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1.
Int J Bipolar Disord ; 11(1): 11, 2023 Mar 16.
Article in English | MEDLINE | ID: mdl-36929031

ABSTRACT

BACKGROUND: Patients should get actively involved in the management of their illness. The aim of this study was to assess the influence of lifestyle factors, including sleep, diet, and physical activity, on lithium levels in patients with bipolar disorder. METHODS: A multicenter study was performed. In total, 157 lithium measurements were done biweekly in a sample of 65 patients (35 women) over 6 weeks. Lifestyle, based on total sleep hours and physical activity, was assessed by actigraphy. Diet was evaluated using the Mediterranean Lifestyle Index (Medlife). RESULTS: 35.4% of patients had a normal weight. The mean Medlife score was 14.5 (± 2.5) (moderate-good adherence to Mediterranean diet). BMI, daily dose of lithium and intensity of physical activity had a combined effect on lithium levels, after adjustment for other variables. Patients who practiced intense physical exercise, who took lower doses and had a higher BMI exhibited lower levels of lithium. CONCLUSIONS: Higher physical activity and BMI contribute to lower lithium levels. Patients should be made aware of these relationships to improve their perception of control and self-management. Lifestyle-based interventions contribute to establishing a more personalized medicine.

2.
Eur Child Adolesc Psychiatry ; 32(4): 639-649, 2023 Apr.
Article in English | MEDLINE | ID: mdl-34714406

ABSTRACT

Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19-24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.


Subject(s)
Psychotic Disorders , Humans , Adolescent , Young Adult , Adult , Longitudinal Studies , Age of Onset , Psychotic Disorders/psychology , Cognition , Neuropsychological Tests
3.
O.F.I.L ; 33(1): 10-14, 2023. tab, graf
Article in Spanish | IBECS | ID: ibc-220691

ABSTRACT

A partir de la publicación de la Orden Ministerial SND/293/2020,del 25 de marzo, tras la declaración de la emergencia sanitariapor SARS-CoV-2 en España, se diseñaron una serie de medidasque garantizaran la restricción de movilidad de la población sinperjuicio del acceso a los medicamentos hospitalarios. Así, a raízde dicha publicación, en el Servicio de Farmacia Hospitalaria delHospital SAS La Línea se desarrolló un programa de Telefarmaciacon puntos de dispensación en los centros de Atención Primariaadscritos y una consulta telefónica de Atención Farmacéutica.Se realizaron un total de 1.007 dispensaciones en 301 pacientesdurante el periodo de estudio comprendido entre el 1 de julio al15 de noviembre de 2020. Así, al finalizar dicho periodo, 235fueron los pacientes que permanecieron incluidos en el programa de Telefarmacia con una edad media de 64 años y un54,5% (128) mujeres. A estos pacientes, se les enviaron por correo postal una encuesta de satisfacción que podrían devolvervoluntaria y anónimamente al Servicio de Farmacia. Se recibieronun total de 62 encuestas, mostrándose los pacientes satisfechosen un 96,77% (60) con el servicio de entrega, 90,32% (56) conel trato recibido, 87,10% (54) con la puntualidad y 98,39% (61)con las condiciones de conservación en el Centro de Salud.El alto grado de satisfacción de los pacientes encuestadosrefleja que el nuevo programa de Telefarmacia podrían responder a las necesidades individuales de los pacientes,siendo para ello fundamental la coordinación de todos losprofesionales implicados, así como la corresponsabilidad delos pacientes en el control de sus tratamientos.Con los resultados obtenidos en el presente estudio, parece justificado mantener en el futuro los centros de atención primariacomo punto de dispensación junto con un mayor desarrollo dela consulta no presencial de Atención Farmacéutica. (AU)


As of the publication of Ministerial OrderSND/293/2020, of March 25, after thedeclaration of the health emergency dueto SARS-CoV-2 in Spain, a series of measures were designed to guarantee therestriction of population mobility withoutprejudice to access to hospital medications. Thus, as a result of said publication,a telepharmacy program was developedat the clinical pharmacy service of theHospital SAS La Línea with dispensingpoints in the attached Primary Care centers and a Pharmaceutical Care Telephone Consultation.A total of 1,007 dispensations weremade in 301 patients during the studyperiod from July 1 to November 15,2020. Thus, at the end of that period,235 were the patients who remainedincluded in the Telepharmacy programwith a mean age 64 years and 54.5%(128) women. A satisfaction survey wassent to these patients by post, whichthey could return voluntarily and anonymously to the pharmacy service. A totalof 62 surveys were received, showing96.77% (60) satisfied patients with thedelivery service, 90.32% (56) with theattention received, 87.10% (54) withthe punctuality and 98.39% (61) withthe conditions of conservation in thehealth center.The high degree of satisfaction of thesurveyed patients reflects that the newTelepharmacy program could respondto the individual needs of the patients,being essential for this the coordinationof all the professionals involved, as wellas the co-responsibility of the patientsin the control of their treatments.With the results obtained in the present study, it seems justified in the future to maintain primary care centersas a dispensing point together with afurther development of the non-faceto-face consultation of PharmaceuticalCare. (AU)


Subject(s)
Humans , Patient Satisfaction , Pharmacy , Primary Health Care
4.
Epidemiol Psychiatr Sci ; 31: e28, 2022 Apr 29.
Article in English | MEDLINE | ID: mdl-35485802

ABSTRACT

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.


Subject(s)
COVID-19 , Depressive Disorder, Major , COVID-19/epidemiology , Depressive Disorder, Major/epidemiology , Health Personnel , Humans , Longitudinal Studies , Pandemics
5.
J Psychiatr Res ; 149: 10-17, 2022 05.
Article in English | MEDLINE | ID: mdl-35217315

ABSTRACT

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.


Subject(s)
COVID-19 , COVID-19/epidemiology , Health Personnel , Humans , Incidence , Organizational Culture , Pandemics , Prospective Studies , Social Justice , Spain/epidemiology , Suicidal Ideation
6.
Psychiatry Res ; 310: 114441, 2022 04.
Article in English | MEDLINE | ID: mdl-35183987

ABSTRACT

INTRODUCTION: The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS: All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS: The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS: . Suicide is higher among physicians than the general population and affects female physicians significantly more.


Subject(s)
Physicians, Women , Physicians , Suicide , Cause of Death , Female , Humans , International Classification of Diseases , Male
7.
World J Biol Psychiatry ; 23(3): 208-218, 2022 03.
Article in English | MEDLINE | ID: mdl-34338147

ABSTRACT

BACKGROUND: Schizophrenia-spectrum disorders (SSD) and Autism spectrum disorders (ASD) are neurodevelopmental disorders that share clinical, cognitive, and genetic characteristics, as well as particular white matter (WM) abnormalities. In this study, we aimed to investigate the role of a set of oligodendrocyte/myelin-related (OMR) genes and their epistatic effect on the risk for SSD and ASD. METHODS: We examined 108 SNPs in a set of 22 OMR genes in 1749 subjects divided into three independent samples (187 SSD trios, 915 SSD cases/control, and 91 ASD trios). Genetic association and gene-gene interaction analyses were conducted with PLINK and MB-MDR, and permutation procedures were implemented in both. RESULTS: Some OMR genes showed an association trend with SSD, while after correction, the ones that remained significantly associated were MBP, ERBB3, and AKT1. Significant gene-gene interactions were found between (i) NRG1*MBP (perm p-value = 0.002) in the SSD trios sample, (ii) ERBB3*AKT1 (perm p-value = 0.001) in the SSD case-control sample, and (iii) ERBB3*QKI (perm p-value = 0.0006) in the ASD trios sample. DISCUSSION: Our results suggest the implication of OMR genes in the risk for both SSD and ASD and highlight the role of NRG1 and ERBB genes. These findings are in line with the previous evidence and may suggest pathophysiological mechanisms related to NRG1/ERBBs signalling in these disorders.


Subject(s)
Autism Spectrum Disorder , Schizophrenia , White Matter , Humans , Schizophrenia/genetics , Autism Spectrum Disorder/genetics , Polymorphism, Single Nucleotide , Genes, erbB , Neuregulin-1/genetics
8.
Transl Psychiatry ; 11(1): 539, 2021 10 19.
Article in English | MEDLINE | ID: mdl-34667144

ABSTRACT

Little is known about the pathophysiological mechanisms of relapse in first-episode schizophrenia, which limits the study of potential biomarkers. To explore relapse mechanisms and identify potential biomarkers for relapse prediction, we analyzed gene expression in peripheral blood in a cohort of first-episode schizophrenia patients with less than 5 years of evolution who had been evaluated over a 3-year follow-up period. A total of 91 participants of the 2EPs project formed the sample for baseline gene expression analysis. Of these, 67 provided biological samples at follow-up (36 after 3 years and 31 at relapse). Gene expression was assessed using the Clariom S Human Array. Weighted gene co-expression network analysis was applied to identify modules of co-expressed genes and to analyze their preservation after 3 years of follow-up or at relapse. Among the 25 modules identified, one module was semi-conserved at relapse (DarkTurquoise) and was enriched with risk genes for schizophrenia, showing a dysregulation of the TCF4 gene network in the module. Two modules were semi-conserved both at relapse and after 3 years of follow-up (DarkRed and DarkGrey) and were found to be biologically associated with protein modification and protein location processes. Higher expression of DarkRed genes was associated with higher risk of suffering a relapse and early appearance of relapse (p = 0.045). Our findings suggest that a dysregulation of the TCF4 network could be an important step in the biological process that leads to relapse and suggest that genes related to the ubiquitin proteosome system could be potential biomarkers of relapse.


Subject(s)
Schizophrenia , Gene Expression , Gene Expression Profiling , Humans , Longitudinal Studies , Recurrence , Schizophrenia/genetics
9.
Psychopharmacology (Berl) ; 238(3): 665-676, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33230696

ABSTRACT

INTRODUCTION: The role of Olanzapine therapeutic drug monitoring is controversial. The present study explores the associations of Olanzapine plasma concentrations with clinical response and metabolic side effects in first episode psychosis (FEP) after 2 months of treatment. METHODS: Forty-seven patients were included. Improvement in clinical symptomatology was assessed using the PANSS. Metabolic assessment included weight, blood pressure, waist circumference, blood glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. RESULTS: The Olanzapine plasma concentrations after 2 months of treatment were positively correlated with weight gain (r = 0.49, p = 0.003), and a concentration > 23.28 ng/mL was identified as a positive predictor of weight gain (≥ 7%). The Olanzapine concentration to dose (C/D) ratio was positively correlated with the percentage of improvement in the total PANSS (r = 0.46, p = 0.004), and a C/D ratio > 2.12 was identified as a positive predictor of a good response (percentage of improvement > 30%) after 2 months of treatment. We also identified several factors that could alter Olanzapine pharmacokinetics: gender (p = 0.03), diagnosis (p = 0.05), smoking habit (p = 0.05), and co-medications such as valproic acid (p = 0.05) and anxiolytics (p = 0.01). DISCUSSION: In conclusion, our results suggest that therapeutic drug monitoring of Olanzapine could be helpful to evaluate therapeutic efficacy and metabolic dysfunction in FEP patients treated with Olanzapine.


Subject(s)
Antipsychotic Agents/blood , Drug Monitoring/methods , Olanzapine/blood , Psychotic Disorders/drug therapy , Adult , Antipsychotic Agents/therapeutic use , Blood Glucose/analysis , Blood Pressure/drug effects , Female , Humans , Male , Middle Aged , Olanzapine/therapeutic use , Psychotic Disorders/blood , Psychotic Disorders/psychology , Smoking/blood , Treatment Outcome , Weight Gain/drug effects
10.
Front Psychiatry ; 11: 568455, 2020.
Article in English | MEDLINE | ID: mdl-33240125

ABSTRACT

Introduction: Recent studies have shown that symptoms of psychiatric illness, functionality, and cognitive function improve with exercise. The aim of this study will be to investigate whether the implementation of an individualized exercise program will improve the functional status of patients with bipolar disorder (BD). Methods: This longitudinal, interventional, randomized, controlled, simple-blind clinical trial will include 80 patients aged 18-65 years, all of them with BD diagnosis. Patients will be randomly assigned to a physical exercise intervention + Treatment-As-Usual (TAU) group and a non-intervention + TAU group. Patients will be assessed by an extensive battery of clinical tests, physical parameters (e.g., brain structure changes measured by optical coherence tomography, cardiorespiratory fitness) and biological parameters (inflammation, oxidative stress and neurotrophic factors) at baseline, after a 4-month intervention period, and 6-month follow-up. Discussion: This is an innovative study aimed at gaining a deeper understanding of the physiopathology of BD and determining whether the prognosis and evolution of the disease can be improved through modifiable areas of the patient's lifestyle. Clinical Trial Registration: NCT04400630. NCT clinicaltrials.gov. Date of registration in primary registry 22 May 2020. clinicaltrials.gov.

11.
Psychol Med ; 50(16): 2702-2710, 2020 12.
Article in English | MEDLINE | ID: mdl-31637990

ABSTRACT

BACKGROUND: Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. METHODS: The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. RESULTS: At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). CONCLUSIONS: Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.


Subject(s)
Cognitive Reserve , Psychosocial Functioning , Psychotic Disorders/psychology , Social Cognition , Adolescent , Adult , Female , Humans , Linear Models , Male , Mediation Analysis , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychotic Disorders/diagnosis , Young Adult
12.
Acta Psychiatr Scand ; 141(6): 541-552, 2020 06.
Article in English | MEDLINE | ID: mdl-31746462

ABSTRACT

AIMS: Here, we present a clustering strategy to identify phenotypes of antipsychotic (AP) response by using longitudinal data from patients presenting first-episode psychosis (FEP). METHOD: One hundred and ninety FEP with complete data were selected from the PEPs project. The efficacy was assessed using total PANSS, and adverse effects using total UKU, during one-year follow-up. We used the Klm3D method to cluster longitudinal data. RESULTS: We identified four clusters: cluster A, drug not toxic and beneficial; cluster B, drug beneficial but toxic; cluster C, drug neither toxic nor beneficial; and cluster D, drug toxic and not beneficial. These groups significantly differ in baseline demographics, clinical, and neuropsychological characteristics (PAS, total PANSS, DUP, insight, pIQ, age of onset, cocaine use and family history of mental illness). CONCLUSIONS: The results presented here allow the identification of phenotypes of AP response that differ in well-known simple and classic clinical variables opening the door to clinical prediction and application of personalized medicine.


Subject(s)
Antipsychotic Agents/therapeutic use , Phenotype , Precision Medicine , Psychotic Disorders/drug therapy , Psychotic Disorders/psychology , Cohort Studies , Female , Humans , Male
13.
Eur Child Adolesc Psychiatry ; 28(10): 1395-1405, 2019 Oct.
Article in English | MEDLINE | ID: mdl-30843122

ABSTRACT

A precise description of the inflammatory response in first-episode psychosis (FEP) by age of onset does not exist. We explored baseline and 6-month follow-up differences in the pro/anti-inflammatory balance in plasma and peripheral blood mononuclear cells in adolescent-onset FEP (≤ 18 y.o., N = 27) and adult-onset FEP (≥ 25 y.o., N = 43) using non-parametric 1-category ANCOVA, with age group as an independent variable and values of pro- and anti-inflammatory markers at baseline and at follow-up as dependent variables. We used a non-parametric repeated-measures mixed-effects model to explore the baseline/6-month change in pro- and anti-inflammatory markers within adolescent- and adult-onset groups, exploring differential trajectories of change by means of the interaction of time by age-of-onset group. Levels of the nuclear transcription factor (NFκB), a master regulator of the inflammatory and oxido/nitrosative status of cells, were higher in adolescent-onset FEP both at baseline and after 6 months. During follow-up, we found further increases in levels of soluble inflammatory markers (PGE2 and NO2-) only in adolescent-onset FEP. In contrast, in adult-onset FEP, the expression of inducible NO synthase (iNOS), which is also pro-inflammatory, tended to decrease, with no further increase in other pro-inflammatory markers. Significant differences in the direction of change by age-of-onset cohort exist only for NFκB (F = 4.165, df = 2, 70.95, p = 0.019). Our results support the existence of changes in the pro/anti-inflammatory balance in FEP depending on the neurodevelopmental stage at illness onset. These results also suggest that inflammation may be a potential therapeutic target in adolescent-onset FEP.


Subject(s)
Biomarkers/blood , Inflammation/metabolism , Psychotic Disorders/etiology , Adolescent , Adult , Child , Cohort Studies , Female , Humans , Male , Young Adult
14.
BMC Psychiatry ; 19(1): 63, 2019 02 11.
Article in English | MEDLINE | ID: mdl-30744589

ABSTRACT

BACKGROUND: The role of dietary patterns in the prevention of unipolar depression has been analyzed in several epidemiological studies. The primary aims of this study are to determine the effectiveness of an extra-olive oil-enriched Mediterranean diet in reducing the recurrence of depression and improving the symptoms of this condition. METHODS: Multicenter, two-arm, parallel-group clinical trial. Arm 1, extra-virgin olive oil Mediterranean diet; Arm 2, control group without nutritional intervention. Dieticians are in charge of the nutritional intervention and regular contact with the participants. Contacts are made through our web platform ( https://predidep.es/participantes/ ) or by phone. Recurrence of depression is assessed by psychiatrists and clinical psychologists through clinical evaluations (semi-structured clinical interviews: Spanish SCID-I). Depressive symptoms are assessed with the Beck Depression Inventory. Information on quality of life, level of physical activity, dietary habits, and blood, urine and stool samples are collected after the subject has agreed to participate in the study and once a year. DISCUSSION: To the best of our knowledge, the PREDI-DEP trial is the first ongoing randomized clinical trial designed to assess the role of the Mediterranean diet in the prevention of recurrent depression. It could be a cost-effective approach to avoid recurrence and improve the quality of life of these patients. TRIAL REGISTRATION: The study has been prospectively registered in the U.S. National Library of Medicine ( https://clinicaltrials.gov ) with NCT number: NCT03081065.


Subject(s)
Depression/prevention & control , Depressive Disorder/prevention & control , Diet, Mediterranean , Olive Oil , Depression/diet therapy , Depressive Disorder/diet therapy , Dietary Supplements , Exercise , Female , Humans , Male , Middle Aged , Quality of Life , Randomized Controlled Trials as Topic , Secondary Prevention
15.
Acta Psychiatr Scand ; 138(5): 441-455, 2018 11.
Article in English | MEDLINE | ID: mdl-30105820

ABSTRACT

OBJECTIVE: Cognitive reserve (CR) refers to the brain's capacity to cope with pathology in order to minimize the symptoms. CR is associated with different outcomes in severe mental illness. This study aimed to analyze the impact of CR according to the diagnosis of first-episode affective or non-affective psychosis (FEP). METHOD: A total of 247 FEP patients (211 non-affective and 36 affective) and 205 healthy controls were enrolled. To assess CR, common proxies have been integrated (premorbid IQ; education-occupation; leisure activities). The groups were divided into high and low CR. RESULTS: In non-affective patients, those with high CR were older, had higher socioeconomic status (SES), shorter duration of untreated psychosis, and a later age of onset. They also showed greater performance in most cognitive domains. In affective patients, those with a greater CR showed a higher SES, better functioning, and greater verbal memory performance. CONCLUSION: CR plays a differential role in the outcome of psychoses according to the diagnosis. Specifically, in order to address the needs of non-affective patients with low CR, cognitive rehabilitation treatments will need to be 'enriched' by adding pro-cognitive pharmacological agents or using more sophisticated approaches. However, a functional remediation therapy may be of choice for those with an affective psychosis and low CR.


Subject(s)
Affective Disorders, Psychotic/physiopathology , Cognitive Dysfunction/physiopathology , Cognitive Reserve/physiology , Psychotic Disorders/physiopathology , Schizophrenia/physiopathology , Adult , Affective Disorders, Psychotic/complications , Age Factors , Age of Onset , Cognitive Dysfunction/etiology , Cognitive Dysfunction/therapy , Cognitive Remediation , Female , Follow-Up Studies , Humans , Male , Psychotic Disorders/complications , Schizophrenia/complications , Social Class , Young Adult
16.
J Affect Disord ; 238: 297-304, 2018 10 01.
Article in English | MEDLINE | ID: mdl-29902733

ABSTRACT

OBJECTIVE: This study aimed to assess (1) whether there were clinical, neuropsychological and functional differences between and within affective and non-affective psychoses at baseline and two years-follow-up and (2) to explore clinical and neuropsychological predictors of psychosocial functioning in the whole sample. METHOD: This is a subanalysis from a multicentre, naturalistic, longitudinal prospective study ('Phenotype-genotype and environmental interaction. Application of a predictive model in first psychotic episodes'). The sample consisted of 192 patients with a first psychotic episode (FEP): 142 with non-affective psychoses and 50 with affective psychoses. Student t-tests, paired t-tests, Pearson correlations, ANOVAs and regression analyses were performed. RESULTS: At baseline, the groups differed in perseverative errors (WCST), Premorbid Adjustment Scale (PAS), family history of psychiatric disorder, negative (PANSS) and manic symptoms (YMRS). At two years follow-up, the groups differed in all the PANSS subscales and in depressive symptoms assessed by the MADRS. When the whole sample was considered, the regression model which best explained the estimated variance in functioning at follow-up (41%) was composed by PANSS total score and verbal fluency assessed by the FAS (COWAT). CONCLUSIONS: We found clinical and neurocognitive differences at baseline which decreased in the follow-up. Reduced performances at baseline in executive functions in combination with symptom severity (PANSS) were predictors of FEP patients' poor functional outcome.


Subject(s)
Affect , Psychotic Disorders/psychology , Adolescent , Adult , Analysis of Variance , Depression , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests , Prospective Studies , Regression Analysis
17.
Acta Psychiatr Scand ; 138(2): 145-154, 2018 08.
Article in English | MEDLINE | ID: mdl-29726004

ABSTRACT

OBJECTIVE: The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. METHODS: Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. RESULTS: The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. CONCLUSIONS: Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.


Subject(s)
Bipolar Disorder/psychology , Cyclothymic Disorder/psychology , Neurocognitive Disorders/psychology , Adult , Bipolar Disorder/classification , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Memory, Short-Term/physiology , Middle Aged , Neuropsychological Tests/statistics & numerical data , Spain/epidemiology , Speech Disorders/psychology
18.
Eur Arch Psychiatry Clin Neurosci ; 268(7): 699-711, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29164332

ABSTRACT

Individual changes over time in cognition in patients with psychotic disorders have been studied very little, especially in the case of first episode psychosis (FEP). We aimed to establish whether change in individual trajectories in cognition over 2 years of a sample of 159 FEP patients was reliable and clinically significant, using the reliable change index (RCI) and clinically significant change (CSC) methods. We also studied a sample of 151 matched healthy controls. Patients and controls were assessed with a set of neuropsychological tests, as well as premorbid, clinical and functionality measures. We analysed the course of cognitive measures over time, using analysis of variance, and the individual trajectories in the cognitive measures with the regression-based RCI (RCISRB) and the CSC. The RCISRB showed that between 5.4 and 31.2% of the patients showed deterioration patterns, and between 0.6 and 8.8% showed improvement patterns in these tests over time. Patients showing better cognitive profiles according to RCISRB (worsening in zero to two cognitive measures) showed better premorbid, clinical and functional profiles than patients showing deterioration patterns in more than three tests. When combining RCISRB and CSC values, we found that less than 10% of patients showed improvement or deterioration patterns in executive function and attention measures. These results support the view that cognitive impairments are stable over the first 2 years of illness, but also that the analysis of individual trajectories could help to identify a subgroup of patients with particular phenotypes, who may require specific interventions.


Subject(s)
Attention/physiology , Cognitive Dysfunction/physiopathology , Disease Progression , Executive Function/physiology , Psychotic Disorders/physiopathology , Adolescent , Adult , Cognitive Dysfunction/etiology , Female , Follow-Up Studies , Humans , Male , Neuropsychological Tests , Psychotic Disorders/complications , Young Adult
19.
Stress Health ; 34(1): 115-126, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28639427

ABSTRACT

The individual process of resilience has been related to positive outcomes in mental disorders. We aimed (a) to identify the resilience domains from the Resilience Questionnaire for Bipolar Disorder that are associated cross sectionally and longitudinally with mental health outcomes in bipolar disorder (BD) and (b) to explore cross-lagged associations among resilience factors. A clinical adult sample of 125 patients diagnosed with BD (62.10% female, mean age = 46.13, SD = 10.89) gave their informed consent and completed a battery of disease-specific tools on resilience, personal recovery, symptomatology, psychosocial functioning, and quality of life, at baseline and at follow-up (n = 63, 58.10% female, mean age = 45.13, SD = 11.06, participation rate = 50.40%). Resilience domains of self-management of BD, turning point, self-care, and self-confidence were significantly associated with mental health indicators at baseline. In addition, self-confidence at baseline directly predicted an increase in personal recovery at follow-up, and self-confidence improvement mediated the relationship between interpersonal support and self-care at baseline and personal recovery at follow-up. These findings highlight that resilience domains are significantly associated with positive mental health outcomes in BD and that some predict personal recovery at follow-up. Moreover, some resilience factors improve other resilience factors over time.


Subject(s)
Bipolar Disorder/psychology , Mental Health , Quality of Life/psychology , Resilience, Psychological , Social Support , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Self Care , Surveys and Questionnaires
20.
Acta Psychiatr Scand ; 136(6): 571-582, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28722128

ABSTRACT

OBJECTIVE: To confirm prior findings that the larger the maximum monthly increase in solar insolation in springtime, the younger the age of onset of bipolar disorder. METHOD: Data were collected from 5536 patients at 50 sites in 32 countries on six continents. Onset occurred at 456 locations in 57 countries. Variables included solar insolation, birth-cohort, family history, polarity of first episode and country physician density. RESULTS: There was a significant, inverse association between the maximum monthly increase in solar insolation at the onset location, and the age of onset. This effect was reduced in those without a family history of mood disorders and with a first episode of mania rather than depression. The maximum monthly increase occurred in springtime. The youngest birth-cohort had the youngest age of onset. All prior relationships were confirmed using both the entire sample, and only the youngest birth-cohort (all estimated coefficients P < 0.001). CONCLUSION: A large increase in springtime solar insolation may impact the onset of bipolar disorder, especially with a family history of mood disorders. Recent societal changes that affect light exposure (LED lighting, mobile devices backlit with LEDs) may influence adaptability to a springtime circadian challenge.


Subject(s)
Bipolar Disorder/epidemiology , Electromagnetic Radiation , Internationality , Seasons , Adolescent , Adult , Africa/epidemiology , Age of Onset , Asia/epidemiology , Australia/epidemiology , Europe/epidemiology , Female , Humans , Male , Middle Aged , North America/epidemiology , Solar System , South America/epidemiology , Sunlight , Young Adult
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