Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.

Spanish translation and analysis of the metric properties of inpatient satisfaction scale in psychiatry: The Satispsy-22-E.

The Satispsy-22 scale is an instrument created for the specific evaluation of psychiatric inpatient satisfaction. Therefore, the study aims to carry out the Satispsy-22 scientific translation to Spanish and to learn its psychometric properties. The Satipsy-22-E was administered to discharged patients from four units of acute psychiatric admission, a unit of dual pathology and two units of subacute psychiatric admission (N = 268). Cronbach's alpha was 0.886, which can be interpreted as good internal reliability. All the dimensions showed a good internal consistency with scores from 0.722 to 0.919. Test-retest offered scores of 0.752-0.951 showing good stability. Confirmatory factor analysis showed that all elements load in the estimated dimensions of the original scale and these were significant and the adjustment measures showed, in general, a rather good adjustment, Root Mean Square Error (RMSE) showed that the error between observations and actual data is small and acceptable. Satispsy-22-E is a specific scale in Spanish language for the assessment of psychiatric inpatient satisfaction. It is an easy to use tool that offers good psychometric properties. The availability of a validated survey in Spanish may help to improve the care provided by psychiatric wards in Spanish-speaking countries.

Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies.

BACKGROUND: Joint hypermobility syndrome (JHS) has repeatedly been associated with anxiety and anxiety disorders, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder. However, the neural underpinnings of these associations still remain unclear. This study explored brain responses to facial visual stimuli with emotional cues using fMRI techniques in general population with different ranges of hypermobility. METHODS: Fifty-one non-clinical volunteers (33 women) completed state and trait anxiety questionnaire measures, were assessed with a clinical examination for hypermobility (Beighton system) and performed an emotional face processing paradigm during functional neuroimaging. RESULTS: Trait anxiety scores did significantly correlate with both state anxiety and hypermobility scores. BOLD signals of the hippocampus did positively correlate with hypermobility scores for the crying faces versus neutral faces contrast in ROI analyses. No results were found for any of the other studied ROIs. Additionally, hypermobility scores were also associated with other key affective processing areas (i.e. the middle and anterior cingulate gyrus, fusiform gyrus, parahippocampal region, orbitofrontal cortex and cerebellum) in the whole brain analysis. CONCLUSIONS: Hypermobility scores are associated with trait anxiety and higher brain responses to emotional faces in emotion processing brain areas (including hippocampus) described to be linked to anxiety and somatic symptoms. These findings increase our understanding of emotion processing in people bearing this heritable variant of collagen and the mechanisms through which vulnerability to anxiety and somatic symptoms arises in this population.

Increased tobacco and alcohol use among women with joint hypermobility: a way to cope with anxiety?

Joint hypermobility (JH) is a common trait of heritable disorders of the connective tissue which has been identified as a risk factor for anxiety states. Anxiety and other negative emotions lead some people to use tobacco and alcohol as a coping strategy. The purpose of this study was to examine JH in relation to the consumption of these psychoactive substances and the associated anxiety and coping strategies. A cross-sectional sample of 305 female college students completed self-administered questionnaires on JH, tobacco and alcohol use, state and trait anxiety, and coping strategies. The prevalence of JH in the final sample (N = 301) was 51.8 %. The percentage of smokers, smokers using tobacco to calm anxiety, at-risk drinkers, tobacco and alcohol users, and the number of standard drinks consumed per week were significantly higher among females with JH than among those without it. The percentage of participants with severe state anxiety was significantly higher in the JH group, as were the emotion-focused coping score. The results of the logistic regression analysis showed that the odds of being assessed with JH were greater in those who consume tobacco and alcohol. This study provides evidence that women with JH report higher levels of state anxiety than non-JH women and use emotion-focused coping (i.e., efforts to regulate affect) more than any other coping strategies to deal with stress. These factors may help explain the increase in tobacco and alcohol use observed in this population.

Striatal volume deficits in children with ADHD who present a poor response to methylphenidate.

Methylphenidate (MPH) is the first choice of medical treatment for attention-deficit/hyperactivity disorder (ADHD). Its mechanism of action is to inhibit the reuptake of dopamine and noradrenaline mainly in the region of the striatum. It has been estimated that 10-30 % of patients with ADHD do not respond adequately to MPH. The aim of this study was to evaluate whether striatal differences exist between good and poor responders to MPH. The sample included 27 treatment-naïve children with ADHD between the ages of 6 and 14. MPH administration started 1 day after the MRI acquisition. After a month, psychiatrists established the good or poor response to treatment according to clinical criteria. MRI images were analyzed using a technique based on regions of interest applied specifically to the caudate and accumbens nuclei. Sixteen patients showed good response to MPH and 11 a poor one. Regions of interest analysis showed that good responders had a higher concentration of gray matter in the head of both caudate nuclei and the right nucleus accumbens. Furthermore, a significant correlation was found between caudate and accumbens nuclei volume and the Conners' Parent Rating Scale and Continuous Performance Test improvement. These results support the hypothesis of the involvement of the caudate and accumbens nuclei in MPH response and in ADHD pathophysiology.

Brain regions related to fear extinction in obsessive-compulsive disorder and its relation to exposure therapy outcome: a morphometric study.

BACKGROUND: The size of particular sub-regions within the ventromedial prefrontal cortex (vmPFC) has been associated with fear extinction in humans. Exposure therapy is a form of extinction learning widely used in the treatment of obsessive-compulsive disorder (OCD). Here we investigated the relationship between morphometric measurements of different sub-regions of the vmPFC and exposure therapy outcome in OCD. METHOD: A total of 74 OCD patients and 86 healthy controls underwent magnetic resonance imaging (MRI). Cortical thickness and volumetric measurements were obtained for the rostral anterior cingulate cortex (rACC), the medial orbital frontal cortex and the subcallosal cortex. After MRI acquisition, patients were enrolled in an exposure therapy protocol, and we assessed the relationship between MRI-derived measurements and treatment outcome. Baseline between-group differences for such measurements were also assessed. RESULTS: Compared with healthy controls, OCD patients showed a thinner left rACC (p = 0.008). Also, left rACC thickness was inversely associated with exposure therapy outcome (r - 0.32, p = 0.008), and this region was significantly thinner in OCD patients who responded to exposure therapy than in those who did not (p = 0.006). Analyses based on regional volumetry did not yield any significant results. CONCLUSIONS: OCD patients showed cortical thickness reductions in the left rACC, and these alterations were related to exposure therapy outcome. The precise characterization of neuroimaging predictors of treatment response derived from the study of the brain areas involved in fear extinction may optimize exposure therapy planning in OCD and other anxiety disorders.

Concurrent Koro and Cotard syndromes in a Spanish male patient with a psychotic depression and cerebrovascular disease.

Koro and Cotard syndromes are uncommon conditions described in a variety of psychiatric and medical disorders. The authors report the third case of a simultaneous presentation of both syndromes, in a 62-year-old inpatient Spanish male with major depressive disorder with psychotic features, parkinsonism and cognitive impairment. A discussion of the literature and the possible relationship between both syndromes and other neuropsychiatric disorders are presented.

Guías y algoritmos clínicos de tratamiento de la depresión en atención primaria: ¿son todos iguales? / Evaluation of clinical guidelines and algorithms for treatment of depression in primary care: are they all the same?

Objetivo. La consulta por depresión ocupa el 40% de las consultas al médico de asistencia primaria. Se buscan maneras de reorganizar el proceso de atención a la depresión integrando herramientas como el uso de guías y algoritmos clínicos. Objetivo. Ante la diversidad de opciones es importante conocer una o dos herramientas para aplicarlas adecuadamente. El objetivo es analizar y comparar las guías de tratamiento de la depresión con mayor difusión que incluyan la consulta de atención primaria. Material y métodos. Se realiza una revisión de la bibliografía encontrada en PubMed y en publicaciones de Sociedades Científicas. Las guías se comparan aplicando el instrumento «Appraisal of Guidelines Research and Evaluation Colaboration» (AGREE). Resultados. Los algoritmos de tratamiento tienen unas características comunes respecto el contenido, la secuenciación del tratamiento y la elección del antidepresivo. Se prefiere elegir la opción más sencilla, más eficaz y con menor riesgo. Existen diferencias en cuanto al rigor, participación de los implicados y aplicabilidad. Conclusiones. Las guías presentan más similitudes que diferencias. Las diferencias se hallan en las dimensiones rigor y participación. Ante el creciente número de guías y algoritmos se recomienda elegir uno y adaptarlo al territorio donde se interviene (AU)

Objective. Depression accounts for 40% of family doctor consultations. Ways of reorganising the process of care for depression are being looked for by integrating tools such as the use of clinical guidelines and algorithms. It is important to know of one or two tools and to implement them properly. The aim is to analyse and compare the guidelines for the treatment of depression in Primary Care cjinics. Material and methods. We reviewed of the literature found on PubMed and in publications of scientific societies. The guidelines are compared using the Appraisal of Guidelines Research and Evaluation Colaboration. Results. The processing algorithms have some common features regarding the content, sequencing of treatment and choice of antidepressant. The preferred choice should be easier, more efficient and less risk. There are differences in the rigor of the implications and applications. Conclusions. The guidelines have more similarities than differences. The differences are in size and participation rigor. With the increasing number of guidelines and algorithms it is recommended to choose one and adapt it to the area where it will be used (AU)

Gray matter volume deficits and correlation with insight and negative symptoms in first-psychotic-episode subjects.

OBJECTIVE: To determine brain areas reduced in first episode of psychotic subjects and its association with lack of insight and negative symptoms. METHOD: Twenty-one drug naive first-episode subjects and 20 controls underwent a structural MRI scan and were clinically assessed. Optimized voxel-based-morphometry analysis (VBM) was implemented to find between-group differences and correlations between GM volume and: (i) lack of insight and (ii) negative symptoms. RESULTS: Patients showed GM reduction in prefrontal and left temporal areas. A significant correlation was found between insight and GM volume in the cerebellum (corrected P = 0.01), inferior temporal gyrus (corrected P = 0.022), medial superior frontal gyrus (corrected P < 0.001), and inferior frontal gyrus (corrected P = 0.012), as the insight decreased, the volume decreased. Negative symptoms correlated with decreased GM volume at cerebellum (corrected P = 0.037) and frontal inferior regions (corrected P < 0.001), the more negative symptoms, the less volume. CONCLUSION: Our findings support an association between prefrontal, temporal, and cerebellar deficits and lack of insight in schizophrenia and confirm previous findings of GM deficits in patients since the first episode of psychosis.

Prevalence and correlates of respiratory and non-respiratory panic attacks in the general population.

BACKGROUND: Panic attacks are heterogeneous with regards to symptom profile. Subtypes of panic attacks have been proposed, of which the most investigated is respiratory panic attacks (RPA). Limited information exists about RPA in the general population. METHOD: The prevalence and correlates of RPA and non-respiratory panic attacks (NRPA) were examined in a subsample (n=8.796) of individuals participating in a cross-sectional survey of the adult general population of six European countries. Panic attacks, mental disorders, and chronic physical conditions were assessed with the Composite International Diagnostic Interview (CIDI) 3.0. Data on use of health services and disability were obtained. RESULTS: The lifetime prevalence of RPA was 6.77 and the 12-month prevalence was 2.26. No robust associations of RPA with sociodemographic characteristics, mental disorders or physical conditions were found as compared to NRPA. RPA were associated with increased use of health services but similar disability in comparison to NRPA. LIMITATIONS: Few direct data are available on the validity of the CIDI to assess RPA. Other definitions of RPA exist in the literature. CONCLUSIONS: Our findings suggest that there are very few differences between RPA and NRPA and do not support the need of subtyping panic attacks in current classification systems.

Impact of psychiatric and neuropsychological sequelae of traumatic brain injury on the duration of legal time periods.

INTRODUCTION: In the forensic setting, diagnosis of sequels and determination of the legal periods are central to the assessment of traumatic brain injury (TBI). The analysis of the relationship between descriptors of TBI and legal periods is undertaken. METHOD: Retrospective study of 50 TBI. Demographic information, severity and characteristics of the TBI, neuroimaging data, treatments, legal periods and sequels were gathered. Descriptive statistics and correlational analysis were performed. RESULTS: Glasgow Comma Scale was available in 47 cases but coma duration and posttraumatic amnesia only in 21. There was information on early TAC in 48 cases and followup neuroimaging (after three months) was available in 46. 26 patients received the diagnosis organic personality disorder and this correlated with longer legal periods. Affective disorder (N=6), anxiety disorder (N=5) and postconcussional syndrome (N=5) were less prevalent. Average "time in hospital" was longer than two months. "Healing time" and "disability time" were on average longer than a year. "Healing time" and "time in hospital" were longer with left sided lesions. CONCLUSION: In the forensic assessment of TBI, availability of information regarding the duration of coma and posttraumatic amnesia should be improved. Left sided lesions and the presence of organic personality disorder predict longer legal periods. Understanding of these facts requires a more detailed analysis.

Impacto de las secuelas psiquiátricas y neuropsicológicas de los traumatismos craneoencefálicos sobre la duración de los tiempos legales / Impact of psychiatric and neuropsychological consequences of traumatic brain injury on the duration of the legal periods

Introducción. En la peritación de los traumatismos cráneoencefálicos (TCE), la determinación de las secuelas y de los tiempos legales (tiempo de hospitalización, de impedimento y de curación) son clave. Se analiza la relación de éstos con descriptores generales de los TCE y con las secuelas psíquicas. Metodología. Estudio retrospectivo de 50 TCE. Se recogió información sociodemográfica, antecedentes, severidad y caracterización del traumatismo, neuroimagen, tratamientos,t iempos legales y secuelas. Las características de los 50 casos se describen utilizando estadística descriptiva, índices de correlación o chi cuadrado. Resultados. En 47 casos consta la escala de coma de Glasgow; sólo en 21 se dispone de la duración del coma o de la amnesia postraumática. En 48 casos consta la tomografía axial computarizada (TAC) temprana y en 46 hay neuroimagen después de los 3 meses. Se diagnosticó un trastorno orgánico de la personalidad en 26 casos y su presencia se correlaciona con tiempos de curación y de impedimento más dilatados. Los trastornos del ánimo (n = 6), los trastornos de ansiedad (n = 5) y los trastornos postconmocionales (n = 5)fueron menos frecuentes. La media del tiempo de hospitalización supera los dos meses. Tanto las medias del tiempo de impedimento como las de curación superan el año. Los tiempos de curación y de hospitalización son superiores si la lesión es izquierda. Conclusiones. Aspectos a mejorar en la peritación de los TCE son la disponibilidad de información relativa a la duración de la amnesia postraumática y la duración del coma. La lesión cerebral izquierda y la presencia de trastorno orgánico de la personalidad predicen tiempos legales más dilatados. Su comprensión merece un estudio pormenorizado (AU)

Introduction. In the forensic setting, diagnosis of sequels and determination of the legal periods are central to the assessment of traumatic brain injury (TBI). The analysis of the relationship between descriptors of TBI and legal periods is undertaken. Method. Retrospective study of 50 TBI. Demographic information, severity and characteristics of the TBI, neuroimaging data, treatments, legal periods and sequels were gathered. Descriptive statistics and correlational analysis were performed. Results. Glasgow Comma Scale was available in 47cases but coma duration and posttraumatic amnesia only in 21. There was information on early TAC in 48 cases and follow-up neuroimaging (after three months) was available in 46. 26 patients received the diagnosis organic personality disorder and this correlated with longer legal periods. Affective disorder (N=6), anxiety disorder (N=5) and postconcussional syndrome (N=5) were less prevalent. Average “time in hospital” was longer than two months.“Healing time” and “disability time” were on average longer than a year. “Healing time” and “time in hospital” were longer with left sided lesions. Conclusion. In the forensic assessment of TBI, availability of information regarding the duration of coma and posttraumatic amnesia shoud be improved. Left sided lesions and the presence of organic personality disorder predict longer legal periods. Understanding of these facts requires a more detailed analysis (AU)

[Somatotype and schizophrenia. A case-control study]. / Somatotipo y esquizofrenia. Un estudio caso-control.

AIMS: To compare somatotypes of schizophrenic patients and healthy controls and to examine some associations between somatic (joint mobility, somatotype) and psychopathological (anxiety, clinical seriousness and schizophrenic types) features. METHODS: Thirty four in-patients with DSM-IV diagnosis of schizophrenia assessed by SCID-I, aged 18 to 50 years, were recruited as cases. Thirty two subjects of a general non-clinical population were recruited as controls. Heath-Carter method and 5 questions to detect joint hypermobility were used to assess both somatotype and joint hypermobility. Trait anxiety (STAI) and BPRS were assessed at medical discharge. RESULTS: There were no statistically significant differences between mean somatotype groups (cases: 4(1/2) 5(1/2) 1(1/2); controls: 5 - 5 - 1(1/2)). Schizophrenic patients showed significantly more divergence among themselves in relationship to their own common mean [t = 1.98; gl = 64; p = 0.05] and accounted for more ectomorphic categories than the control group. Somatotype means of paranoid and disorganized types were significantly more homogeneous (with greater values of ectomorphism) than undifferentiated type [X2 = 6.61; gl = 2; p = 0.037]. There was a tendency towards positive association between anxiety - joint hypermobility and anxiety- ectomorphism, but it did not reach a statistically significant level. CONCLUSIONS: In spite of their limitations, the results provide suggestive data for identification of subtypes in mental illnesses that can be used as a nosologic knowledge or as potential risk markers.

Somatipo y esquizofrenia. Un estudio caso-control / Somatotype and schizophrenia. A case-control study

Objetivos. Comparar los somatotipos de pacientes esquizofrénicos y controles sanos y examinar algunas asociaciones entre condiciones somáticas (laxitud articular, somatotipo) y psicopatológicas (ansiedad, gravedad clínica y tipos de esquizofrenia). Método. La muestra (n = 66) se compone de pacientes entre 18 y 50 años ingresados con el diagnóstico DSM-IV de esquizofrenia (n = 34) valorados mediante la SCID-I. Se añade otro grupo de población general no clínica (n = 32). Para el somatotipo se utiliza el método Heath-Carter y para la laxitud, las cinco preguntas para detectar hiperlaxitud articular. Se miden al alta las escalas STAI rasgo y BPRS. Resultados. No se han hallado diferencias significativas entre las medias de los somatotipos de ambos grupos (casos:4 1/2 – 5 1/2 – 1 1/2 controles: 5 – 5 – 1 1/2). Los pacientes esquizofrénicos resultan significativamente más divergentes entre ellos respecto a su propia media común [t = 1,98; gl = 64; p =0,05] y llegan a representar más categorías ectomórficas que el grupo control. Los tipos paranoide y desorganizado presentan significativamente unas medias del somatotipo más homogéneas (con valores más elevados de ectomorfismo) que el tipo indiferenciado [x2= 6,61; gl = 2; p = 0,037]. Existe una tendencia a favor de la asociación entre laxitud articular y ansiedad,y entre ectomorfismo y ansiedad, aunque sin llegar a la significación estadística. Conclusiones. A pesar de sus limitaciones, estos resultados aportan datos sugerentes para la identificación de subgrupos de enfermedades psiquiátricas útiles para un avance nosológico o incluso como potenciales indicadores de riesgo (AU)

Aims. To compare somatotypes of schizophrenic patients and healthy controls and to examine some associations between somatic (joint mobility, somatotype) and psychopathological (anxiety, clinical seriousness and schizophrenic types) features. Methods. Thirty four in-patients with DSM-IV diagnosis of schizophrenia assessed by SCID-I, aged 18 to 50 years, were recruited as cases. Thirty two subjects of a general non-clinical population were recruited as controls. Heath-Carter method and 5 questions to detect joint hypermobility were used to assess both somatotype and joint hypermobility. Trait anxiety (STAI) and BPRS were assessed at medical discharge. Results. There were no statistically significant differences between mean somatotype groups (cases: 4 1/2 –5 1/2 – 1 1/2 controls: 5 – 5 – 1 1/2). Schizophrenic patients showed significantly more divergence among themselves in relationship to their own common mean [t =1.98; gl = 64; p = 0.05] and accounted for more ectomorphic categories than the control group. Somatotype means of paranoid and disorganized types were significantly more homogeneous (with greater values of ectomorphism) than undifferentiated type [x2 = 6.61; gl = 2; p = 0.037]. There was a tendency towards positive association between anxiety - joint hypermobility and anxiety-ectomorphism, but it did not reach a statistically significant level. Conclusions. In spite of their limitations, the results provide suggestive data for identification of subtypes in mental illnesses that can be used as a nosologic knowledge or as potential risk markers (AU)

[Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments]. / Impacto de la ola de calor del verano 2003 en la actividad de dos servicios de urgencias psiquiátricas.

INTRODUCTION: Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. METHODS: We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. RESULTS: No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item "dangerousness toward others" (part of the SPI scale) scored significantly higher during the heat waves. CONCLUSIONS: There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon.

Impacto de la ola de calor del verano 2003 en la actividad de dos servicios de urgencias psiquiátricas / Impact of the summer 2003 heat wave on the activity of two psychiatric emergency departments

Introducción. La ola de calor se ha relacionado con efectos letales, especialmente en Europa durante el caluroso verano de 2003. Pero aparte del incremento de muertes y enfermedades, no existen datos específicos de los efectos psiquiátricos de la ola de calor. Metodología. Se compararon las urgencias psiquiátricas de dos hospitales de Barcelona durante los 15 días de la ola de calor con el resto del verano de 2003. Las principales variables del estudio fueron: urgencias totales, ingresos, diagnósticos, gravedad, variables psicosociales, tratamientos aplicados (incluyendo contención mecánica), y derivaciones. Resultados. No se encontraron diferencias en el número de urgencias ni de ingresos. Durante la ola de calor, hubo más pacientes con antecedentes psiquiátricos, más diagnóstico de abuso de alcohol y drogas, pero menos trastornos de ansiedad. También aumentó la proporción de pacientes con sujeción mecánica, pero sólo en la mitad de casos, esto ocurrió en pacientes con abuso de alcohol o drogas. El ítem «peligro hacia los demás» de la escala de gravedad se puntuó significativamente más alto en la ola de calor. Conclusiones. No hubo incrementos o disminuciones significativos en urgencias o los ingresos psiquiátricos, aunque los que acudieron tenían más antecedentes psiquiátricos. Durante la ola de calor hubo un cierto incremento significativo de violencia y de abuso de alcohol y drogas, pero menor porcentaje de trastornos de ansiedad y menos prescripciones de benzodiazepinas durante este período. Estos datos exploratorios indican el interés de considerar medidas preventivas médico psiquiátricas frente al fenómeno de la ola de calor (AU)

Introduction. Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. Methods. We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. Results. No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item «dangerousness toward others» (part of the SPI scale) scored significantly higher during the heat waves. Conclusions. There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon (AU)

Immigrants and borderline personality disorder at a psychiatric emergency service.

BACKGROUND: Several studies have suggested that immigrants have higher rates of psychiatric emergency service use and a higher risk of mental disorders such as schizophrenia than indigenous populations. AIMS: To compare the likelihood that immigrants (immigrant group) v. indigenous population (indigenous group) will be diagnosed with borderline personality disorder in a psychiatric emergency service and to determine differences according to area of origin. METHOD: A total of 11 578 consecutive admissions over a 4-year period at a tertiary psychiatric emergency service were reviewed. The collected data included socio-demographic and clinical variables and the Severity of Psychiatric Illness rating score. Psychiatric diagnosis was limited to information available in the emergency room given that a structured interview is not usually feasible in this setting. The diagnosis of borderline personality disorder was based on DSM-IV criteria. Immigrants were divided into five groups according to region of origin: North Africa, sub-Saharan Africa, South America, Asia and Western countries. RESULTS: Multivariate statistical logistic regression analysis showed that all subgroups of immigrants had a lower likelihood of being diagnosed with borderline personality disorder than the indigenous population independently of age and gender. Furthermore, the rates of borderline personality disorder diagnosis were considerably lower in Asian and sub-Saharan subgroups than in South American, North African, Western or native subgroups. CONCLUSIONS: Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.

Onset of mania after CPAP in a man with obstructive sleep apnea.

BACKGROUND: This short report presents the case of a man with chronic anergy and mild depressive symptoms probably due to obstructive sleep apnea (OAS). METHOD: The patient was treated with continuous positive airway pressure (CPAP). RESULT: He developed a first manic episode at an atypical age simultaneously with the beginning of treatment. DISCUSSION: Several possible connections between affective syndromes, OAS, and CPAP treatment are proposed and discussed relating to current literature.

Clinical characteristics and psychopathological profile of patients with vulvodynia: an observational and descriptive study.

BACKGROUND: Vulvodynia is a fairly common dermatological symptom that often interferes with the personal, social and working activities of affected women and results in a significant loss of their quality of life. It is a persistent and tedious clinical disorder which is often resistant to conventional treatments. OBJECTIVES: The aim of this study is to evaluate the main clinical signs, associated psychopathological disorders and outcome after antidepressant treatment of patients with vulvodynia. METHODS: Eighty patients were included. Clinical characteristics and psychopathological profiles were determined by appropriate instruments. The improvement of clinical symptoms after combined antidepressant drug therapy was also evaluated. RESULTS: Pain (70%), burning (63.7%), dyspareunia (57.5%) and stinging (56.2%) were the most commonly reported symptoms. Most patients (56.5%) showed anxiety, and 52.2% of them were reported as having a depression disorder. When evaluated by psychometric tools, 81.4% of patients scored >150 on the Life Event Scale, which means a risk >50% of suffering an illness in the near future, and patients' scores in the Dermatology Life Quality Index showed higher values than the mean of the Spanish validation group. After 6 months of combined treatment with escitalopram (10-20 mg/day), perfenazine (2-4 mg/day) and amytriptiline (10 mg/day), a complete remission of the clinical symptoms was achieved in 41% of patients. In contrast, only 12% of patients who did not follow drug treatment reported a complete resolution of the clinical symptoms. CONCLUSIONS: Our results seem to confirm that vulvodynia is associated with psychiatric co-morbidity such as stress and depression. The study highlights that the psychiatric treatment may be a useful option to improve clinical symptoms. Whether these patients should be evaluated for depression or be referred to a psychiatrist, remains to be investigated.

Clinical and prognostic implications of seasonal pattern in bipolar disorder: a 10-year follow-up of 302 patients.

BACKGROUND: More than 20% of bipolar patients may present with seasonal pattern (SP). Seasonality can alter the course of bipolar disorder. However, to date, long-term follow-up studies of bipolar patients presenting with SP are scarce. We present a 10-year follow-up study comparing clinical and demographic features of bipolar patients with and without SP. METHOD: Three hundred and twenty-five bipolar I and II patients were followed up for at least 10 years. SP was defined according to DSM-IV criteria. Clinical variables were obtained from structured interviews with the patients and their relatives. Patients with and without SP were compared regarding clinical and sociodemographic variables and a stepwise logistic regression was performed. RESULTS: Seventy-seven patients (25.5%) were classified as presenting with SP, while 225 (74.5%) were considered as presenting with no significant seasonal variation. Twenty-three patients (7%) were excluded from the study because it was unclear whether they had seasonality or not. There were no differences between groups regarding demographic variables. Patients with SP predominantly presented with bipolar II disorder, depressive onset, and depressive predominant polarity. The greater burden of depression did not correlate with indirect indicators of severity, such as suicidality, hospitalizations or psychotic symptoms. CONCLUSIONS: Our study links the presence of SP with both bipolar II disorder and predominant depressive component. However, we could not find any difference regarding functionality or hospitalization rates. Modifications in the criteria to define SP are suggested for a better understanding of bipolar disorder.