Adherence, insight and disability in paranoid schizophrenia.

Insight has long been linked to both prognosis and functioning in patients with schizophrenia; likewise, it is key to treatment adherence. This study seeks to assess the association between insight, adherence to pharmacological treatment, and disability in schizophrenia, and to study the potential mediating role of adherence between insight and disability. Insight (SUMD), adherence (CRS), and disability (WHO-DAS) were measured in 80 clinically stable patients with DSM-IV TR paranoid schizophrenia. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In a first step, predictors of disability were identified using linear regression to identify variables related to disability and further a mediation analysis was carried out. Negative symptoms, insight, and adherence account for 54.2% of the variance in disability. Negative symptoms act directly on disability, while the effect of insight on disability is partially mediated by adherence. Insight is key in disability in schizophrenia and should be leveraged in treatment programs.

Prevalencia del consumo de drogas en adolescentes con patología mental grave / Prevalence of drug use among adolescents with severe mental illness

Objetivos. El objetivo de este trabajo es estudiar la prevalencia de consumo de drogas entre adolescentes, y comparar su uso entre aquéllos que presentan un trastorno mental grave y los adolescentes sanos. Material y métodos. Comparamos la prevalencia de distintas drogas (alcohol, tabaco, cannabis, éxtasis, heroína, cocaína, anfetaminas) en una muestra de adolescentes sanos procedente de un centro de Atención Primaria (n = 58) y en pacientes consecutivamente ingresados en una unidad de hospitalización de adolescentes de psiquiatría de un hospital general (n = 62). A todos los adolescentes se les preguntó sobre el consumo de tóxicos en la última semana, mes, año, vida y edad de comienzo y se les realizó un análisis de tóxicos en orina. Resultados. La prevalencia de consumo de alcohol en el último mes es significativamente mayor en adolescentes sin patología psiquiátrica, mientras que los pacientes ingresados presentan un consumo significativamente mayor de cocaína, anfetaminas y éxtasis. La edad de comienzo es menor para los pacientes ingresados, aunque sólo alcanza diferencias significativas en el caso del cannabis. Por diagnósticos, son los trastornos de conducta y personalidad los que presentan un mayor consumo de drogas. Conclusiones. El consumo de drogas es prevalente entre adolescentes que tienen una patología psiquiátrica que precisa ingreso hospitalario

Objectives. The aim of this study is to assess drug use between adolescents and analyze differences between those who have a severe mental illness and healthy ones. Material and methods. We compare the prevalence of use of different drugs in a sample of healthy adolescents (n = 58) and in a patient sample of subjects admitted into an inpatient adolescent psychiatric unit (n = 62). All adolescents were asked about the use of toxic substances during the course of the last week, month, year, at any point during their lifetime, as well as the age at which they began using substances. A urine toxicology screen was also performed in all subjects. Results. The prevalence of alcohol use during the last month is significantly greater in adolescents without psychiatric illness, whereas the inpatients present a significantly higher rate of cocaine, amphetamines, and ecstasy use. Substance use began at younger ages in the inpatient group. Conduct disorders and personality disorders present a higher rate of drug use. Conclusions. Drug use is prevalent amongst adolescents with psychiatric illness requiring hospital admission

Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence.

PURPOSE: The aim of this longitudinal study was to determine whether the depot formulation of an antipsychotic reduces violence in outpatients with schizophrenia as compared to oral administration of the same antipsychotic. METHODS: Forty-six previously violent patients with schizophrenia were randomised to receive treatment with oral or depot zuclopenthixol for 1 year. Clinicians interviewed patients at baseline and every month thereafter to assess treatment adherence. An interviewer blinded to treatment assignments interviewed an informant about any violent behaviour during the previous month. RESULTS: Violence during the follow-up year was inversely proportional to treatment adherence, better compliance, and greater reduction of positive symptoms. Lower frequency of violent acts was observed in the depot group. The level of insight at baseline was not significantly associated with violence recidivism. Regardless of route of administration, treatment non-adherence was the best predictor of violence. CONCLUSIONS: Some patients with schizophrenia and prior violent behaviour may benefit from the depot formulation of antipsychotic medication.

MDMA and serotonin: based on two cases.

3,4-methylenedioxyamphetamine (MDMA) or "ecstasy" damages serotonin neurons in all animal species and there is growing evidence that this finding also applies to humans. This fact, together with the increasing extended use in the young population, has important repercussions in the appearance of specific psychopathologic and cognitive disturbances associated to its use. The authors present two clinical cases, in which psychopathological and cognitive symptoms are detected in MDMA users that support this hypothesis. Problems in the diagnosis of psychiatric disorders associated to MDMA and its clinical and therapeutic implications are discussed.

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain.

OBJECTIVE: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. METHOD: Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. RESULTS: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long DUP was associated with insidious onset, poor global functioning, and laboral incapability. Among the Finnish patients exclusively, long DUP correlated with a weak earlier social network, instability of professional identity, long duration of prodromal symptoms, psychological dependency on the family, and criticism by the parents of the patient. Among the Spanish patients only, longer DUP was associated with more severe positive symptoms at admission. CONCLUSION: There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.

Subjective response to antipsychotic treatment and compliance in schizophrenia. A naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study).

BACKGROUND: In order to compare the effectiveness of different antipsychotic drugs in the treatment of schizophrenia it is very important to evaluate subjective response and compliance in patient cohorts treated according to routine clinical practice. METHOD: Outpatients with schizophrenia entered this prospective, naturalistic study when they received a new prescription for an antipsychotic drug. Treatment assignment was based on purely clinical criteria, as the study did not include any experimental intervention. Patients treated with olanzapine, risperidone or haloperidol were included in the analysis. Subjective response was measured using the 10-item version of the Drug Attitude Inventory (DAI-10), and treatment compliance was measured using a physician-rated 4 point categorical scale. RESULTS: A total of 2128 patients initiated treatment (as monotherapy) with olanzapine, 417 with risperidone, and 112 with haloperidol. Olanzapine-treated patients had significantly higher DAI-10 scores and significantly better treatment compliance compared to both risperidone- and haloperidol-treated patients. Risperidone-treated patients had a significantly higher DAI-10 score compared to haloperidol-treated patients. CONCLUSION: Subjective response and compliance were superior in olanzapine-treated patients, compared to patients treated with risperidone and haloperidol, in routine clinical practice. Differences in subjective response were explained largely, but not completely, by differences in incidence of EPS.

[Psychosis with topiramate]. / Psicosis por topiramato.

Topiramate is a new antiepileptic drug which acts in the sodium channels, GABA and glutamatergic receptors. It is an efficient treatment in epilepsy and has been approved as co-therapy for partial seizures. Topiramate has a safe profile of side effects, however, as any other antiepileptic drug, could produce psychiatric side effects. We present the case of a woman who develops a schizophreniform disorder after topiramate treatment. Before this one, she also had a very similar disorder when she was treated with vigabatrin. The gabaergic action of topiramate is proposed as the principal reason for the psychotic crisis, in relation to an inhibition in the substantia nigra which could produce an overactivity in ascending dopaminergic systems.

[Factors related to treatment adherence in schizophrenic patients]. / Factores relacionados con la adherencia al tratamiento en pacientes esquizofrénicos.

BACKGROUND: The percentage of lack of adherence in schizophrenia is estimated in 50%. Non-compliance cause higher rates of relapses, rehospitalizations, suicide, homicide and violent behaviour among schizophrenic patients. The aim of this study was to find several factors related to adherence in schizophrenia. MATERIAL AND METHODS: 40 schizophrenic patients were assessed with a protocol which examined sociodemographic, clinical and therapeutical variables, scales in order to evaluate insight (Birchwood), drug attitude (Drug Attitude Inventory), psychopathology (BPRS) and side effects (UKU). Variables of outcome and overall functioning (GAS) in the previous year were also included. RESULTS: Multiple regression analysis revealed that BPRS thought disorder subscale and UKU neurologic side effects subscale predicted 24% of the variance of adherence. Adherence is related to insight and attitude to medication too. An adequate adherence was related to better overall functioning, less psychopathology and fewer hospitalizations during the year prior to the study.

[Mental disorders due to lacunar infarcts. Two case reports]. / Trastorno mental por infartos lacunares. Dos ejemplos clínicos.

Lacunar infarcts have a high prevalence, about 10%, mainly in the elderly. Although the most frequent feature are the lacunar syndromes as a neurologic form, psychiatrist should bear them in mind because it is possible the presence of psychiatric symptoms as the only manifestation of them. We report two examples of it. The first case in a man with a transitory episode of uninhibition, with maniform characteristics, and frontal disturbance signs. The second one is a woman with a peduncular ballucinosis. The only neuroradiological finding were lacunar infarcts in both of them. We discuss a pathogenic hypothesis to explain these features. The first case may be a disconnection of the system that integrates the basal ganglia, thalamus and thalamocortical projections; the second one can be originated because of interruptions of the nigroestriatal connections.