ABSTRACT
This research studies the dose-plasma level (PL) relationship of second-generation antipsychotics, together with the treatment outcomes achieved, in seriously ill people with schizophrenia. An observational, prospective, one-year follow-up study was carried out with patients (N = 68) with severe schizophrenia treated with paliperidone three-month (PP3M) or aripiprazole one-month (ARIM). Participants were divided into standard-dose or high-dose groups. PLs were divided into "standard PL" and "high PL" (above the therapeutic reference range, TRR) groups. The dose/PL relationship, and severity, hospitalizations, tolerability, compliance, and their relationship with doses and PLs were evaluated. There was no clear linear relationship between ARIM or PP3M doses and the PLs achieved. In half of the subjects, standard doses reached PLs above the TRR. The improvements in clinical outcomes (decrease in clinical severity and relapses) were related to high PLs, without worse treatment tolerability or adherence. All participants remained in the study, regardless of dose or PL. Clinical severity and hospitalizations decreased significantly more in those patients with high PLs. Considering the non-linear dose-PL relationship of ARIM and PP3M in people with severe schizophrenia, PLs above the TRR are linked to better treatment outcomes, without worse tolerability. The need in a notable number of cases for high doses to reach those effective PLs is highlighted.
ABSTRACT
La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM. Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones. (AU)
The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed. The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain. (AU)
Subject(s)
Humans , Male , Female , Adult , Substance-Related Disorders , Mental Disorders , Prevalence , Spain , Cross-Sectional StudiesABSTRACT
OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHODS: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (Nâ¯=â¯344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (Pâ¯<â¯.0001), as well the involuntary admissions (Pâ¯<â¯.001). Being on long-acting injectable antipsychotic medication was related with these results (Pâ¯<â¯.0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.
Subject(s)
Antipsychotic Agents , Schizophrenia , Antipsychotic Agents/therapeutic use , Delayed-Action Preparations/therapeutic use , Follow-Up Studies , Hospitalization , Humans , Schizophrenia/drug therapyABSTRACT
Objetivos:Conocer los ingresos en una unidad hospitalaria de psiquiatría de pacientes con esquizofrenia grave antes (tratamiento estándar en CSM) y después de su incorporación a un programa comunitario, integral y con gestión de casos. También la influencia de la medicación antipsicótica (oral o inyectable de larga duración) en ello.Método:Estudio observacional, en espejo, de 10 años de seguimiento y 10 retrospectivos («pretratamiento»: estándar) de pacientes con esquizofrenia grave en un programa comunitario, de tratamiento farmacológico y psicosocial integrado y con gestión de casos intensiva (n=344). Se registraron los motivos de alta en el programa y los ingresos hospitalarios (y si eran involuntarios) 10 años antes y durante el tratamiento. También los antipsicóticos utilizados.Resultados:La retención conseguida en el programa fue elevada: a los 10 años solo el 12,2% de los pacientes fueron altas voluntarias, frente a al 84,3% que lo habían sido en algún momento en el tratamiento estándar previo. El porcentaje de pacientes con ingresos hospitalarios y su número disminuyeron drásticamente tras la incorporación al programa (p<0,0001), así como su involuntariedad (p<0,0001). El hecho de estar con medicación antipsicótica inyectable de larga duración se relacionó estos resultados (p<0,0001).Conclusiones:La incorporación de pacientes con esquizofrenia grave a un programa integral, de base comunitaria y con gestión de casos intensiva consiguió una elevada retención en el tratamiento, y fue efectivo para disminuir drásticamente las hospitalizaciones por recaídas, comparado con el tratamiento estándar previo en CSM. El tratamiento con antipsicóticos inyectables de larga duración se relacionó con estos resultados. (AU)
Objectives:To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).Method:Observational, mirror image study of ten years of follow-up and ten retrospectives (pre-treatment: standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.Results:The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001).Conclusions:Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes. (AU)
Subject(s)
Humans , Schizophrenia , Hospitals, Psychiatric , Drug TherapyABSTRACT
The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed.The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain.
La concurrencia de trastornos por consumo de sustancias (TUS) y de otros trastornos mentales (OTM) es desconocida en su conjunto en España, y su abordaje se hace desde diferentes redes asistenciales. El objetivo del presente estudio era conocer la prevalencia de esta comorbilidad tanto en las redes de tratamiento de las adicciones como en las de salud mental. Se diseñó un estudio observacional, transversal, multicéntrico, con una muestra aleatorizada de pacientes en tratamiento por TUS u OTM en diferentes Comunidades Autónomas (N=1.783). Se completó un cuestionario ad hoc on-line recogiendo variables sociodemográficas, sobre uso de sustancias, y de diagnósticos de TUS y de OTM.Los datos obtenidos en la encuesta arrojan una importante concurrencia de diagnósticos TUS y OTM. Se encontró una elevada prevalencia de OTM en aquellos en tratamiento en redes de adicciones por su TUS (71%) y también tanto de diagnósticos de T.U. de cualquier sustancia (68,9%) como de consumo activo de sustancias (50%, exceptuando tabaco) en las personas en tratamiento por diagnósticos de OTM en redes de salud mental. Y, además, relaciones significativas entre la adicción a determinadas sustancias y trastornos mentales concretos: trastorno de personalidad con todos los TUS; trastornos psicóticos con trastorno por uso de cannabis, pero no de cocaína; trastornos afectivos con trastornos por consumo de cocaína, y trastorno de ansiedad con trastorno por uso de cannabis. Este estudio aporta información preliminar sobre la elevada coexistencia en la práctica clínica habitual de trastornos adictivos y otros trastornos mentales en España, tanto en redes asistenciales de salud mental como específicas de adicciones.
ABSTRACT
OBJECTIVES: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). METHOD: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. RESULTS: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001). CONCLUSIONS: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.
ABSTRACT
Se analiza en una muestra de 142 centros, la mayoría de drogodependencias y algunos de alcoholismo, de 11 comunidades autónomas españolas, los programas que realizan para el tratamiento del tabaquismo. El 55.6% llevan a cabo tratamiento de fumadores. A lo largo del año 2004 en dichos centros hubo una demanda de tratamiento por parte de 3.771 personas. Fueron tratadas unas 3.000, finalizando el tratamiento la mitad de ellas. Los niveles de abstinencia indicados para el final del tratamiento como en los seguimientos a los 6 y 12 meses son buenos, en relación a los estudios clínicos publicados. El tratamiento más utilizado es el combinado (psicológico y farmacológico) seguido del psicológico. Suelen ser los distintos profesionales del equipo terapéutico los que llevan a cabo el tratamiento. Indican varias limitaciones para realizar este tratamiento, incluidos los presentes en cualquier adicción (ej., baja motivación de los fumadores), carencia de tiempo, poco personal, etc. Aprecian un claro incremento de la demanda, tanto de personas que acuden con solo dependencia de la nicotina como de sus usuarios clásicos que están a tratamiento por otras dependencias. Tienen clara su relevancia profesional en el tratamiento de esta adicción y la alta eficacia de los tratamientos que llevan a cabo con los fumadores. Ven necesario que se les aporten más medios para hacer frente al incremento continuo de demanda que están teniendo para el tratamiento de la dependencia de la nicotina en sus centros
We analyzed in a sample of 142 Centers of Drug Abuse and Alcoholism, in 11 regions of Spain, the programs that they carry out for smoking cessation. The 55.6% of centers carries out treatment of smokers. Along the year 2004 in this centers had a treatment demand of 3,771 smokers, 3,000 were treated, concluding the treatment half of them. The levels of abstinence for the end of the treatment and in the 6- and 12-months followup are good, in relation to the published clinical studies. The most utilized treatment are the combined (psychological and pharmacological) followed by the psychological treatment. They are usually apply by diferent professionals as therapits. They indicate several limitations to carry out this treatment, included usual in any addiction (e.g., the smokers low motivation), lack of time, limited personal, etc. They appreciates a clear increment of the demand, so much of people that they go with single nicotine dependence like of its classic users that are to treatment for other dependences. This data indicated the professional relevance of Centers of Drug Dependence in the treatment of nicotine dependence and the high effectiveness of the treatments that carry out with the smokers. They consider necessary that they have more means to make in front of the continuous increment of demand that they are having for the treatment of the nicotine dependence in their centers
Subject(s)
Male , Female , Adult , Adolescent , Humans , Tobacco Use Disorder/therapy , Substance Abuse Treatment Centers/methods , Substance Abuse Treatment Centers/organization & administration , Substance Abuse Treatment Centers , Tobacco Use Disorder/therapy , Tobacco Use Disorder/diagnosis , Surveys and Questionnaires , Epidemiology, Descriptive , Community Mental Health Centers , Spain/epidemiology , Substance Withdrawal Syndrome/therapyABSTRACT
El interés por los trastornos de personalidad (TP) en el campo de las adicciones radica en su importancia epidemiológica, su papel etiológico y su influencia en el pronóstico y tratamiento de la drogodependencia. Numerosos estudios muestran que los TP son comunes entre los adictos, aunque en muchos se solapan conductas derivadas de la propia dependencia con las descriptivas de determinados TP, lo que dificulta su diagnóstico. Esto último es más evidente en el caso de la dependencia por opioides, donde el TP disocial es el más notificado, seguido del de inestabilidad emocional. En cualquier caso, la mayoría de los heroinómanos diagnosticados de TP presentan más de uno. Se han propuesto al menos tres vías causales para la adicción en las que los factores de personalidad son etiológicamente importantes. En cuanto a su influencia en la evolución de la dependencia y en el pronóstico de los tratamientos, en general parecen ensombrecerlos, con más abandonos de tratamiento y mayor y más problemático consumo de drogas. Pero parece que pueden beneficiarse en igual medida que los adictos sin TP de los apoyos terapéuticos. De hecho, la mejora de la efectividad de los tratamientos de la dependencia de heroína pasará por una mayor detección y abordaje de los TP. En el presente artículo se revisan todos estos aspectos. Además, se describen los hallazgos en pacientes en PMMs en Asturias respecto a TP y su relación con la gravedad de la adicción y los resultados del tratamiento (AU)
There is a strong interest in the field of drug abuse about personality disorders (PD), due to their epidemiological importance, etiological role, influence on drug dependence prognosis and treatment possibilities. A large number of studies have shown that PD are very common among drug abusers, although in most of them it is not clear if some behaviour is related with PD or with drug dependence itself, what difficulties its diagnosis. This is even more relevant is heroin addicts, among which antisocial is the most reported PD, and borderline is the second one. Anyway, most of the heroin addicts with PD show more than one. Three causes for addiction in which personality factors are etiologically important have been proposed. About their influence in prognosis of the dependence and its treatment, it has been shown that worsens both in general terms, with higher rates of treatment discharge, drug consumption and related problems. However, therapeutic interventions with patients with PD seem to be as effective as with no PD. Moreover, drug abuse treatment effectiveness would be improving by giving greater attention to the detection and care to personality disorders. All these issues are reviewed in this paper. Moreover, findings of Asturian researches on PD, severity of addiction and methadone maintenance treatment outcomes are shown (AU)
Subject(s)
Humans , Personality Disorders/epidemiology , Heroin Dependence/psychology , Behavior, Addictive/psychology , Personality Assessment , Severity of Illness Index , Heroin Dependence/epidemiology , Opioid-Related Disorders/epidemiologyABSTRACT
Los programas de mantenimiento con metadona (PMMs) tuvieron gran expansión tras la aparición del SIDA y han sido el tratamiento de la dependencia de opiáceos más evaluado, acumulándose muchos conocimientos sobre su efectividad. Aunque pocos estudios son controlados, otros muchos observacionales coinciden en mostrar su éxito en relación a la elevada capacidad de retención en tratamiento, la disminución del consumo de drogas, de las prácticas de riesgo en su uso, de la comorbilidad (VIH, hepatitis víricas), de la mortalidad y de la criminalidad asociadas, y la mejora en el empleo y de la calidad de vida del adicto. Dosis de metadona por encima de 80 mg/día y una amplia y accesible oferta asistencial con apoyos psicosociales se relacionan con mayor retención y disminución del uso de drogas, mientras que la comorbilidad psiquiátrica y la codependencia de sustancias (cocaína, benzodiacepinas) ensombrecen el pronóstico. En nuestro país, a pesar de su implantación durante los años 90, las evaluaciones sobre resultados de PMMs son en general parciales. Se concluye en esta revisión que los PMMs han demostrado ser un recurso válido para muchos adictos, tanto reduciendo daños asociados al consumo de drogas como, a menudo, constituyendo una auténtica estrategia terapéutica para la reinserción social y la abstinencia. Por tanto, deberán continuar teniendo un lugar destacado en el abordaje de la dependencia de opioides. Y habrán de concretarse variables pronósticas, oferta asistencial específica y su coste-efectividad (AU)
Methadone maintenance treatments (MMTs) have got a wide spread after AIDS epidemic and are the most evaluated opiate dependence treatment, and the knowledge about their effectiveness is high. Although most of them are observational ones and very few have controlled design, MMTs effectiveness studies show they success in getting high treatment retention, in decreasing drug use, risk behaviours, comorbidity (HIV, viral hepatitis), mortality and criminality related, and in increasing employment rates and addicts quality of life. Methadone doses over 80 mg/day and a wide and accessible psychosocial support are linked with higher treatment retention and with decreasing in drug consumption. Psychiatric comorbidity and other substances co-dependence (cocaine, benzodiacepines) worsens the prognosis. In our country, although the high MMTs expansion along 90s, evaluation studies are partials. As a conclusion of this review, it is highlighted that MMTs have showed to be really useful to addicts, not only reducing drug use harms but also being a true therapeutic strategy for social reintegration and abstinence. That is why they will have in the future a main role in opiate dependence treatment. And it will be necessary to know prognostic variables, support services needed and their cost-effectiveness (AU)
Subject(s)
Methadone/therapeutic use , Opioid-Related Disorders/drug therapy , Opiate Substitution Treatment/methods , Evaluation of Results of Therapeutic Interventions , Acquired Immunodeficiency Syndrome/complications , Substance-Related Disorders/complicationsABSTRACT
En salud mental, la 'cronicidad' ha pasado de necesidad de largos tiempos de cuidados a déficits de ajuste entre necesidades de los pacientes y oferta sociosanitaria comunitaria. Los mantenimientos con opiáceos han tendido a la reducción de daños, con gran efectividad, pero arrastrando la etiqueta de 'cronificadores'. Aunque la masificación puede alargar permanencias, los mantenimientos largos son soporte prolongado para romper la cronicidad de los problemas de la adicción. A mayor efectividad, menor será la cronicidad, entendida como dependencia del tratamiento, que no propiciaría la autonomía para una vida sin drogas. La calidad pasaría por dar a los pacientes lo que necesitan o demandan, disminuyendo sus discapacidades y cronificación.La ventaja de un sistema de calidad es que su gestión implica mejora continua. Y esta pasa por la completa integración de los PMMs en la red sanitaria general, consiguiendo así una atención integral e integrada. Y por la definición de subprogramas, desde la abstinencia a lo paliativo, y de procedimientos en cada uno de ellos, además de diversificar niveles asistenciales. Es necesaria la adaptación a nuevas necesidades en viejos consumidores y a nuevos usuarios, actualizando objetivos e indicadores, identificando variables relacionadas con efectividad y cronicidad. El éxito de los PMMs para contener el sida no debe hacer olvidar que son verdaderos tratamientos biopsicosociales de efectividad contrastada, y que deberán de ser por ello adecuados a este objetivo (AU)
e importance of the patients opinion on the quality of health services has been emphasized in the last few years. This evaluation is useful in guiding those responsible for the centres in improving welfare resources. The present study was designed to evaluate the satisfaction level of drugaddicted women with the treatment they received in Asturias (Spain). The research was carried out with a sample of 108 drug-addicted women who were undergoing treatment in public or private centres in Asturias. The interviews were 'face to face' or by telephone. The results showed a high satisfaction level among drug-addicted women who had followed treatment programmes in Asturias. In addition, the personnel working in the different welfare centres were evaluated most highly by these women. Private centres score higher than public centres (AU)
Subject(s)
Humans , Methadone/therapeutic use , Quality of Health Care , Substance Withdrawal Syndrome , Treatment OutcomeABSTRACT
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