Incident psychopharmacological treatment and psychiatric hospital contact in individuals with newly developed type 2 diabetes - a register-based cohort study.

To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact. Via Danish registers, we identified all 56 640 individuals from the Central and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000-2016 as well as 315 694 age- and sex-matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the 5 years prior to the onset of T2D were not included. For this cohort, we first assessed the 2-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score-matched controls - taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact. A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age- and sex-matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score-matched controls (HR = 1.51, 95% CI = 1.43-1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR = 1.14, 95% CI = 0.98-1.32). Older age, somatic comorbidity, and being divorced/widowed were associated with both psychopharmacological treatment and psychiatric hospital contact following T2D. Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.

Características clínicas de los pacientes derivados a un servicio hospitalario de psiquiatría de enlace e interconsulta: un estudio observacional evaluando cambios a lo largo de un período de 10 años / Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-year-period

Objetivo. Existen diversas investigaciones previas que han descrito las características de distintos servicios hospitalarios de Psiquiatría de Enlace e Interconsulta (PEI) a lo largo de un periodo de tiempo de uno o más años. El propósito del presente artículo es el de examinar las características de una muestra amplia de pacientes remitidos a un servicio hospitalario de PEI, durante un período de 10 años (2005-2014) y determinar los posibles cambios de la práctica clínica a lo largo del tiempo. El tamaño muestral de nuestro estudio, la duración del periodo de observación y la aplicación de procedimientos estandarizados para la obtención y codificación de los datos, aportan una evidencia más sólida en comparación con otros estudios similares publicados en los últimos años. Métodos. Estudio observacional, longitudinal y descriptivo. Los datos se recopilaron de forma prospectiva mediante procedimientos estandarizados, en base a las solicitudes recibidas en el servicio hospitalario de PEI del Hospital Clínico Universitario de Barcelona. Resultados. se solicitaron un total de 9.808 consultas psiquiátricas (tasa de derivación=2,2%). Las derivaciones a nuestro servicio fueron realizadas principalmente por unidades médicas. Los diagnósticos psiquiátricos más frecuentes fueron los trastornos relacionados con el consumo de alcohol, los cuadros confusionales y los trastornos de adaptación. El porcentaje medio de pacientes manejados con tratamiento psicofarmacológico fue del 81,6%. La duración media de las hospitalizaciones de los pacientes con comorbilidad psiquiátrica, derivados a nuestro servicio de psiquiatría de enlace, fue significativamente mayor a la estancia media global del hospital durante ese periodo. La mayoría de las variables estudiadas permanecieron constantes durante el período de 10 años. Sin embargo, algunos diagnósticos médicos en el momento del ingreso, motivos de derivación y recomendaciones de tratamiento psicofarmacológico presentaron cambios significativos. Conclusiones. A pesar de la evolución continua y los importantes cambios que se han producido en los sistemas de salud en las dos últimas décadas, la práctica clínica de los servicios de PEI ha permanecido bastante estable en el tiempo. Sin embargo, nuestros resultados apoyan la idea de una especialidad dinámica

Objective. Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005-2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. Methods. Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. Results. 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. Conclusions. Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research.

Background: The current fourth paper on the International College of Neuropsychopharmacology guidelines for the treatment of bipolar disorder reports on the unmet needs that became apparent after an extensive review of the literature and also serves as a conclusion to the project of the International College of Neuropsychopharmacology workgroup. Materials and Methods: The systematic review of the literature that was performed to develop the International College of Neuropsychopharmacology guidelines for bipolar disorder identified and classified a number of potential shortcomings. Results: Problems identified concerned the reliability and validity of the diagnosis of bipolar disorder and especially of bipolar depression. This, in turn, has profound consequences for early detection and correct treatment of the disorder. Another area that needs improvement is the unsatisfactory efficacy and effectiveness of therapeutic options, especially in special populations such as those with mixed features and rapid cycling course. Gender issues and adherence problems constitute an additional challenge. The literature suggests that while treatment providers are concerned more with treatment-related issues, patients and their caregivers worry more about issues pertaining to the availability of services and care, quality of life, and various types of burden. The workgroup identified additional unmet needs related to the current standard of research in bipolar disorder. These include the fragmentation of bipolar disorder into phases that are handled as being almost absolutely independent from each other, and thus the development of an overall therapeutic strategy on the basis of the existing evidence is very difficult. Trials are not always designed in a way that outcomes cover the most important aspects of bipolar disorder, and often the reporting of the results is biased and unsatisfactory. The data on combination treatments and high dosages are sparse, whereas they are common in real world practice. Conclusions: The workgroup endorses the full release of raw study data to the scientific community, and the development of uniform clinical trial standards (also including more realistic outcomes) and the reporting of results. The 2 large appendices summarize the results of this systematic review with regard to the areas of lack of knowledge where further focused research is necessary.

Prevención del suicidio en España: una necesidad clínica no resuelta / Suicide prevention in Spain: An uncovered clinical need

No disponible

Psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study.

RATIONALE: Previous studies on psychotropic drugs prescribing in autism spectrum disorder (ASD) were from the USA or the UK. However, these studies may not be generalizable to other countries. There is a need to understand the extent of psychopharmacological prescribing for ASD treatment at a multinational level to identify areas of prescribing which lack evidence. METHODS: We used the IMS Prescribing Insights database to investigate psychotropic drugs prescribing patterns for ASD treatment in children and adults in 2010-2012. Data were obtained from Europe (France, Germany, Italy, Spain and UK), South America (Mexico and Brazil), North America (Canada and USA) and Asia (Japan). RESULTS: North American countries have the highest prescription rates, followed by the European and South American countries. Prescribing rates were higher in children compared to adults in individual countries. The most commonly prescribed drug for ASD was risperidone in young people (except in UK and Japan). In the UK, methylphenidate (34 %) was the most commonly prescribed for young people and haloperidol (44.1 %) in Japan. In adults, the most commonly prescribed drug class was antipsychotics and particularly risperidone (thioridazine and ziprasidone were the most prescribed antipsychotics in Brazil and USA, respectively). CONCLUSION: There is variation in medication prescription for people with ASD among countries, which may be attributable to diagnostic criteria, clinical guidelines or health care systems. However, there is a lack of evidence of efficacy and safety for many psychotropic drugs prescribed for people with ASD. Research is needed to bridge the evidence gaps in prescribing.

Monitorización de niveles plasma de antipsicóticos atípicos / Atypical antipsychotics plasma level monitoring

Introducción: El estudio de la concentración de psicofármaco en sangre o en suero permite individualizar el perfil farmacocinético del sujeto tratado. Esto se conoce como monitorización de fármacos. Actualmente se pueden analizar antidepresivos, antipsicóticos, estabilizadores del ánimo, fármacos sustitutivos de los opioides, ansiolíticos e hipnóticos. Objetivos: Revisar el estado actual del conocimiento sobre monitorización de antipsicóticos, de utilidad tanto para evaluar la adherencia terapéutica como para conocer la concentración del fármaco en plasma. Metodología: Se revisaron los trabajos publicados sobre monitorización de antipsicóticos desde 1975 hasta 2010. Como fuente de información se empleó:Embase, Medline y Pubmed. Conclusiones: La monitorización de antipsicóticos, así como de otros psicofármacos, es una práctica establecida que debe conocerse y ser objeto de actualización por parte del psiquiatra interesado en un ejercicio terapéutico basado en datos objetivos(AU)

Introduction: Analysis of psychotropic drug concentration in blood or serum is a mean to ascertain the pharmacokinetic profile of the treated subject. This is known as drug monitoring. Currently plasma antidepressants, antipsychotics, mood stabilizers, drugs substitutes for opioids, anxiolytics and hypnotics can be monitorized. Methodology: We reviewed all published articles on monitoring of psychotropic drugs in general from 1975 to 2010. As a source of information used: Embase, Medline and Pubmed. Objetive: To review the current state of science in relation to the monitoring of atypical antipsychotics. Antipsychotic plasma level monitoring is crucial both to assess adherence and to determine the plasma drug concentration. Conclusions: The monitoring of antipsychotics and other psychotropic drugs, is an established practice must be known and be maintained by a psychiatrist, like other aspects of psychopharmacology, for a therapeutic exercise based on the current state of science(AU)

Correlatos neurobiológicos de la intervención psicoterapéutica / Neurobiological Correlates of Psychotherapeutic Intervention

Los avances en neurociencia permiten profundizar la comprensión de los correlatos neurobiológicos de las diferentes intervenciones psicoterapéuticas. Con el objetivo de presentar un panorama abarcativo de esta temática, se presentan estudios que dan cuenta de los efectos neurales de las psicoterapias, y que se enfocan en las diferentes áreas cerebrales involucradas y los posibles mecanismos subyacentes en los diferentes niveles, incluyendo tanto los moleculares como los que están relacionados con modificaciones en los circuitos. El artículo contiene también, una referencia a los procesos de memoria que podrían estar vinculados con los efectos de las psicoterapias. Se realiza una breve referencia a la comunicación empática, y a la neurobiología del apego, procesos posiblemente involucrados también en el trabajo psicoterapéutico, incluyendo una mención al rol de la oxitocina. Dada la importancia que en los últimos años ha adquirido el concepto de epigénesis y la posibilidad de que la eficacia de las psicoterapias pueda ser incrementada a través de la aplicación de fármacos moduladores de eventos epigenéticos, se incluye también una referencia a estos hallazgos (AU)

Advances in neuroscience allow to deepen the understanding of the different psychotherapeutic interventions and its neurobiological correlations. With the aim of presenting a comprehensive overview of this topic, studies that focus on the neural effects of psychotherapies, the different brain areas involved on it and the possible underlying mechanisms at different levels, including both the molecular as those that are linked to changes in the cicuits, are presented. The article also includes a reference to the processes of memory that could be linked with the effects of psychotherapies. its also made a brief reference to empathic communication and the neurobiology of attachment, processes possibly also involved in psychoterpaeutic work, including a mention of the role of oxytocin. Given the importance that has acquired the concept of epigenesis and the possibility that the effectiveness of pscychotherapies could be increased through the application of modulating drugs of epigenetic events in recent years, a reference to these findings was also included (AU)

Correlatos neurobiológicos de la intervención psicoterapéutica / Neurobiological Correlates of Psychotherapeutic Intervention

Los avances en neurociencia permiten profundizar la comprensión de los correlatos neurobiológicos de las diferentes intervenciones psicoterapéuticas. Con el objetivo de presentar un panorama abarcativo de esta temática, se presentan estudios que dan cuenta de los efectos neurales de las psicoterapias, y que se enfocan en las diferentes áreas cerebrales involucradas y los posibles mecanismos subyacentes en los diferentes niveles, incluyendo tanto los moleculares como los que están relacionados con modificaciones en los circuitos. El artículo contiene también, una referencia a los procesos de memoria que podrían estar vinculados con los efectos de las psicoterapias. Se realiza una breve referencia a la comunicación empática, y a la neurobiología del apego, procesos posiblemente involucrados también en el trabajo psicoterapéutico, incluyendo una mención al rol de la oxitocina. Dada la importancia que en los últimos años ha adquirido el concepto de epigénesis y la posibilidad de que la eficacia de las psicoterapias pueda ser incrementada a través de la aplicación de fármacos moduladores de eventos epigenéticos, se incluye también una referencia a estos hallazgos

Advances in neuroscience allow to deepen the understanding of the different psychotherapeutic interventions and its neurobiological correlations. With the aim of presenting a comprehensive overview of this topic, studies that focus on the neural effects of psychotherapies, the different brain areas involved on it and the possible underlying mechanisms at different levels, including both the molecular as those that are linked to changes in the cicuits, are presented. The article also includes a reference to the processes of memory that could be linked with the effects of psychotherapies. it's also made a brief reference to empathic communication and the neurobiology of attachment, processes possibly also involved in psychoterpaeutic work, including a mention of the role of oxytocin. Given the importance that has acquired the concept of epigenesis and the possibility that the effectiveness of pscychotherapies could be increased through the application of modulating drugs of epigenetic events in recent years, a reference to these findings was also included

A theory of behaviour on progressive ratio schedules, with applications in behavioural pharmacology.

RATIONALE: Mathematical principles of reinforcement (MPR) provide the theoretical basis for a family of models of schedule-controlled behaviour. A model of fixed-ratio schedule performance that was applied to behaviour on progressive ratio (PR) schedules showed systematic departures from the data. OBJECTIVE: This study aims to derive a new model from MPR that will account for overall and running response rates in the component ratios of PR schedules, and their decline toward 0, the breakpoint. METHOD: The role of pausing is represented in a real-time model containing four parameters: T (0) and k are the intercept and slope of the linear relation between post-reinforcement pause duration and the prior inter-reinforcer interval; a (specific activation) measures the incentive value of the reinforcer; δ (response time) sets biomechanical limits on response rate. Running rate is predicted to decrease with negative acceleration as ratio size increments, overall rate to increase and then decrease. Differences due to type of progression are explained as hysteresis in the control by reinforcement rates. Re-analysis of extant data focuses on the effects of acute treatment with antipsychotic drugs, lesions of the nucleus accumbens core, and destruction of orexinergic neurones of the lateral hypothalamus. RESULTS: The new model resolves some anomalies evident in earlier analyses, and provides new insights to the results of these interventions. CONCLUSIONS: Because they can render biologically relevant parameters, mathematical models can provide greater power in interpreting the effects of interventions on the processes underlying schedule-controlled behaviour than is possible for first-order data such as the breakpoint.

Iatrogenia y prevención cuaternaria en salud mental / Iatrogenesis and quaternary prevention on mental health

La prevención cuaternaria evita o atenúa las consecuencias de la actividad innecesaria o excesiva del sistema sanitario. La iatrogenia producida por la actividad sanitaria es un grave problema de salud pública que en salud mental está poco estudiado. El perjuicio que se puede infligir a los pacientes abarca todo el episodio de atención, desde la prevención hasta el tratamiento pasando por el proceso diagnóstico. Se revisan los perjuicios que causan las actividades preventivas como el abordaje del duelo o el debriefing, los tratamientos farmacológicos y psicoterapéuticos, la iatrogenia del diagnostico y del sistema de atención relacionado especialmente con el estigma. Tomar conciencia de la gravedad de la iatrogenia que nuestras intervenciones "bien hechas" pueden producir permite poner en primer plano la relevancia de la prevención cuaternaria y la necesidad de trabajar con el modelo de decisiones compartidas considerando siempre alternativas y extremando las medidas que garanticen la seguridad y derechos de los pacientes(AU)

Quaternary prevention avoids or mitigates the consequences of unnecessary or excessive activity of the health system. Iatrogenia produced by care systems activity is a serious public health problem and in mental health is poorly understood. The damage that can be inflicted to patients covers the entire episode of care, from prevention to treatment through the diagnostic process. We review the damage caused by preventive activities as the approach of mourning or debriefing, pharmacological and psychotherapeutic treatments, the iatrogenia produced in diagnosis and the deleterious effects of being under care in the psychiatric system especially related to stigma. Become aware of the seriousness of iatrogenic effects of our "well done" interventions allows foregrounding the importance of quaternary prevention and the need to work with the shared decision making model always considering alternatives and measures to ensure safety and rights of patients(AU)

Do psychotherapists speak to psychopharmacologists? A survey of practicing clinicians.

While more Americans are taking psychotropic medication than ever before, psychiatrists are providing less psychotherapy, leading to the prevalence of "split-treatment" whereby two professionals provide care. Communication between clinicians treating the same patient has traditionally been an accepted principle of optimal care, however there has been no published data documenting whether or not private practice therapists actually do communicate with the psychiatrists who prescribe for their patients. A pilot study was conducted in which a nine-item anonymous survey was distributed to non-medical psychotherapists in Manhattan. Information was gathered about professional degree and discipline, duration and size of practice, and frequency of communication with professionals who prescribe for their patients. Fifty-three psychotherapists averaging over 21 years in practice returned completed surveys. Respondents reported on 1,197 psychotherapy patients, with 434 (36%) concurrently taking medication. No communication had taken place between psychotherapist and psychopharmacologist on behalf of 22% of the psychotherapy patients taking medication. Only 7 of the 53 respondents reported having quarterly communication with the prescribing physician for all split-care patients. Despite methodological limitations, study findings document that communication between professionals is not taking place on behalf of many patients in split-treatment. These findings raise questions about the quality and safety of treatment delivered in this fashion, about the need for guidelines for the conduct of split treatment, and perhaps about the traditionally assumed need for communication itself.

Resultados de los parámetros de evaluación asistenciales de una unidad de atención intermedia para pacientes con demencia / Care assessment parameters in an intermediate care unit for patients with dementia

Objetivo. Evaluar los resultados asistenciales de nuestra unidad de Psicogeriatría. Material y métodos. Estudio prospectivo de 46 pacientes con demencia ingresados en la unidad de Psicogeriatría entre mayo y agosto del 2008. Se analizó: a) mediana del Neuropsychiatric Inventory al ingreso, a la semana y al alta; b) porcentaje de pacientes procedentes de domicilio y procedentes del hospital de agudos; c) porcentaje de pacientes procedentes del hospital con estancia media inferior o igual a 7 días; d) porcentaje de caídas y restricciones físicas, y e) destino al alta. Las comparaciones entre variables se realizaron con el T-test y el chi-cuadrado. Resultados. Se observaron diferencias estadísticamente significativas entre la mediana del Neuropsychiatric Inventory al ingreso (37,7) y a la semana (13,7) (p<0,001). El 50% de los pacientes procedía de domicilio y el 50% del hospital de agudos, de éstos, el 73,9% tuvo una estancia media en el hospital de procedencia inferior o igual a 7 días. El 19,6% de los pacientes presentó caídas. Se utilizaron restricciones físicas en el 43,5% de los pacientes. Al ingreso se observó un bajo grado de prescripción de benzodiacepinas de vida media larga (6,5%) y neurolépticos típicos (2,2%), y un 6,7% de los pacientes no presentó prescripción de psicofármacos. Un 33% de los pacientes fueron dados de alta sin prescripción de psicofármacos. El porcentaje de nueva institucionalización fue del 43,5%. Conclusiones. Las unidades de Psicogeriatría de media estancia permiten el control de los síntomas psicológicos y conductuales y probablemente optimizan el recurso de los hospitales de agudos(AU)

Objective. To evaluate the care outcomes of a psychogeriatric unit. Material and methods. A prospective study of 46 patients with dementia consecutively admitted to Psychogeriatric Unit between May and August 2008. The parameters analysed were: a) median Neuropsychiatric Inventory (NPI) on admission, after one week and at discharge, b) percentage of patients coming from home or discharged from the acute hospital, c) percentage of patients coming from the acute hospital with an average stay equal or less than 7 days, d) percentages of falls and physical restraints, and e) destination at discharge. Comparisons between variables were performed using t-test and chi-squared. Results. There were a statistically significant difference between the median NPI on admittance (37.7) and after a week (13.7) (p<0.001). Half of the patients came from home and the other half from acute hospital, 73.9% of whom had had an average hospital stay equal or less than 7 days. Falls were reported in 19.6% of patients. Physical restraints were used in 43.5% of patients. On admission there was a low level of prescription of long half-life benzodiazepines (6.5%) and typical neuroleptics (2.2%), and 6.7% of patients had no prescription of psychotropic drugs. At discharge psychotropic drugs were not prescribed in 33% of patients. The institutionalisation rate was 43.5%. Conclusions. Intermediate Psychogeriatric wards enable behavioural symptoms to be controlled (BPSD) and they probably optimize the use of acute hospitals(AU)

A bibliometric analysis of research in psychopharmacology by psychology departments (1987-2007).

From the very outset of scientific Psychology, psychologists have shown interest for drugs and their effects on behavior. This has given rise to numerous contributions, mostly in the form of Psychopharmacology publications. The aim of this study was to quantitatively evaluate these contributions and compare them with other academic disciplines related to Psychopharmacology. Using the PubMed database, we retrieved information about articles from 15 journals included in the Pharmacology and Pharmacy category of the Journal Citation Reports database for a 21-year period (1987 to 2007). There were 37540 articles which about 52% were represented by 3 journals. About 70% of psychology publications were represented by 2 of these journals. Psychology departments accounted for the 11% of the published papers, which places Psychology third behind Psychiatry and Pharmacology, which contributed to 22.69 and 13% respectively. Psychology contributed to the greatest number of studies in 3 journals, second in 3 and third in 8. This report represents the first effort to explore the contribution of academic Psychology to the multidisciplinary science of psychopharmacology. Although leaders of production of psychopharmacology research were from Psychiatry and Pharmacology, Psychology departments are an important source of studies and thus of knowledge in the field of Psychopharmacology.

Morbilidad psíquica, existencia de diagnóstico y consumo de psicofármacos. Diferencias por comunidades autónomas según la Encuesta Nacional de Salud de 2006 / Mental disease, existence of diagnostic, use of psychotropic medication. Differences by autonomous communities under the National Health Survey 2006

Fundamentos: En España no existe ningún estudio en el que sehayan tomado muestras representativas por Comunidades Autónomas(CCAA) para estudiar la morbilidad psíquica. Los objetivos deeste trabajo son describir su prevalencia, la presencia de diagnóstico,el consumo de psicofármacos, el apoyo social y la salud autopercibiday la relación entre la morbilidad psíquica y el resto de variables,tanto a nivel nacional como de CCAA.Método: Estudio transversal. Fuente de información: EncuestaNacional de Salud 2006, muestra 29.478 personas. Variables estudiadas:sociodemográficas, morbilidad psíquica (GHQ-12), estadode salud autopercibido, diagnóstico de trastorno mental, apoyosocial funcional (Duke) y consumo y prescripción de psicofármacos.Para determinar la frecuencia se utilizó el porcentaje y los intervalosde confianza al 95%. Para estudiar la relación entre morbilidad psíquicay el resto de variables se utilizó la prueba de Chi cuadrado,considerando la significación estadística con un valor de p<0,05.Resultados: La prevalencia de morbilidad psíquica fue del20,1%, siendo la CA más alta la de las Islas Canarias (28,2%) y LaRioja la más baja (12,2%). El 62,4% de las personas con morbilidadpsíquica nunca había recibido un diagnóstico y el 71,6% no habíaconsumido psicofármacos en los últimos 12 meses. La Rioja fue laCA con un mayor porcentaje de casos no diagnosticados (81,8%) yno tratados con psicofármacos (83,1%), mientras que en el Principadode Asturias estos porcentajes fueron los más bajos. El 8,1% de laspersonas con morbilidad psíquica tenían bajo apoyo social y el63,8% afirmaban tener mala salud.Conclusiones: La morbilidad psíquica es un fenómeno prevalentey más de la mitad de las personas que la sufren no recibendiagnóstico ni tratamiento farmacológico, existiendo importantesvariaciones entre las CCAA(AU)

Background: Most of the studies on psychological distress inSpain have been conducted in small geographical areas or specificpopulation groups. However, there are no studies that provide representativedata for each Autonomous Community (AC). The objectivesof this paper are to determine, both in Spain and in the AC, theprevalence of psychological distress, diagnosis, use of psychoactivemedication, social support and self-perceived health, as well as tostudy the association between psychological distress and the rest ofthe variables.Methods: Cross-sectional study, using data from the 2006National Health Survey, that was completed by 29,478 persons.Variables studied: sociodemographics, psychological distress(GHQ-12), self-perceived health, mental disorder diagnosis, functionalsocial support (Duke) and use and prescription of psychoactivemedication.Results: The prevalence of psychological distress in Spain was20,1%; the highest prevalence was found in Canary Islands (28,2%)and the lowest in La Rioja (12,2%). Among those who presented psychologicaldistress, 62,4% had never received a mental disorder diagnosis,and 71,6% had not used psychoactive medication in the lastyear. The highest prevalences of non-diagnosed cases (81,8%) andcases non-treated with psychoactive medication (83,1%) were foundin La Rioja, whereas the lowest prevalences were found in Asturias.Eight percent of the persons who presented psychological distress hadlow social support and 63,8% reported bad self-perceived health.Conclusions: Psychological distress is a prevalent phenomenon,and more than half of the persons who suffer it receive neither a diagnosisnor psychoactive medication. Moreover, there are considerabledifferences between the AC(AU)

Donepecilo bucodispersable: ¿están los cuidadores principales del paciente con enfermedad de Alzheimer más satisfechos que con la formulación tradicional de donepecilo? / Orally disintegrating donepezil: are the main caregivers of patients with alzheimer´s disease more satisfied with this formulation of donepezil than with the traditional one?

Objetivo. Conocer si los cuidadores principales de los pacientes con enfermedad de Alzheimer (EA) tratados condonepecilo están más satisfechos con la formulación bucodispersable que con los comprimidos convencionales. Pacientes ymétodos. Estudio multicéntrico y transversal que reclutó pacientes con posible/probable EA según el Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición (DSM-IV) o según el NINCDS-ADRDA en monoterapia con donepecilo, bucodispersable o en comprimidos. La satisfacción con el tratamiento se midió mediante el cuestionario genérico Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) –rango: de 0, nada satisfecho, a 100, totalmente satisfecho–, de forma global y en seis dimensiones: tolerabilidad, eficacia, cuidado médico, comodidad de uso, impacto de la medicación y satisfaccióngeneral. Resultados. Se incluyeron 546 pacientes; el 64,8% eran mujeres, con una media de edad de 78,2 ± 6,5 años,22,5 ± 24,6 meses de evolución y una puntuación media en el test minimental de 18,5 ± 5; el 67,9% fue tratado con comprimidos, y el 32,1%, con bucodispersables. Tras corregir por test minimental y tiempo de tratamiento, los cuidadores de pacientes tratados con donepecilo bucodispersable mostraron puntuaciones más elevadas que con comprimidos en la puntuación total de satisfacción (74,5 ± 11,8 frente a 70,4 ± 12,3; p < 0,01), comodidad de uso (84,9 ± 16,4 frente a 79,8 ± 17,6; p = 0,0059) e impacto de la medicación en la vida diaria (50,2 ± 22,8 frente a 43,7 ± 25,5; p = 0,0006). El 91,6% de los cuidadores de pacientes tratados con bucodispersables declaró que le resultaba fácil tomar la medicación, frente al 82,9% con comprimidos (p = 0,023) (AU)

Aim. To know whether caregivers of Alzheimer’s disease (AD) patients on donepezil treatment are more satisfied with the orally disintegrating tablet (ODT) formulation than with the film-coated tablets. Patients and methods. Multicenter,cross-sectional study of patients with probably AD by DSM-IV or NINCDS-ADRDA criteria, on monotherapy with donepezil, ODT or film-coated tablets. Satisfaction with treatment was assessed by the caregiver self-administered generic TreatmentSatisfaction with Medicines Questionnaire (SATMED-Q) –range: 0, no satisfaction, to 100, maximal satisfaction–, total andin six dimensions: undesirable effects, efficacy, medical care, medication ease and convenience, medication impact on daily activities, and overall satisfaction. Results. 546 patients were enrolled (9,6% institutionalized); 64,8% women; 78,2 ± 6,5 years of age; disease evolution of 22.5 ± 24.6 months, Minimental State Examination (MMSE) mean score: 18,5 ± 5; 67.9%on film-coated tablets and 32.1% on ODT. After adjusting by MMSE and time of treatment, caregivers of patients on ODT showed significantly higher SATMED-Q total score (74.5 ± 11.8 vs. 70.4 ± 12.3; p < 0.0004) and medication ease and convenience (84.9 ± 16.4 vs. 79.8 ± 17.6; p = 0.0059), impact of medication on daily activities (50.2 ± 22.8 vs. 43.7 ± 25.5;p = 0.0006) and satisfaction with medical care (79.4 ± 19.5 vs. 75.6 ± 21.8; p = 0.04894) scores. 91.6% of caregivers of patients on ODT (versus 82.9% of those on film-coated tablets; p = 0.023) stated that taking the medication was easy for theirrelatives. Conclusions. Results show that caregivers of AD patients on donepezil treatment are more satisfied with ODT versus film-coated tablets, especially due to its better ease of use (AU)