Prevalence of Insomnia and Associated Factors in Outpatients With Generalized Anxiety Disorder Treated in Psychiatric Clinics.

Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder (GAD). In this cross-sectional, prospective, observational, and multicenter study, factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated. Using multivariate analyses, the factor most strongly associated with the presence of insomnia (ISI ≥ 8) was the severity of the disorder (Odds Ratio [OR]: 9.253 for severe GAD; 95% Confidence Interval [CI]: 1.914-44.730; p = 0.006), pain interference and symptoms of depression (OR: 1.018; 95% CI 1.003-1.033; p = 0.016 and OR: 1.059; 95% CI 1.019-1.101; p = 0.004, respectively). Insomnia was not related to quality of life. Our results show insomnia to be a common health condition among patients with GAD, associated with the severity of anxiety and depressive symptoms and pain interference.

Chemobrain: ¿podemos hablar de un daño cerebral adquirido por quimioterapia? / Chemobrain: can we consider an acquired brain injury from chemotherapy?

Objetivo: Conocer el deterioro cognitivo producido por la quimioterapia en una muestra de pacientes con cáncer de mama frente a los controles y frente a sí mismas, antes y después del tratamiento. Pacientes y método: Estudio de corte longitudinal prospectivo. Se administró la Mini International Neuropsychiatric Interview, se evaluó depresión, ansiedad, función sexual, calidad de vida y sueño. Se midió memoria, atención, velocidad de procesamiento, memoria de trabajo, función ejecutiva y fluidez. Tanto la muestra inicial como la final fue de 19 pacientes y 19 controles. Resultados: Las pacientes presentaron diferencias en depresión, ansiedad, calidad de vida, función sexual y calidad de sueño frente al grupo control en el momento basal y a los seis meses. Se encontraron diferencias neurocognitivas entre pacientes y controles antes del tratamiento en memoria y en función ejecutiva y después del tratamiento en memoria, función ejecutiva e índice de función prefrontal. Conclusiones: Encontramos diferencias entre pacientes y controles antes de comenzar el tratamiento, síntomas de ansiedad, depresión, calidad de vida y sueño, en función sexual y en las variables neurocognitivas de memoria y función ejecutiva. Tras la quimioterapia, se observó declive en las pacientes respecto a los controles en: ansiedad, depresión, calidad de vida, calidad de sueño y función sexual y los dominios cognitivo de atención, memoria, función ejecutiva e índice de función prefrontal (AU)

Objective: To meet the cognitive impairment caused by chemotherapy in a sample of patients with breast cancer versus controls and themselves, before and after treatment. Patients and methods: Prospective longitudinal study. The Mini International Neuropsychiatric Interview was administered and other emotional symptoms like depression, anxiety, sexual function, quality of life and sleep was assessed. Memory, attention, processing speed, working memory, executive function and flow were measured. Both the initial and the final sample were 19 patients and 19 controls. Results: Patients differ in depression, anxiety, quality of life, sexual function, and quality of sleep versus controls at baseline and 6-month. Neurocognitive differences between patients and control group were found in memory before treatment and executive function. After treatment the differences were in memory, executive function and index of prefrontal function. Conclusion: There are significant differences between patients and control group before starting treatment, symptoms of anxiety, depression, quality of life and sleep, sexual function and neurocognitive variables in memory and executive function. After chemotherapy, decline was seen in patients respect control group in: anxiety, depression, and quality of life, quality of sleep and sexual function and cognitive domains of attention, memory, executive function and index of prefrontal function (AU)

[Tolerability and efficacy of combined antidepressant therapy]. / Eficacia y seguridad de la asociación de antidepresivos.

OBJECTIVES: Utilisation of antidepressant combination and augmentation strategies in management of treatment-resistant depression is very common in spite of have been hardly analysed with clinic and neuropharmacological rigor. The aim of this review is to analyse frequency of utilisation, neurobiological mechanisms involved and clinic results observed, with all combination usually used in clinical practice. METHODOLOGY: A bibliographic research was carried out by means of exhaustive review of scientific database (Medline and NLM), from specific key words. Subsequently we realised a cross with all bibliographic references obtained. Less some casuistical references published in difficult access journals, we have revised all outstanding open or controlled published studies. CONCLUSIONS: It is remarkable large quantity of casuistic information and lack of controlled studies. Most of combinations are justified and supported by hypothetical neurobiological augmentation mechanisms hardly verified. Some combinations (MAOI+TCA, MAOI+SSRI, TCA+TCA, SSRI+SSRI, SSRI+TCA), bring forward few advantages and important risks, so that it should be inadvisable. Nevertheless combinations using SSRI with another antidepressant, as Maprotiline, Mianserine, Bupropion or Mirtazapine, bring forward positive results and suppose low risks, so that should be recommended in resistant depressions or to reduce response latency.

Eficacia y seguridad de la asociación de antidepresivos / Tolerability and efficacy of combined antidepressant therapy

Planteamiento y objetivos. La utilización de asociaciones o combinaciones de antidepresivos para el tratamiento de las depresiones resistentes es una práctica habitual, pese a haber sido escasamente analizada con rigor clínico y neurofarmacológico. El objetivo de esta revisión es analizar la frecuencia de utilización, los mecanismos neurobiológicos implicados y los resultados clínicos observados, tanto en eficacia como en seguridad, con todas las asociaciones habitualmente utilizadas en la clínica. Metodología. Se realizó una búsqueda bibliográfica mediante una revisión exhaustiva de bases de datos (MEDLINE y NLM), partiendo de palabras clave. Posteriormente se realizó un cruce de todas las referencias bibliográficas recogidas en las publicaciones encontradas. Salvo algunas referencias casuísticas, publicadas en revistas de difícil acceso, se han analizado todos los estudios amplios, tanto abiertos como controlados publicados. Conclusiones. En general destaca la profusión de informaciones casuísticas y la escasez de estudios controlados. La mayor parte de las asociaciones se justifican y apoyan en mecanismos de potenciación neurobiológicos hipotéticos difícilmente verificables. Algunas asociaciones (IMAO+ADT, IMAO+ISRS, ADT+ADT, ISRS+ISRS, ISRS+ADT) aportan escasas ventajas y considerables riesgos, por lo que deben ser desaconsejadas.Sin embargo, las asociaciones de un ISRS con otros ADs, como maprotilina, mianserina, bupropión o mirtazapina aportan resultados positivos y suponen escasos riesgos, por lo que podrían recomendarse en depresiones resistentes o para acortar la latencia de respuesta. (AU)

[Prevalence of psychiatric disturbances and psychopathologic status in patients with systemic lupus erythematosus]. / Prevalencia de trastornos psiquiátricos y estado psicopatológico en pacientes con lupus eritematoso sistémico.

BACKGROUND: Psychiatric disorders are commonly associated with systemic lupus erythematosus (SLE). Some authors consider that these disorders can be associated with cognitive impairment. OBJECTIVES: The objectives of this study were to establish the particular prevalence of psychiatric disorders in these patients and to investigate the relationship between psychiatric disorders, cognitive impairment, life quality, psychological status and adjustment to illness. MATERIAL AND METHODS: A cross-sectional study is reported of 46 spanish patients with systemic lupus erythematosus (SLE) attending the outpatients clinics of the Internal Medicine and Rheumatology Departments at a University Hospital. The following instruments were used: a Structured Clinical Interview for DSM-III-R, the Nottingham Health Profile, the Symptom Check-List 90-Revised, the Psychological Adjustment to Illness Scale and the Integrated Program of Neuropsychological Assessment Test-Barcelona. RESULTS: The prevalence of psychiatric disorders at interview was 33%. The most common diagnoses were affective disorders and psycho-organic syndrome. Affective disorders were associated with a poorer life quality, number of hospitalizations and psychiatric background. Adjustment to illness accounted for the psychologic status of the patients.

Cerebral perfusion correlates of negative symptomatology and parkinsonism in a sample of treatment-refractory schizophrenics: an exploratory 99mTc-HMPAO SPET study.

There is a well recognized clinical overlap between primary and secondary neuroleptic negative symptoms in schizophrenia, but their cerebral substrates are probably different. The study of these substrates could contribute to a better understanding and management of these syndromes. In the present work, the cerebral perfusion correlates, as an indirect measure of the underlying neuronal function, of negative symptoms and parkinsonism were studied with single-photon emission tomography in a group of treatment-refractory paranoid schizophrenic patients. Perfusion ratios with respect to the homolateral cerebellum were compared with a normal database. Correlation coefficients were calculated between perfusion ratios, negative symptoms and parkinsonism scores on exploratory grounds. As a group, the patients showed a bilateral, but predominantly left-sided, hypofrontality and hypotemporality, as well as an increased perfusion in right basal ganglia. Negative symptoms scores negatively correlated with prefrontal perfusion, while parkinsonism positively correlated with the activity of primary motor and sensory cortex. These findings support the existence of different cerebral substrates for primary and secondary negative symptoms in schizophrenia.

[Psychiatric intervention in liver transplantation]. / Intervención psiquiátrica en el trasplante de hígado.

We present a review of the current bibliography on psychiatric aspects of liver transplantation. We focused on the preoperative and postoperative transplantation period. In the former, we considered the criteria patient selection, psychiatric screening, psychiatric contraindications and most common psychopathology associated with liver transplantation. In regards to the postoperative period, we looked at the quality of life after intervention and the role of the immunosuppressant treatment (Cyclosporine) concerning psychiatric complications.