución y la respuesta al tratamiento de dicho trastorno. Material y métodos. La muestra está constituida por 79 casos con diagnóstico de trastorno de pánico o agorafobia con trastorno de pánico según la CIE-10 y 83 controles con otros trastornos psiquiátricos en tratamiento en el mismo centro. Se realizó un seguimiento durante 6 meses. Resultados. Se obtuvo una prevalencia para el consumo habitual de drogas a lo largo de la vida del 13 % para el alcohol, el 52 % para el tabaco y el 47 % para el café; no hubo consumos de otras sustancias. El consumo actual de cafeína era inferior en los casos que en los controles, no existiendo diferencias respecto a los otros consumos, y el consumo de café se relacionó con requerimientos de mayores dosis de antidepresivos. Conclusiones. Por tanto, la prevalencia de consumo habitual de sustancias a lo largo de la vida en pacientes con trastorno de pánico en tratamiento ambulatorio se sitúa alrededor de un 13 % para el alcohol, un 47 % para el café y un 52 % para el tabaco; hay un menor consumo de cafeína, aunque no existen diferencias en otros consumos respecto a un grupo de controles psiquiátricos. La presencia de agorafobia no repercute en el consumo. El consumo tiene escasas repercusiones sobre la clínica y la respuesta al tratamiento, aunque puede modificar las dosis requeridas de antidepresivos

Introduction. The objectives of this study were to evaluate the prevalence of drug use in out-patients with panic disorder and their influence in evolution and therapeutic response of panic disorder. Material and methods. The sample was made up of 79 out-patients diagnosed of panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria and 83 controls from the same center with other psychiatric disorders. Subjects were followed-up for six months. Results. Prevalence of regular lifetime drug use was: 13 % for alcohol, 52 % for nicotine and 47 % for caffeine. No other drug use was observed. Patients with panic disorder used less caffeine than controls, there being no differences in other drug use. Caffeine use was associated with higher antidepressant dosages. Conclusions. Thus, prevalence of regular drug use in panic disorder during the lifetime of out-patients with panic disorder was: 13 % for alcohol, 47 % for caffeine use and 52 % for nicotine use. Those with panic disorder use less caffeine than other psychiatric patients, but there were no differences in other drug use. Presence of agoraphobia has no repercussion on consumption. There were no differences in clinical manifestations and treatment responses between users and non-users, but drug use may modify antidepressant dosages

[Psychoactive drugs use in patients with panic disorder]. / Consumo de sustancias psicoactivas en pacientes con trastorno de pánico.

INTRODUCTION: The objectives of this study were to evaluate the prevalence of drug use in out-patients with panic disorder and their influence in evolution and therapeutic response of panic disorder. MATERIAL AND METHODS: The sample was made up of 79 out-patients diagnosed of panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria and 83 controls from the same center with other psychiatric disorders. Subjects were followed-up for six months. RESULTS: Prevalence of regular lifetime drug use was: 13 % for alcohol, 52 % for nicotine and 47 % for caffeine. No other drug use was observed. Patients with panic disorder used less caffeine than controls, there being no differences in other drug use. Caffeine use was associated with higher antidepressant dosages. CONCLUSIONS: Thus, prevalence of regular drug use in panic disorder during the lifetime of out-patients with panic disorder was: 13 % for alcohol, 47 % for caffeine use and 52 % for nicotine use. Those with panic disorder use less caffeine than other psychiatric patients, but there were no differences in other drug use. Presence of agoraphobia has no repercussion on consumption. There were no differences in clinical manifestations and treatment responses between users and non-users, but drug use may modify antidepressant dosages.

Efectividad del uso del citalopram en pacientes con trastornos de pánico / Effectiveness of citalopram in out-patients with panic disorder

Nuestro objetivo fue estudiar la efectividad y tolerancia del citalopram en el trastorno de pánico. Cincuenta y cinco pacientes con trastorno de pánico o agorafobia con trastorno de pánico según criterios de la CIE-10 que iniciaron tratamiento ambulatorio, fueron seguidos durante seis meses. La dosis de citalopram se ajustó según criterios clínicos y se pautaron benzodiacepinas si se consideraba que estaban indicadas. Se valoró la efectividad del tratamiento usando como variables dependientes el cambio en la frecuencia de las crisis y en la impresión clínica global del médico (ICG), como variables de efectividad secundarias se usaron los cambios en diversas escalas de depresión y ansiedad. Once pacientes abandonaron el seguimiento. El 83,4% de los pacientes presentó una mejoría marcada o notable según la ICG de eficacia. Los efectos secundarios más frecuentes, fueron las disfunciones sexuales y las molestias abdominales. Por lo tanto, el citalopram puede resultar efectivo en disminuir el número de crisis de angustia y mejora sustancialmente otras manifestaciones clínicas en más del 80% de los pacientes, con un favorable perfil de tolerancia, en las condiciones clínicas habituales

The objective of this study was to study the effectiveness and tolerability of citalopram in panic disorder. Fifty five out-patients with panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria who initiated treatment, were followed up for six months. Dosages of citalopram were ajusted according clinical criteria, and use of benzodiacepines was permitted. Effectiveness variables were the changes in number of panic attacks, and the clinical global impression (CGI) of efficacy, and secondary variables, were the changes of scores in a variety of depressión and anxiety scales. Eleven patients were drop-outs. A 83.4% of patients had a notably or excellent improvement according to the CGI. More prominent adverse effects were sexual dysfunction and gastrointestinal discomfort. Citalopram appears effective to improve the number of panic attacks and another clinical manifestations of panic disorder in 80% of the patients, with a favourable tolerability profile

Mirtazapine versus paroxetine in panic disorder: an open study.

Introduction Open studies suggest that mirtazapine has efficacy in panic disorder treatment. We designed an open study that evaluates changes induced by mirtazapine compared with paroxetine in panic disorder. Methodology Patients 18-65 years old consecutively referred to a psychiatry liaison service with panic disorder (DSM-IV criteria) were offered either mirtazapine or paroxetine treatment. Results There were statistically significant reductions from baseline to week 3 and from week 3 to 8 for mirtazapine and paroxetine groups for: number of panic attacks, Beck Anxiety or Depression Inventory (BAI, BDI) Clinical Global Impresion (CGI) of panic disorder severity and CGI of panic disorder response (these variables were evaluated by the patient, the clinician or a blind evaluator). Responders at week 3 (BAI decrease of 50%) were 83% for the mirtazapine group and 84% for the paroxetine group. Responders at week 8 (number of panic attacks equal to 0) were 77% for the mirtazapine group and 73% for the paroxetine group Statistically significant differences between mirtazapine and paroxetine were found for number of panic attacks at weeks 3 and 8 and BAI at week 3, suggesting a faster response for mirtazapine. Responders at week 8 maintained a no recurrence figure of 95% at follow-up 6 months later. Panic disorder either with or without comorbid depression improved in both groups of treatment. Discussion Our study supports the hypothesis that mirtazapine has efficacy in the treatment of panic disorder either with or without comorbid depression.

Disminución del uso de recursos sanitarios tras un programa de tratamiento de alcoholismo / No disponible

El objetivo de nuestro estudio fue evaluar el uso de recursos sanitarios en un hospital general tras un programa ambulatorio de tratamiento del alcoholismo. Se incluyeron 46 pacientes que iniciaron el tratamiento. Se estableció una comparación del uso de consultas externas de otras especialidades del hospital, ingresos hospitalarios y urgencias, entre los pacientes que permanecían en tratamiento a los 6 meses de iniciarlo y aquellos que no permanecían ese tiempo. Se calculó un índice de uso de cada recurso considerando el tiempo de seguimiento de cada paciente. Los pacientes que permanecieron en tratamiento de deshabituación 6 meses presentaron un descenso significativo en el uso de urgencias y en los ingresos hospitalarios tanto respecto a su nivel pretratamiento como al compararlos con los pacientes que no permanecieron los 6 meses. No hubo diferencias en el uso de consultas externas. Por lo tanto, los programas de deshabituación producen beneficio al reducir la utilización de algunos recursos sanitarios (AU)

The objective of our study was to evaluate the use of medical care resources in a general hospital after an outpatient alcoholism treatment programme. 46 outpatients who initiated the programme were included. We compared the use of outpatient care in hospital, days of hospitalization, and use of emergency room, between patients who remained in alcoholism treatment for six months with those who did not. We calculated a medical care index for outpatient, inpatient and emergency use on the basis of the follow-up time for each patient. Patients who had spent 6 months undergoing alcoholism treatment had a significant reduction in the number of days of hospitalization and emergency use in comparison with their pre-treatment levels and with those who had not remained 6 months. There were no differences in outpatient care in hospital. Therefore, alcoholism treatment programmes are beneficial in reducing the utilization of certain health resources (AU)

[Relevance of drug use in clinical manifestations of schizophrenia]. / Influencia del consumo de drogas en las manifestaciones clínicas de la esquizofrenia.

OBJECTIVES: To study the association between drugs use with schizophrenia clinical manifestations. MATERIAL AND METHODS: The sample consists of 82 out-patients with schizophrenia, between 18 and 45 years old. They were evaluated with Addiction Severity Index (ASI) and with Positive and Negative Syndrome Scale (PANSS). A 6 months follow up was carried out. RESULTS: 37,8% patients had lifetime drug dependence (including alcohol and others drugs except for tobacco). The prevalence of dependence for the different drugs were: opioids 9,8%, cocaine 11%, alcohol 29,3%, cannabis 24,4%, tobacco 68,3%, caffeine 15,9%. Drug dependent had more family and legal problems. At the multiple regression analysis it was observed that cannabis and tobacco dependence was associated with a decrease in the PANSS negative symptoms subscale, and on the contrary, alcohol dependence produces a similar intensity increase at that scoring. We don't detect any clinical relevance effects over positive symptoms. CONCLUSIONS: Cannabis and tobacco may improve schizophrenia negative symptoms or neuroleptic secondary effects or patients with few negative symptoms may have more predisposition to the use, on the contrary alcohol use can impairment those symptoms.

Influencia del consumo de drogas en las manifestaciones clínicas de la esquizofrenia / Relevance of drug use in clinical manifestations of schizophrenia

Objetivos. Estudiar la asociación del consumo de drogas con las manifestaciones clínicas de la esquizofrenia. Material y métodos. Ochenta y dos pacientes con diagnóstico de esquizofrenia, entre 18 y 45 años, que inician tratamiento ambulatorio. Se evaluaron con el Índice de Severidad de la Adicción (ASI) y con la Escala del Síndrome Positivo y Negativo (PANSS). Se realizó un seguimiento de 6 meses. Resultados. Un 37,8 por ciento de los pacientes tenían una dependencia de drogas a lo largo de la vida (incluido alcohol y otras drogas excepto tabaco). Las cifras de prevalencia de dependencia para las distintas drogas fueron: opiáceos 9,8 por ciento, cocaína 11 por ciento, alcohol 29,3 por ciento, cannabis 24,4 por ciento, tabaco 68,3 por ciento y cafeína 15,9 por ciento. Los dependientes de drogas tenían más problemas familiares y legales. En el análisis de regresión múltiple, se observa que las dependencias de cannabis y de tabaco producen un descenso en la puntuación de la subescala de síntomas negativos de la PANSS y, por el contrario, la dependencia de alcohol produce un aumento de similar intensidad en dicha puntuación. No detectamos un efecto sobre los síntomas positivos. Conclusiones. El cannabis y el tabaco pueden mejorar los síntomas negativos de la esquizofrenia o los efectos secundarios de los neurolépticos o pacientes con menos síntomas negativos pueden tener mayor predisposición al consumo, por el contrario el consumo de alcohol puede empeorar dichos síntomas. (AU)