Perspectiva de los psiquiatras españoles respecto a la atención de las demencias. La encuesta PsicoDem / Perspectives of Spanish psychiatrists on the management of dementias: the PsicoDem survey

Introducción. Aunque los recursos sanitarios empleados en la atención de las demencias en España no incluyen sistemáticamente a los servicios de salud mental, muchos de los pacientes atendidos en ellos sufren demencia. La perspectiva de los psiquiatras al respecto, no evaluada a nivel nacional hasta la fecha, es de interés para conocer su implicación real e identificar estrategias para aumentarla. Material y métodos. Se realizó una encuesta a una muestra de 2.000 psiquiatras con actividad en diferentes ámbitos asistenciales. Se recogieron datos sociodemográficos de los encuestados y sobre aspectos clínicos y opiniones relativos al abordaje de las demencias. Se calcularon las frecuencias de cada opción de respuesta y medidas de asociación para las frecuencias cruzadas entre pares de preguntas de interés, junto con sus intervalos de confianza del 95%. Resultados. Salvo en unidades de psicogeriatría y centros de larga estancia, la participación de los psiquiatras en la atención de las demencias es limitada. No obstante, se observaron diferencias importantes entre comunidades autónomas. Casi todos los encuestados (81%) se mostraron dispuestos a ampliar sus conocimientos en el área de las demencias. Precisamente la falta de formación, junto con otros factores de tipo organizativo como el difícil acceso a pruebas complementarias (por ejemplo, técnicas de neuroimagen) o la prescripción de fármacos antidemencia fueron dificultades comúnmente citadas para el abordaje de los pacientes con demencia. Conclusiones. El incremento de la implicación de los psiquiatras y su coordinación con otros especialistas para proporcionar cuidados integrados son aspectos mejorables de la atención sanitaria de las demencias en España (AU)

Introduction. Mental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it. Material and methods. A survey was conducted on 2,000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals. Results. Psychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organizational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia. Conclusions. Increasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level (AU)

[Perspectives of Spanish psychiatrists on the management of dementias: the PsicoDem survey]. / Perspectiva de los psiquiatras españoles respecto a la atención de las demencias. la encuesta PsicoDem.

INTRODUCTION: Mental health services are not systematically involved in the care of dementias in Spain. Nevertheless, many patients with dementia attend these services. The perspective of psychiatrist as regards this situation has not been evaluated at the national level to date, and it may be of interest to determine their actual involvement and the strategies to foster it. MATERIAL AND METHODS: A survey was conducted on 2,000 psychiatrists on a range of mental health care services. Respondents provided socio-demographic data and information about clinical aspects, together with their opinions regarding the management of dementia. Responses were described by their raw frequencies and measures of association for cross-tabulations resulting from selected pairs of questions. Inferences were made by calculating their 95% confidence intervals. RESULTS: Psychiatrist involvement in the management of dementias was limited, aside from those involved in psycho-geriatric units or nursing homes facilities. However, there were wide, regional differences. Nearly all respondents (81%) were ready to augment their knowledge and skills in the area of dementia. In particular, the insufficient medical education, together with other organizational factors, such as the difficulties in ordering diagnostic tests (i.e. neuroimaging), or prescribing anti-dementia drugs in some regions, were common barriers psychiatrists faced when approaching patients with dementia. CONCLUSIONS: Increasing psychiatrist involvement and boosting coordinated efforts with other specialists in a form of integrated care may advance the care of dementias in Spain to a more valuable level.

Hipofisitis linfocitaria en gestante de 34 semanas / Lymphocytic hypophysitis in a woman at 34 weeks of pregnancy

Presentamos el caso de una gestante de 23 años, de 33+ 4 semanas, ingresada por un cuadro de hemianopsia bitemporal y alteraciones endocrinas para estudio. Mencionamos los principales diagnósticos diferenciales haciendo un repaso de la fisiopatología de la hipofisitis linfocitaria, así como el manejo de la patología (AU)

We report the case of a 23-year-old woman at 33 + 4 weeks of pregnancy who was admitted for investigation of bitemporalhemianopsia and endocrine disruption. We discuss the main differential diagnoses by reviewing the pathophysiology of lymphocytic hypophysitis, as well as the management of this disease (AU)

Valores de referencia de la translucencia intracraneal / Reference values for intracranial translucency

Objetivo: Determinar los rangos de referencia de la translucencia intracraneal (TIC) en nuestra población. Material y métodos: Se ha realizado un estudio de regresión lineal sobre 471 gestaciones únicas sin anomalías asociadas para valorar la relación entre LCC y TIC. Resultados: Se realizó la medición de TIC en el 98,9%. La TIC presenta una distribución normal con una desviación estándar de 0,4139. La media es 2,0502 mm (0,9-3,6 mm), los percentiles 5 y 95% corresponden con 1,4 y 2,7 mm. La TIC presenta una correlación lineal con la LCC (TIC: 0,0125* LCC + 1,2628; R2: 0,055 p < 0,0001). Se calcula la TIC estimada para el percentil 5: (0,0125* LCC + 1,2628) − 0,6505. El coeficiente de correlación intraclase es de 0,816 (0,606-0,921; IC 95%). Conclusiones: La medición del cuarto ventrículo durante la ecografía del primer trimestre es posible y sencilla de realizar. Se recomienda realizar un estudio neurológico ampliado ante mediciones situadas por encima del percentil 95 o inferiores al 5 (AU)

Objective: To determine reference ranges for intracranial translucency (ICT) in our population. Material and methods: To assess the relationship between crown-rump length (CRL) and ICT, we performed a linear regression analysis of 471 singleton pregnancies without associated anomalies. Results: ICT was measured in 98.9%. ICT had a normal distribution with a standard deviation of 0.4139. The mean was 2.0502 mm (0,9-3.6 mm), and the 5% and 95% percentiles corresponded to 1.4 mm and 2.7 mm. ICT had a linear correlation with CRL (ICT: 0.0125 + 1.2628 * CRL; R2:0,055 P <0.0001). The estimated ICT was calculated for the 5th percentile (1.2628 + 0.0125 * LCC)- 0.6505. The intraclass correlation coefficient was 0,816 (0606-0921 CI: 95%). Conclusions: Measurement of the fourth ventricle during first trimester ultrasound examination is feasible and is simple to perform. An extended neurological evaluation should be carried out if measurements are above the 95th percentile or below the 9th percentile (AU)

Characteristics of patients with Alzheimer's disease who switch to rivastigmine transdermal patches in routine clinical practice.

BACKGROUND: The aim of this study was to assess the sociodemographic and clinical characteristics of patients with Alzheimer's disease who switched from any oral cholinesterase inhibitor to rivastigmine patches. METHODS: An observational, retrospective, multicenter study was conducted in patients with a diagnosis of Alzheimer's disease who had switched to rivastigmine patches within the previous year in the routine clinical practice of 150 neurologists. Sociodemographic, clinical, and therapeutic data were collected in one office visit. Stepwise logistic regression models were used to find associations. RESULTS: Data were obtained from a total of 1022 patients and their caregivers, and showed a mean age of 78.4 ± 6.62 years, 62.61% being women, and mostly having a family caregiver. The switch to rivastigmine patches was mainly instigated on the initiative of the physician (82.39%) or on request of the caregiver (21.23%) or patient (10.37%). Reasons for the switch included improving ease of administration (56.65%), tolerability (36.79%), efficacy (31.60%), and adherence (18.59%). Prior treatment with oral rivastigmine versus donepezil or galantamine increased the probability of switching in order to improve ease of administration (odds ratio, oral rivastigmine versus donepezil 4.20, P < 0.0001; odds ratio, oral rivastigmine versus galantamine 3.55, P < 0.0001). Conversely, previous treatment with donepezil or galantamine produced an approximate four-fold increase in the odds of switching due to lack of efficacy. A higher level of education as well as more concomitant diseases increased the probability of switching because of intolerance. CONCLUSION: Improved ease of administration was the main reason for switching to transdermal rivastigmine. Other reasons involved in the decision to switch to rivastigmine patches included sociodemographic and clinical characteristics, including the educational level of patients and caregivers, number of concomitant diseases, and previous treatment for Alzheimer's disease.

Transdermal is better than oral: observational research of the satisfaction of caregivers of patients with Alzheimer's disease treated with rivastigmine.

BACKGROUND AND AIMS: Poor adherence to anti-dementia drugs is common among patients with Alzheimer's disease. This study evaluated whether caregivers were more satisfied with, and patients more adherent to, transdermal rivastigmine than oral rivastigmine. METHODS: Neurologists, psychiatrists and geriatricians collected sociodemographic and clinical data from 1,078 patients and administered the Treatment Satisfaction with Medicines (SATMED-Q) and the Morisky-Green questionnaires to their caregivers at outpatient consultations. RESULTS: Satisfaction reported was greater with transdermal than oral rivastigmine: mean ± SD of the total SATMED-Q score, 72.5 ± 14.1 vs. 65.2 ± 12.5, p < 0.001. The proportion of adherent patients was greater with transdermal than with oral rivastigmine (65.0 vs. 41.4%, p < 0.001). Satisfaction, in turn, was significantly greater in adherent cases than in nonadherent cases. CONCLUSIONS: Facilitating the administration of anti-dementia drugs would improve adherence.

Impact of transdermal drug delivery on treatment adherence in patients with Alzheimer's disease.

OBJECTIVE: As a part of a study investigating which strategies are effective to improve pharmacological compliance among nonadherent Alzheimer's disease patients, we assessed the impact of the galenic form (oral medications or patches) on treatment adherence in patients with dementia of Alzheimer's type (DAT). DESIGN AND METHODS: We performed a 6-month prospective, multicenter, observational study with three study visits (baseline, 3 months and 6 months). Patients with mild-to-moderately severe DAT receiving medication for ≥3 months who were nonadherent to treatment were recruited. OUTCOME MEASURES: The main variable was adherence rate recorded at each visit. Patients were adherent if they missed <20% of the doses of their medication and they took it at the dose, manner and timing prescribed by the physician >80% of times. Secondary variables included strategies followed by physicians to improve adherence and reasons for nonadherence reported by patients. RESULTS: A total of 649 patients (35.2% men) were included. The percentage of adherent patients reached 73.6% at 3 months and rose to 85.9% at 6 months. The most common reasons for nonadherence were forgetfulness, avoidance of adverse events and refusal of treatment. Modification of treatment was the most frequent strategy followed by physicians for improving treatment adherence at baseline, and the only intervention that substantially improved adherence at the 3-month visit (the percentage of patients treated with patches increased from 6.1% at baseline to 64.8% at 3-month visit). Patients using patches were more likely to comply than patients using capsules/tablets, as demonstrated by logistic regression analysis. CONCLUSIONS: The results suggested that the transdermal patch may improve adherence, which may lead to an increase of treatment benefits in patients with DAT.