Determinants of medicine-taking in psychiatric patients.

Lack of adherence is a universal risk in medicine. Its consequences in terms of outcome, suffering and economic costs are immense. This is a selective review of the putative factors involved in medicine taking behavior. Adherence is multidetermined by a number of variables ranging from patient sociodemographic characteristics to factors related to patient/ psychiatrist interaction, drug tolerability and organization of care. A relevant piece of responsibility comes from the drug itself and the patient's subjective tolerability which together with the characteristics of long term treatment and insufficient insight and support result in poor or lack of adherence. The context of the patient/professional therapeutic alliance, the patient's capacities and health system availability are ultimately decisive.

Clinical guideline recommendations for antipsychotic long-acting injections.

BACKGROUND: Long-acting injections (LAIs) of antipsychotic drugs were developed over 40 years ago in an attempt to improve the long-term treatment of schizophrenia. AIMS: To review existing guidelines concerning antipsychotic use generally, and LAIs in particular, and how patients might be identified as potential candidates for LAI treatment. METHOD: Literature review. RESULTS: Currently several first-generation and one second-generation antipsychotic LAIs are available, with others under development. Although the use of LAIs is widespread around the world, patterns of use vary widely. Important considerations regarding the use of LAIs include the indications for long-term pharmacotherapy in schizophrenia in general, the indications for LAIs, the risks associated with LAIs, the need to update guidelines and the issue of cost. CONCLUSIONS: The use of these injections in first-episode psychosis and treatment-refractory schizophrenia is not currently a focus of recommendations, but should be considered. Long-acting injections remain an underutilised option in many countries despite frequent non-adherence with oral medication and subsequent relapse.

[Somatic conditions in patients suffering from anxiety disorders]. / Enfermedades somáticas en pacientes con trastornos de ansiedad.

BACKGROUND AND OBJECTIVE: Several studies have shown a higher prevalence of somatic illnesses in patients with anxiety disorders, especially cardiopathy, pneumopathy, digestive diseases and cephalea. The aim of this study was to investigate the comorbidity between anxiety disorders and medical illnesses in a group of patients with anxiety disorders compared with patients without psychiatric disorder attended at a primary care clinic and with psychiatric patients without anxiety pathology. PATIENTS AND METHOD: Retrospective case-control study comparing 3 groups of patients paired by age and sex. The group of patients with anxiety disorders included 130 patients diagnosed by DSM-IV as panic disorders with/without agoraphobia and agoraphobia without panic attacks. There were 2 control groups: 150 patients without psychiatric disorder attended at primary care and 130 psychiatric patients without anxiety disorder attended at a psychiatric service. RESULTS: Patients with anxiety disorders showed higher risk of medical illnesses than patient without anxiety. Multivariate statistical logistic regression analysis showed that patients with anxiety presented 4.2-fold increase in the risk of cephalea, 3.9 of cardiopathy, 3.8 of osteomuscular disorder and 2-fold increase in the risk of digestive diseases. CONCLUSIONS: Patients with anxiety disorders presented higher risk of somatic illness. Similar physiopathology and genetic etiology could explain this association.

Enfermedades somáticas en pacientes con trastornos de ansiedad / Somatic conditions in patients suffering from anxiety disorders

Fundamento y objetivo: Diversos estudios han indicado una mayor prevalencia de enfermedades somáticas en pacientes con trastornos de ansiedad, entre los que especialmente destacan la cardiopatía, la neumopatía, las enfermedades digestivas y la cefalea. El objetivo del presente estudio es investigar la comorbilidad entre trastornos de ansiedad y enfermedades somáticas en una muestra de pacientes con trastornos de ansiedad atendidos en atención primaria y pacientes con otras enfermedades psiquiátricas, pero sin ansiedad. Pacientes y método: Es un estudio retrospectivo de casos y controles en el que los pacientes fueron apareados por edad y sexo. En el grupo con trastornos de ansiedad se incluyó a 130 pacientes diagnosticados de trastorno de pánico con/sin agorafobia y agorafobia sin crisis de pánico según criterios de la cuarta edición del Manual de Clasificación de los Trastornos Mentales (DSM-IV). Se los comparó con 2 grupos control, un grupo de 150 pacientes atendidos en atención primaria sin diagnóstico de enfermedad psiquiátrica y otro grupo de 130 pacientes atendidos en servicios de psiquiatría sin diagnóstico de trastorno de ansiedad. Resultados: Los pacientes con trastornos de ansiedad presentaron mayor riesgo para algunas enfermedades somáticas que otros pacientes sin trastornos de ansiedad. Tras el análisis de regresión logística multivariante, las variables que se mantuvieron significativas fueron la cefalea (4,2 veces más riesgo), la cardiopatía (3,9), las enfermedades osteomusculares (3,8) y las enfermedades digestivas (2). Conclusiones: Los pacientes con trastornos de ansiedad presentan significativamente mayor comorbilidad con algunas enfermedades somáticas. Mecanismos fisiopatológicos o causas genéticas comunes podrían explicar esta asociación

Background and objective: Several studies have shown a higher prevalence of somatic illnesses in patients with anxiety disorders, especially cardiopathy, pneumopathy, digestive diseases and cephalea. The aim of this study was to investigate the comorbidity between anxiety disorders and medical illnesses in a group of patients with anxiety disorders compared with patients without psychiatric disorder attended at a primary care clinic and with psychiatric patients without anxiety pathology. Patients and method: Retrospective case-control study comparing 3 groups of patients paired by age and sex. The group of patients with anxiety disorders included 130 patients diagnosed by DSM-IV as panic disorders with/without agoraphobia and agoraphobia without panic attacks. There were 2 control groups: 150 patients without psychiatric disorder attended at primary care and 130 psychiatric patients without anxiety disorder attended at a psychiatric service. Results: Patients with anxiety disorders showed higher risk of medical illnesses than patient without anxiety. Multivariate statistical logistic regression analysis showed that patients with anxiety presented 4.2-fold increase in the risk of cephalea, 3.9 of cardiopathy, 3.8 of osteomuscular disorder and 2-fold increase in the risk of digestive diseases. Conclusions: Patients with anxiety disorders presented higher risk of somatic illness. Similar physiopathology and genetic etiology could explain this association

Utilization of psychiatric emergency services by homeless persons in Spain.

OBJECTIVE: Studies examining the relationship between homeless persons and the use of psychiatric emergency services (PES) in a country with universal access to health care are lacking. This study aimed to determine the prevalence of homelessness in adults visiting a PES in Spain, identify the differences between homeless and non-homeless patients in the use of PES and analyze the factors associated with homelessness and the decision to hospitalize. METHOD: The study included a total of 11 578 consecutive admissions to a PES in a tertiary hospital in Barcelona, Spain, over a 4-year period. Data collected included socio-demographic and clinical information, and score on the Severity of Psychiatric Illness (SPI) scale. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness and the decision to hospitalize. RESULTS: Five hundred sixty (4.8%) admissions were considered homeless. Homeless patients had more psychotic and drug abuse disorders, greater severity of symptoms, more risk of being a danger to others and more frequent hospitalization needs than non-homeless patients. Factors related to homelessness were male gender, substance abuse and immigrant status from North Africa, Sub-Sahara Africa and Western countries. The decision to hospitalize homeless patients was associated with psychosis diagnosis, suicide risk, danger to others, symptom severity, medical problems and noncompliance with treatment. CONCLUSIONS: In an attempt to decrease the use of emergency resources and prevent the risk of homelessness, mental health planners in a universal healthcare system should improve outpatient access for populations with risk factors such as substance abuse and immigration.

Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

OBJECTIVE: This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. METHODS: A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. RESULTS: Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. CONCLUSIONS: Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.