[Morphine maintenance treatment in opiate dependent patients]. / Tratamiento con morfina en la dependencia de opiáceos.

Morphine is an opiate drug widely used as an analgesic in multiple medical diseases. Currently, its management in the maintenance treatment of opiate dependent patients is being studied. The most significant studies are described. In these, its usefulness has been assessed in comparison with other treatments, such as methadone, buprenorphine. Morphine has shown efficacy and tolerability. Its management is easy both in patients who consume heroin as well as those who have received other opiate drugs. Thus, it is a drug that may extend the therapeutic armamentarium in patients who begin with treatment with other opiates for the first time or who have previously received them. However, new studies must be conducted to adequately characterize its clinical use.

Tratamiento con morfina en la dependencia de opiáceos / Morphine maintenance treatment in opiate dependent patients

La morfina es un fármaco opiáceo ampliamente utilizado como analgésico en múltiples patologías médicas. En la actualidad se está estudiando su manejo en el tratamiento de mantenimiento en pacientes dependientes de opiáceos. Se describen los estudios más significativos en los que se ha valorado su utilidad en comparación con otros tratamientos, como la metadona o la buprenorfina. La morfina ha demostrado eficacia y tolerabilidad, su manejo es sencillo tanto en pacientes que consumen heroína como en los que han recibido otros fármacos opiáceos, por lo que es un medicamento que puede ampliar el arsenal terapéutico en pacientes que se incorporen por primera vez o que hayan recibido previamente tratamiento con otros opiáceos. Sin embargo es necesario realizar nuevos estudios para caracterizar adecuadamente su uso clínico (AU)

Morphine is an opiate drug widely used as an analgesic in multiple medical diseases. Currently, its management in the maintenance treatment of opiate dependent patients is being studied. The most significant studies are described. In these, its usefulness has been assessed in comparison with other treatments, such as methadone, buprenorphine. Morphine has shown efficacy and tolerability. Its management is easy both in patients who consume heroin as well as those who have received other opiate drugs. Thus, it is a drug that may extend the therapeutic armamentarium in patients who begin with treatment with other opiates for the first time or who have previously received them. However, new studies must be conducted to adequately characterize its clinical use (AU)

[Attention deficit hyperactivity disorder in adults: a clinical and therapeutic characterization]. / Trastorno por deficit de atencion con hiperactividad en adultos: caracterizacion clinica y terapeutica.

AIM: To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, with special interest given to aspects concerning epidemiology, diagnosis, progression and treatment. DEVELOPMENT: Acknowledging the fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few years evidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adult population is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. The symptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with the same symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familial repercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction, personality disorders and depression). CONCLUSIONS: A number of different psychometric instruments are available in Spanish for evaluating ADHD in adults. The use of structured interviews, together with a systemized evaluation of possible comorbid disorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially the same as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and results show methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has been most widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD.

Trastorno por déficit de atención con hiperactividad en adultos: caracterización clínica y terapéutica / Attention deficit hyperactivity disorder in adults: a clinical and therapeutic characterisation

Objetivo. Actualizar los conocimientos existentes sobreel trastorno por déficit de atención con hiperactividad (TDAH) enadultos, centrándose en aspectos relativos a la epidemiología, diagnóstico,evolución y tratamiento. Desarrollo. El reconocimiento dela persistencia del TDAH en la edad adulta es relativamente reciente.A pesar de ello, durante los últimos años se han aportadoevidencias que sustentan la validez del diagnóstico en adultos. Laprevalencia del TDAH en la población general adulta se estima entorno al 4%. Más del 50% de niños afectados continuarán presentandoel trastorno en la edad adulta. Los síntomas del TDAH puedenmanifestarse de diferente forma en los adultos, mostrandomenor hiperactividad y una leve disminución de la impulsividadpero manteniéndose los síntomas de inatención. El TDAH en laedad adulta se asocia a graves repercusiones económicas, laborales,académicas, familiares, así como a accidentes de tráfico y a lapresencia de otras patologías psiquiátricas (como drogodependencias,trastornos de personalidad y depresión). Conclusiones. Se disponede diferentes instrumentos psicométricos en español paraevaluar el TDAH en adultos. El empleo de entrevistas estructuradas,así como una evaluación sistematizada de los posibles trastornoscomórbidos, facilitarán el correcto diagnóstico diferencial. Eltratamiento farmacológico en adultos es esencialmente el mismoque en niños, pero adaptado al peso. Existen ensayos clínicos conpsicoestimulantes, destacando el metilfenidato por su eficacia y seguridad.Dentro del grupo de fármacos no estimulantes, la atomoxetinaes el mejor estudiado en adultos. Los tratamientos psicológicoscognitivoconductuales se han mostrado eficaces en adultoscon TDAH

Aim. To update the existing knowledge about attention deficit hyperactivity disorder (ADHD) in adults, withspecial interest given to aspects concerning epidemiology, diagnosis, progression and treatment. Development. Acknowledgingthe fact that ADHD can persist into adulthood is a relatively recent development. Nevertheless, over the last few yearsevidence has been put forward to support the validity of its diagnosis in adults. The prevalence of ADHD in the general adultpopulation is estimated to be around 4%. Over 50% of the children with the disorder will continue to have it as adults. Thesymptoms of ADHD can be different in adults, with less hyperactivity and a slight decrease in impulsiveness, but with thesame symptoms of inattention. ADHD in adulthood is linked to serious economic, occupational, academic and familialrepercussions, as well as to road accidents and to the presence of other psychiatric pathologies (such as drug addiction,personality disorders and depression). Conclusions. A number of different psychometric instruments are available in Spanishfor evaluating ADHD in adults. The use of structured interviews, together with a systemised evaluation of possible comorbiddisorders, makes it easier to reach a correct differential diagnostic. Pharmacological treatment in adults is essentially thesame as that used with children, but weight-adjusted. Clinical trials have been carried out with psychostimulants and resultsshow methylphenidate to be the most effective and the safest. Atomoxetine is the non-stimulating pharmaceutical that has beenmost widely studied in adults. Cognitive behavioural psychological treatments have proved to be effective in adults with ADHD

[Large-scale genotyping in research into autism spectrum disorders and attention deficit hyperactivity disorder]. / Genotipado a gran escala en la investigación del trastorno del espectro autista y el trastorno por deficit de atención con hiperactividad.

INTRODUCTION AND DEVELOPMENT: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative genomic methylation and hybridisation in order to identify chromosomal rearrangements in patients with autism and severe mental retardation. CONCLUSIONS: Genotyping large SNP-type collections that are potentially functional in genes that are candidates for these disorders, based on pharmacological, biochemical and neuropathological data together with that coming from animal models and linkage studies in a wide collection of samples from patients and controls, will enable us to identify the genetic components of these pathologies and to define their biological foundations.

Programas experimentales de mantenimiento con heroína: la amplitud de la distancia entre lo que podría llevarse a cabo y lo que realmente se hace / Experimental heroin maintenance programmes: the distance between what might be done and what is really done

No disponible

[Treatment of schizophrenia in subjects with substance use disorders: A review]. / Revisión del tratamiento de la esquizofrenia en individuos con abuso de drogas.

BACKGROUND: Schizophrenic patients have a high comorbidity with substance use disorders. However, there are few studies on the efficacy of antipsychotics on psychopathology and on their repercutions on substance abuse. METHODS: All studies about pharmacological treatment of schizophrenic patients with substance abuse, included in Medline over the last ten years were analyzed. RESULTS: Of the 17 studies reviewed, most were prospective with small samples (< 30 patients, 5 studies) or case reports (7 studies). Objectives were to assess the efficacy on schizophrenic symptoms and the effect of the treatment on substance use. Atypical antipsychotics were the most studied. These pharmacological agents were effective at reducing symptoms and had few side effects. They also managed lo reduce substance abuse in 66-75% of patients. CONCLUSIONS: In spite of underlyng methodological problems of these studies, the findings suggest that atypical antipsychatics could be the treatment of choice in these patients.

Revisión del tratamiento de la esquizofrenia en individuos con abuso de drogas / Treatment of schizophrenia in subjects with substance use disorders: a review

Introducción: Los pacientes diagnosticados de esquizofrenia tienen una elevada comorbilidad para los trastornos por uso de sustancias. Por el contra rio, no son frecuentes los estudios sobre la eficacia de los antipsicóticos en la psicopatología de estos pacientes y en las repercusiones sobre el consumo de drogas.Metodología: Se analizan los estudios publicados en los últimos diez años incluidos en Medline, sobre el tratamiento fa rmacológico de los pacientes con trastornos esquizofrénicos y abuso de sustancias.Resultados: De los 17 estudios, la mayor parte eran prospectivos de muestras pequeñas (< 30 pacientes, cinco trabajos) o estudios de casos (siete artículos). Los objetivos señalados eran evaluar la eficacia sobre la sintomatología de la esquizofrenia (siete estudios) y la influencia del tratamiento sobre el consumo de drogas (seis estudios). Los antipsicóticos más estudiados eran los atípicos (12/17). Estos fármacos eran eficaces en reducir la clínica de los pacientes y tenían pocos efectos secundarios. Los antipsicóticos atípicos conseguían además reducir el consumo de drogas de abuso entre el 66-75 por ciento de los pacientes. Conclusiones: Pese a los problemas metodológicos subyacentes en los estudios, los hallazgos apuntan a que los antipsicóticos atípicos pueden ser el tratamiento de elección en estos pacientes (AU)