Predictive factors of functional capacity and real-world functioning in patients with schizophrenia.

PURPOSE: This study was performed to identify the predictive factors of functional capacity assessed by the Spanish University of California Performance Skills Assessment (Sp-UPSA) and real-world functioning assessed by the Spanish Personal and Social Performance scale (PSP) in outpatients with schizophrenia. METHODS: Naturalistic, 6-month follow-up, multicentre, validation study. Here, we report data on 139 patients with schizophrenia at their baseline visit. ASSESSMENT: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Sp-UPSA and PSP. STATISTICS: Pearson's correlation coefficient (r) was used to determine the relationships between variables, and multivariable stepwise linear regression analyses to identify predictive variables of Sp-UPSA and PSP total scores. RESULTS: Functional capacity: scores on the PSP and PANSS-GP entered first and second at P<0.0001 and accounted for 21% of variance (R(2)=0.208, model df=2, F=15.724, P<0.0001). Real-world functioning: scores on the CGI-S (B=-5.406), PANSS-N (B=-0.657) and Sp-UPSA (B=0.230) entered first, second and third, and accounted for 51% of variance (model df=3, F=37.741, P<0.0001). CONCLUSION: In patients with schizophrenia, functional capacity and real-world functioning are two related but different constructs. Each one predicts the other along with other factors; general psychopathology for functional capacity, and severity of the illness and negative symptoms for real-world functioning. These findings have important clinical implications: (1) both types of functioning should be assessed in patients with schizophrenia and (2) strategies for improving them should be different.

Impact of substance use on the physical health of patients with bipolar disorder.

OBJECTIVE: To describe the impact of tobacco, alcohol and cannabis on metabolic profile and cardiovascular risk in bipolar patients. METHOD: Naturalistic, cross-sectional, multicenter Spanish study. Current use of tobacco, alcohol and cannabis was determined based on patient self-reports. Metabolic syndrome was defined using the National Health and Nutrition Examination Survey 1999-2000 and the American Heart Association/National Heart, Lung and Blood Institute criteria, and cardiovascular risk using the Framingham and the Systematic Coronary Risk Evaluation functions. RESULTS: Mean age was 46.6 years, 49% were male. Substance use: 51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reported consuming any substance were significantly younger and a higher proportion was male. After controlling for confounding factors, tobacco was a risk factor for coronary heart disease (CHD) (unstandardized linear regression coefficient 3.47, 95% confidence interval 1.85-5.10). CONCLUSION: Substance use, mainly tobacco, was common in bipolar patients. Tobacco use negatively impacted CHD risk.

Asociación entre el polimorfismo A-1438G del gen del receptor de serotonina 2A (5-HT2A) e impulsividad del comportamiento suicida / Association of serotonin 2A (5HT2A) receptor gene A-1438G polymorphism and impulsivity within the context of suicidal behaviour

Objetivos: Investigar la posible asociación entre cuatro polimorfismos serotoninérgicos (A-1438G (rs6311) y T102C (rs6313) del gen del receptor 5-HT2A y STin2 VNTR y 5-HTTLPR del gen SLC6A4) e impulsividad de la tentativa suicida (TS).Método: 180 pacientes (Asturias – Norte de España) que habían realizado una tentativa suicida fueron evaluados utilizando la Suicidal Intent Scale (SIS) y, posteriormente, genotipados utilizando métodos estándar. Las TS fueron divididas en dos subgrupos: impulsivas (puntuaciones inferiores a 6 puntos) o no impulsivas (6 o más puntos), utilizándola subescala de planificación suicida de la SIS. Resultados: Edad media (SD) de la muestra total = 35,6 (12,5) años; mujeres: 63,3%.La mayoría de los pacientes (95,6%) tenían al menos un diagnóstico psiquiátrico. Los diagnósticos más prevalentes fueron: trastornos afectivos (36,7%), esquizofrenia y otras psicosis (18,3%), trastornos de ansiedad (12,2%) y trastornos de la personalidad(11,1%). En un 49,4% se constató la existencia de TS previas. Un 64,4% de las TS fueron de tipo impulsivo. Los polimorfismos A-1438G y T102C estaban en completo desequilibrio de ligamiento en nuestra población. El genotipo –1438GG y el alelo –1438Gfueron más prevalentes entre los pacientes que realizaron TS impulsivas [34,5% vs14,1%, X2 (2) = 11,5, p corregida = 0,012; 0,59 vs 0,41; X2 (1) = 11,2, p corregida =0,004, OR = 2,11 (1,36-3,27), respectivamente]. No se encontraron diferencias en las distribuciones genotípicas o alélicas de los polimorfismos del gen SLC6A4.Conclusiones: Variaciones polimórficas del gen 5-HT2A podrían predisponer hacia la realización de TS de tipo impulsivo (AU)

Objective: To determine the association between four serotonergic polymorphisms (A-1438G (rs6311) and T102C(rs6313) of the 5-HT2A receptor gene, and STin2 VNTR and 5-HTTLPR of the SLC6A4 gene) and impulsivity in suicide attempts (SA).Methods: 180 suicide attempters from Asturias (Northern Spain) were assessed using the Suicidal Intent Scale (SIS)and genotyped by standard methods. According to the SIS definition SA were divided into two subgroups (impulsive and non-impulsive). A score of 6 on the planning subscale was used to classify attempts as impulsive or non-impulsive. Results: Mean age (SD) was 35.6 (12.5) years and about 63.3% of cases were female. Most of patients (95.6%) had at least one psychiatric diagnosis. More prevalent diagnoses were affective disorders (36.7%), schizophrenia and other psychosis (18.3%), anxiety disorders (12.2%), and personality disorders (11.1%). Previous SA was found in 49.4% of cases. About 64.4% of SA patients were classified as impulsive SA. A-1438G and T102C polymorphisms were in complete linkage disequilibrium in our population. We found and excess of –1438GG genotype and –1438G allele when compared impulsive SA with the non-impulsive group (34.5% vs 14.1%, X2 (2) = 11.5, corrected P = 0.012; 0.59% vs0.41%, X2 (1) = 11.2, corrected P = 0.004, OR = 2.11 (1.36-3.27), respectively). No differences in genotypic or allele frequencies of the SLC6A4 gene polymorphisms were found. Conclusions: Our findings suggest that polymorphic variants on the 5-HT2A gene may predispose for impulsive suicidal behaviour (AU)

Negative evidences in association between apolipoprotein E polymorphism and panic disorder.

The aim is to investigate the association between apolipoprotein E (ApoE) and panic disorder (PD). Genotyping 92 PD patients [Diagnostic Statistic Manual IV (DSM IV) criteria] and 174 controls no differences were found between both groups. Variation in the ApoE-gene was not associated with the development of PD.

[Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression]. / Efectividad de la venlafaxina en el tratamiento de la dependencia de alcohol con depresión comórbida.

INTRODUCTION: There are no conclusive data on the effectiveness of antidepressant drugs in the treatment of comorbid cases of alcohol dependence and depression. OBJECTIVES: To determine the effectiveness of venlafaxine on depression and on severity (need of treatment) of alcohol dependence and related problems. METHODS: Observational, open-label, multicenter, 24-week follow-up study. PATIENTS: 90 outpatients with diagnosis of alcohol dependence and associated major depression disorder (DSMIV criteria). OUTCOMES MEASURES: the Hamilton Rating Scale for Depression (HAM-D17), European Addiction Severity Index (EuropASI) and Clinical Global Impression, severity and improvement subscales, (CGI-S and CGI-I). Evaluations were performed at baseline and at weeks 2, 4, 8 and 24. RESULTS: Mean age 44.94+/-9.74 years; 73.3 % man. HAM-D17 mean scores significantly decreased from baseline (24.85+/-5.94) to week 24 (5.976+/-4.68) and at each of the follow-up visits vs previous visit (p < 0.0005). Significant decreases from baseline to week 24 were obtained in four areas of EuropASI: medical status (2.12+/-2.45 to 1.07+/-1.68), alcohol use (5.29+/-2.24 to 3.04+/-2.35), family/ social relationships (3.68+/-2.36 to 1.71+/-2.06) and psychiatric status (5.61+/-1.81 to 2.67+/-2.03). Tolerance was excellent or good in 76.7% of the patients. CONCLUSIONS: Venlafaxine demonstrated to be effective in the treatment of depressive alcoholic patients. Furthermore, it seems to be useful to decrease the severity of problems related with the alcohol use.

Efectividad de la venlafaxina en el tratamiento de la dependencia de alcohol con depresión comórbida / Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression

Introducción. Faltan datos concluyentes sobre la efectividad de los antidepresivos en el tratamiento de los casos comórbidos de dependencia de alcohol y depresión. Objetivos. Determinar la efectividad de la venlafaxina sobre la depresión y sobre la gravedad (necesidad de tratamiento) de la dependencia de alcohol y problemas relacionados. Métodos. Estudio observacional, abierto, multicéntrico de 24 semanas de seguimiento. Pacientes. Noventa pacientes ambulatorios con diagnóstico de dependencia de alcohol y trastorno depresivo mayor (criterios DSM-IV). Medidas de resultados: escala de Hamilton de depresión (HAM-D17), Índice Europeo de Severidad de la Adicción (EuropASI) e Impresión Clínica Global (subescalas de gravedad y mejoría) (ICG-S e ICG-M). Evaluaciones basal y en las semanas 2, 4, 8 y 24. Resultados. Edad media: 44,94+-9,74 años; 73,3 % varones. Disminución significativa de las puntuaciones en la HAM-D17 desde la visita basal (24,85+-5,94) a la semana 24 (5,97+-4,68) y en cada una de las visitas de seguimiento frente a la visita previa (p<0,0005). Reducciones significativas en el EuropASI desde la basal a la semana 24 en las áreas: situación médica (2,12 ± 2,45 a 1,07+-1,68), uso de alcohol (5,29+-2,24 a 3,04+-2,35), relaciones familiares/sociales (3,68+-2,36 a 1,71+-2,06) y estado psiquiátrico (5,61+-1,81 a 2,67+-2,03). La tolerancia fue excelente o buena en el 76,7% de los casos. Conclusiones. La venlafaxina demostró ser efectiva en el tratamiento de la depresión en pacientes dependientes de alcohol. Además parece ser útil para reducir la gravedad

Introduction. There are no conclusive data on the effectiveness of antidepressant drugs in the treatment of comorbid cases of alcohol dependence and depression. Objectives. To determine the effectiveness of venlafaxine on depression and on severity (need of treatment) of alcohol dependence and related problems. Methods. Observational, open-label, multicenter, 24-week follow-up study. Patients. 90 outpatients with diagnosis of alcohol dependence and associated major depression disorder (DSMIV criteria). Outcomes measures: the Hamilton Rating Scale for Depression (HAM-D17), European Addiction Severity Index (EuropASI) and Clinical Global Impression, severity and improvement subscales, (CGI-S and CGI-I). Evaluations were performed at baseline and at weeks 2, 4, 8 and 24. Results. Mean age 44.94+-9.74 years; 73.3 % man. HAM-D17 mean scores significantly decreased from baseline (24.85+-5.94) to week 24 (5.976+-4.68) and at each of the follow-up visits vs previous visit (p < 0.0005). Significant decreases from baseline to week 24 were obtained in four areas of EuropASI: medical status (2.12+-2.45 to 1.07+-1.68), alcohol use (5.29+-2.24 to 3.04+-2.35), family/ social relationships (3.68+-2.36 to 1.71+-2.06) and psychiatric status (5.61+-1.81 to 2.67+-2.03). Tolerance was excellent or good in 76.7% of the patients. Conclusions. Venlafaxine demonstrated to be effective in the treatment of depressive alcoholic patients. Furthermore, it seems to be useful to decrease the severity of problems related with the alcohol use

Maintenance treatment with depot opioid antagonists in subcutaneous implants: an alternative in the treatment of opioid dependence.

A report is presented of treatment of 156 patients (male 98%) with opioid dependence (ICD-10 criteria) using a maintenance programme with depot opioid antagonists (naltrexone) as subcutaneous implants, started after an outpatient rapid antagonization regimen. The retention index in the treatment was from 80% in the sixth month, and 65% after one year. The patients were followed-up for 1 year after discharge. For 6 months after discharge 55.4% were still returning for follow-up visits and 20.8% after 1 year, all of them remaining abstinent to opioids. It is concluded that the programme is safe for the patients and shows a better retention index than programmes using oral antagonists, with an improved compliance (negative urine analysis) compared to the latter.

Use of cocaine by secondary school students in northern Spain.

AIM: To describe the prevalence of cocaine and other drug use in secondary school students in Oviedo (Asturias, Northern Spain) and determine the personality features and levels of sensation seeking in cocaine users. METHODS: 2,862 secondary school students (mean age +/- SD = 15.87+/-1.48 years; 50.6% males) were interviewed during the 1998-1999 academic year. For evaluation, the World Health Organization questionnaire for drug consumption, the Eysenck Personality Questionnaire (EPQ) for adults and the Zuckerman Sensation Seeking Scale were used. RESULTS: The prevalence of lifetime, previous year and previous month cocaine use among secondary school students was 6.1, 4.9 and 2.7%, respectively. Cocaine ranked sixth among illicit drugs ever used by this population. Once individuals had used cocaine for the first time, they were likely to use it again (44.8% of those who had ever used cocaine reported that they had done so in the previous month). Compared to students who had never used cocaine (but who may have used other substances), cocaine users had a more extensive drug abuse history. Students who had used cocaine at some point during their lifetime scored significantly higher on the EPQ psychoticism subscale and reported higher levels of sensation seeking. CONCLUSIONS: There is a significant rate of cocaine consumption amongst secondary school students of both sexes. Cocaine users are polyconsumers of other substances, both legal and illicit. Those who consume cocaine have a different psychological profile, characterized by high sensation seeking and high levels of psychoticism.

Use of MDMA and other illicit drugs by young adult males in northern Spain. A five-year study.

AIM: To measure the prevalence of 3,4-methylenedioxymethamphetamine (MDMA) and other drug use in young males entering compulsory military service in Asturias (northern Spain) and to define trends in MDMA use in this group during the period from 1995 to 1999. We also sought to determine whether MDMA users have distinct personality features or higher levels of sensation seeking. METHODS: 3,634 conscripts [mean age (SD) = 20.19 years (2.52)] who entered military service during the period between 1995 and 1999 were evaluated using the World Health Organization (WHO) questionnaire for drug consumption, the Eysenck Personality Questionnaire-A (EPQ-A), and the Zuckerman Sensation Seeking Scale. RESULTS AND CONCLUSIONS: The prevalence of lifetime, previous year and previous month MDMA use among military recruits between 1995 and 1999 was 10.9, 7.8 and 4.5%, ranking fifth among illicit drugs ever used. Once individuals used MDMA for the first time, they were likely to use it again, with 71% of individuals who had ever used MDMA reporting that they had used it during the past year (ranking second only to hallucinogens), and 41% reporting having used it in the last month. Compared to recruits who had never used MDMA (but who may have used other illicit drugs), MDMA users had a more extensive drug abuse history. Recruits who had used MDMA during the year prior to study had significantly higher scores on the Neuroticism and Psychoticism Subscales of the EPQ-A, and reported higher levels of sensation seeking.

24-Hour opiate detoxification and antagonist induction at home--the 'Asturian method': a report on 1368 procedures.

The technique of domiciliary rapid opiate detoxification (ROD) developed in Asturias since 1994 enables patients dependent on heroin and/or methadone (or other opiates) to start antagonist maintenance with a full dose of naltrexone (50 mg) and largely recover from the acute opiate withdrawal syndrome in a few hours at home without direct medical or nursing involvement. Detailed information on 1368 procedures is presented but in Asturias, over 3000 procedures have been completed to date without any deaths or serious medical or psychiatric complications. We also describe some recent modifications to the procedure involving the use of octreotide as an antidiarrhoeal and the insertion of subcutaneous naltrexone implants to prevent early relapse. Rather than domiciliary ROD, we think the procedure is more usefully conceptualized as domiciliary rapid antagonist induction (RAI), because treatment with well-supervised naltrexone is known to be effective in reducing relapse rates. Now that controlled studies uniformly describe greatly increased rates of transfer to naltrexone maintenance treatment following RAI, compared with conventional slower withdrawal and naltrexone induction procedures, it is important that the safety, acceptability and simplicity of this 'Asturian' RAI/ROD technique become more widely known.

Evaluating changes in sexual functioning in depressed patients: sensitivity to change of the CSFQ.

Accurately evaluating alterations in sexual functioning requires a validated instrument that measures clinically relevant change over time. One-hundred one depressed patients from 15 Spanish out-patient clinics completed the Changes in Sexual Functioning Questionnaire (CFSQ; Clayton, McGarvey, & Clavet, 1997) at baseline and after 6 months of treatment with fluoxetine, nefazodone, paroxetine, or venlafaxine. Sexual desire/interest showed a nearly substantial floor effect (30% of patients indicated the maximum score) for women in the nefazodone group at baseline and in the paroxetine group at final visit. The percentage of dimensions recording change was greater for women (80%) than for men (20%) in the nefazodone group (improving changes) and greater for men (40%) than for women (20%) in the paroxetine group (worsening changes). Highest effect sizes were found on sexual desire/frequency with improvement in women in the nefazodone group (SES = 0.49), and on orgasm/ejaculation with worsening in men in the paroxetine group (SES = -1.45). In conclusion, the CSFQ is sensitive to bidirectional changes and is appropriate for measuring sexual dysfunction.

Polimorfismos serotoninérgicos y trastorno obsesivo-compulsivo / Serotonin gene polymorphisms and obsessive compulsive disorder

OBJETIVO: Determinar la posible asociación entre 4 polimorfismos de genes serotoninérgicos (T102C, A-1438G, 5-HTTLPR, VNTR-5HHT]) y el trastorno obsesivo-compulsivo (TOC).PACIENTES Y MÉTODOS: Se incluye a 41 pacientes ambulatorios diagnosticados de TOC (criterios DSMIV) (edad media: 36,22 [9,62]; 31,7 por ciento varones) y 119 voluntarios sanos (donantes de sangre) (edad media: 43,29 [11,28]; 75,8 por ciento varones) de Asturias.Los polimorfismos se determinaron tras amplificación de los genes mediante reacción en cadena de la polimerasa y su posterior digestión con enzimas de restricción y electroforesis en gel de agarosa.RESULTADOS: Polimorfismos 5-HT2A, ambos polimorfismos 5-HT2A (T102C y A-1438G) se encuentran en desequilibrio de ligamiento completo en nuestra población. T102C o A-1438G (TOC frente a controles): TT o AA: 22,0 por ciento, 19,3, por ciento; TC o AG: 48,8 por ciento, 52,9 por ciento; CC o GG: 29,3 por ciento, 27,7 por ciento (p = 0,908).Polimorfismos del transportador de serotonina, 5HTTLPR (TOC frente a controles): LL: 26,8 por ciento, 30,3 por ciento; LS: 56,1 por ciento, 47,9 por ciento; SS: 17,1 por ciento, 21,8 por ciento (p = 0,648). VNTR-5HTT (TOC frente a controles): 12rep12rep: 53,7 por ciento, 39,5 por ciento; 12rep10rep: 41,5 por ciento, 31,1 por ciento; 12rep9rep: 0 por ciento, 0,8 por ciento; 10rep10rep: 4,9 por ciento, 27,7 por ciento; 10rep9rep: 0 por ciento, 0,8 por ciento (p= 0,034). El alelo 12rep fue más frecuente en los pacientes con TOC: el 74,4 frente al 55,5 por ciento, p = 0,008. El análisis en función del sexo pone de manifiesto que esas diferencias sólo se dan en las mujeres (p = 0,006 para las frecuencias genotípicas y p = 0,001 para las frecuencias alélicas).CONCLUSIONES: En las mujeres, las variaciones polimórficas VNTR del gen del transportador de serotonina podrían estar relacionadas con el TOC.No obstante, son necesarios estudios con un mayor número de pacientes para poder confirmar o desechar estos hallazgos (AU)

Quality of life and disability in patients with obsessive-compulsive disorder.

UNLABELLED: The aim of this study is to describe the situation of Spanish obsessive-compulsive disorder (OCD) patients and compare it to that of the general population and other patient groups. METHODS: Thirty-six OCD patients on maintenance treatment were evaluated using the Y-BOCS, SF-36, and DAS-S. Their SF-36 scores were compared to Spanish norms and to those obtained from U.S. OCD patients, schizophrenic outpatients, depressed outpatients, heroin dependents, patients on hemodialysis, and kidney transplant recipients. RESULTS: Sixty-one percent of the patients had severe or extremely severe symptoms. Their quality of life was worse when compared with the Spanish norms in all SF-36 areas, but especially with respect to mental health. In contrast to U.S. OCD patients, social functioning is more impaired in the Spanish OCD patients. OCD patients reported the same quality of life as schizophrenics in the areas of mental health, but better in the areas of physical health. Compared with heroin dependents and depressed patients, their quality of life was worse. On mental health scales, OCD patients scored worse than somatic patients. CONCLUSIONS: OCD in the Spanish population was shown to be associated with worse quality of life than for any other patient group (including physical groups), except schizophrenics.

[Evaluation of the psychometric properties of the Spanish version of 5 questionnaires for the evaluation of post-traumatic stress syndrome]. / Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático.

AIM: To determine the psychometric properties of the Spanish versions of the following scales for assessing PTSD patients: TQ, CAPS-DX, DTS, TOP-8, and DGRP. METHODS: Data from 63 PTSD patients and 23 healthy subjects were analysed. Internal consistency and test-retest reliability (after 15 days) were calculated. Convergent validity was analysed by correlating subjects' scores with the number of symptoms (DSM-IV) and scores on the CGI scale. Discriminative capability was analysed by comparing TQ, CAPS-DX, DTS, TOP-8, and DGRP patients' scores with scores from healthy subjects, and between patients' subgroups according to the presence or absence of psychiatric comorbidity and to the degree of severity as determined by the CGI-S. RESULTS: CAPS-DX, DTS, TOP-8, and DGRP showed an adequate internal consistency (Cronbach alpha: 0.74-0.91) and all of them obtained ICC between 0.77 and 0.93. The five questionnaires were able to discriminate between patients and healty subjects, and between the patients' subgroups. CONCLUSIONS: The Spanish versions of the TQ, CAPS-DX, DTS, TOP-8, and DGRP have shown adequate reliability and validity for assessing PTSD patients in daily clinical practice. CAPS-DX seems to be more adequate a diagnostic and DTS a severity rating scale.

Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático / Evaluation of the psychometric properties of the Spanish version of five questionnaires for the assessment of post-traumatic stress disorders

Objetivo: Evaluar las propiedades psicométricas de la versión española de los instrumentos de medida TQ, CAPSDX, DTS, TOP-8 y DGRP para su uso en la investigación y la práctica asistencial con pacientes que padecen trastorno de estrés postraumático (TEPT). Métodos: 63 pacientes diagnosticados de TEPT y 23 individuos sanos fueron reclutados y valorados. Se analizó la fiabilidad en términos de consistencia interna y test-retest (a los 15 días). La validez concurrente se analizó mediante análisis correlacionales con el número de síntomas según criterios DSM-IV y la escala CGI. La validez discriminante se evaluó comparando la puntuación obtenida en los cuestionarios de evaluación de TEPT entre pacientes y controles y entre subgrupos de pacientes según presencia de trastornos psiquiátricos concomitantes y el estado de salud en la escala CGI. Resultados: Todas las subescalas de los cinco cuestionarios mostraron una adecuada consistencia interna (alfa de Cronbach: 0,74-0,91), excepto el cuestionario TQ y los criterios B y C del cuestionario TOP-8. Además, todas mostraron adecuada fiabilidad test-retest (CCI= 0,77-093), excepto la subescala del criterio D del cuestionario TOP-8. Los cinco cuestionarios discriminaron entre pacientes y controles y entre subgrupos de pacientes según comorbilidad y el nivel de gravedad medido mediante la escala CGI. Conclusiones: La versión española de los cuestionarios TQ, CAPS-DX, DTS, TOP-8 y DGRP ha mostrado poseer adecuada fiabilidad y validez en la evaluación de pacientes con TEPT, aunque la entrevista CAPS-DX parece ser más adecuada para ayuda diagnóstica y el cuestionario DTS para la evaluación en la práctica asistencial habitual. (AU)

Validation of the Spanish version of the Changes in Sexual Functioning Questionnaire (CSFQ).

The aim of this study is to adapt and validate the Changes in Sexual Functioning Questionnaire (CSFQ) in Spanish. The CSFQ was administered to 206 depressed patients in different Spanish cities, to 326 health sciences students at the University of Oviedo, and to 48 workers undergoing routine health check-ups. The Hamilton Depression Rating Scale (HAM-D) was administered to the depressed patients. The average time spent answering the CSFQ was 15.19 minutes. The CSFQ discriminated the depressed patients from the workers and university students. In the three areas of reliability (internal, test-retest, and inter-rater), the coefficients obtained were greater than 0.80. The factor analysis demonstrated differences in the internal construct of the American CSFQ and its Spanish equivalent. The psychometrc properties of the Spanish version of the CSFQ indicate that it is a valid instrument for clinical use in treating depressed patients.

Moxonidina en las pautas de antagonización rápida ambulatoria en adictos a la heroína / Moxonidine in the outpatient rapid antagonization schedules in heroin addicts

Objetivo: Evaluar la efectividad de moxonidina en pautas de antagonización rápida ambulatoria (PARA). Pacientes y método: Veinte pacientes que solicitaron desintoxicación ambulatoria por consumo de opiáceos entre abril y octubre (1998). Dichos pacientes fueron asignados a dos grupos, según consumo de heroína: grupo A (< 250 mg/día), grupo B (250 mg/día). Ambos grupos fueron subdivididos en dos subgrupos en función del protocolo asignado: PARA con clonidina o PARA con moxonidina. A las 12 h de la PARA se administró la Escala de Gold modificada (EG) para valorar sintomatología de abstinencia (SAO). Resultados: Grupo A: clonidina: sólo un paciente presentó sintomatología (diarrea leve; EG = 1). Moxonidina: sintomatología en 2 pacientes (bostezos y sudación, respectivamente). En ambos pacientes la puntuación total en la EG fue de 1. Grupo B: clonidina: síntomas en 2 pacientes (diarrea y náuseas, respectivamente). En ambos casos la puntuación en la EG fue de 1. Moxonidina: síntomas en todos los pacientes (puntuación total en la EG entre 13 y 36 puntos, indicativos de mal control del SAO). Todos los pacientes experimentaron descenso de la temperatura corporal (0,4-0,9 ºC). Conclusiones: La moxonidina no es tan efectiva como la clonidina en control del SAO en las PARA. El uso de moxonidina obliga a aumentar las dosis de benzodiacepinas para conseguir un nivel similar de sedación que con clonidina. El descenso de temperatura obliga a monitorizar mejor este parámetro que en los tratamientos con clonidina. Nuestros resultados sugieren que el SAO podría trascender más allá del sistema noradrenérgico (AU)

[Validation of the Spanish version of the social adaptation scale in depressive patients]. / Validación de la versión española de la Escala de Adaptación Social en pacientes depresivos.

INTRODUCTION: The Social Adaptation Self-evaluation Scale (SASS) allows a very easy evaluation of the individual's perspective about himself and his environment, together with his behaviour and social motivation. Taking into account that social maladjustment is high prevalent and well documented for depressed subjects and it is one of the most limiting aspects of their global performance, the aim of the present work is to validate the Spanish version of SASS for its application in subjects diagnosed as suffering major depression (DSM-IV). METHODOLOGY: A cross sectional multicentre study was carried out by collecting information on 464 patients (34.7% men and 65.3% women range 18 to 65 years), which included their answers to the scale and relevant sociodemographic and clinical variables. RESULTS: The principal component analysis corroborated the identification of 4 main factors: the first one being extrafamily relationships (31.4% of inertia); the second, work and leisure (7.6% of inertia); the third, social and cultural interests (5.6% of inertia); and the fourth factor, family relationships and behavioral strategies (5.5% of intertia). The scale has provided adequate reliability and validity indexes as well as sensitivity to the severity of the depressive episode. CONCLUSIONS: The Spanish version of the SASS has proven to be an adequate instrument for evaluating social adjustment in depressive subjects. However, future studies must corroborate its sensitivity to the effects of antidepressant treatment and potential differences between the antidepressant agents employed.