El perfil de disregulación del SDQ y su relación con conductas y pensamientos de suicidio en adolescentes evaluados en contexto clínico / The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting

Introducción: La ideación suicida, la conducta suicida y las conductas autolesivas sin intención suicida (autolesiones) son un grave problema de salud pública en la adolescencia. Una proporción significativa de de adolescentes evaluados en contexto clínico muestran un perfil de disregulación (DP). El DP se caracteriza por inquietud, irritabilidad, «tormentas afectivas», inestabilidad emocional y agresiones que aparecen de forma desproporcionada ante determinadas situaciones, y parece estar relacionado con un mayor riesgo de pensamientos y conductas suicidas y autolesivas. Métodos: Doscientos treinta y nueve adolescentes del Centro de Salud Mental Infantojuvenil del Servicio de Psiquiatría de la Fundación Jiménez Díaz fueron evaluados con la Escala de Fortalezas y Dificultades para obtener el DP y con la entrevista estructurada sobre suicidio y autolesiones; se recogió también información sociodemográfica. Resultados: Estudios de regresión logística mostraron que los adolescentes con elevación del DP tenían más riesgo de presentar planes de suicidio, gestos suicidas e intentos suicidas. Igualmente, mostraron más riesgo de autolesiones. Conclusiones: Los resultados apuntan a dificultades de autorregulación tras la presencia de planes de suicidio, gestos suicidas, intentos de suicidio y autolesiones. De cara al futuro, estudios longitudinales permitirían esclarecer la dirección de dicha relación

Introduction: Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, "affective storms", mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. Methods: Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. Results: Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. Conclusions: Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors

The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting. / El perfil de disregulación del SDQ y su relación con conductas y pensamientos de suicidio en adolescentes evaluados en contexto clínico.

INTRODUCTION: Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, "affective storms", mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. METHODS: Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. RESULTS: Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. CONCLUSIONS: Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors.

Ecological Assessment of Clinicians' Antipsychotic Prescription Habits in Psychiatric Inpatients: A Novel Web- and Mobile Phone-Based Prototype for a Dynamic Clinical Decision Support System.

BACKGROUND: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management. OBJECTIVE: The aim of our study was to develop a novel Web- and mobile phone-based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes. METHODS: We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio. RESULTS: MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines. CONCLUSIONS: MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.

Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications.

PURPOSE: The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS. METHOD: A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio. RESULTS: The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine. CONCLUSIONS: In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system.

A survey of nonmedical use of tranquilizers, stimulants, and pain relievers among college students: patterns of use among users and factors related to abstinence in non-users.

BACKGROUND: This study examined lifetime non-medical prescription drug use among college students at a small liberal arts college in the Northeast. We assessed the motives, frequency of use, sources, and perceived emotional/physical risks of nonmedical prescription drugs. Specifically, we examined the non-medical use of prescription pain relievers, stimulants, and anti-anxiety medication. METHODS: We sent an internet-based survey to 1/3 of the student body and 303 students completed the survey. RESULTS: We found that 36.8% of the sample reported using prescription drugs for non-medical purposes. First-year students were less likely to have used the drugs than those in other class years. Of those reporting use, 48% reported non-medical use of pain relievers, 72.8% reported using stimulants, and 39.8% reported using anti-anxiety medication. The most commonly used pain relievers were Vicodin (hydrocodone/acetaminophen), OxyContin (oxycodone), and codeine (acetaminophen/codeine). The most commonly used stimulants were Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate), while the most commonly used anti-anxiety medication was Xanax (alprazolam). When non-users were asked what factors influenced their choice not to abuse prescription drugs, 82% cited a lack of interest, 61% responded it was due to a fear of damaging their physical health, and 60.1% responded fear of damaging their mental health. CONCLUSION: This study supports recent findings that show widespread non-medical use of prescription drugs among college students. Our report brings a more detailed understanding of the patterns of drug usage, and the factors influencing both drug use in those who use them and abstinence in those who choose not to use them.