Basic quality indicators for clinical care of patients with major depression, schizophrenia, and bipolar disorder.

OBJECTIVE: To identify a set of indicators to monitor the quality of care for patients with major depression, schizophrenia, or bipolar disorder. METHODS: A group of 10 experts selected the most automatically applicable indicators from a total of 98 identified in a previous study. Five online sessions and 5 discussion meetings were performed to select the indicators that met theoretical feasibility criteria automatically. Subsequently, feasibility was tested in a pilot study conducted in two hospitals of the Spanish Health Service. RESULTS: After evaluating its measurement possibilities in the Spanish Health Service, and the fulfillment of all the quality premises defined, 16 indicators were selected. Three were indicators of major depression, 5 of schizophrenia, 3 of bipolar disorder, and 5 indicators common to all three pathologies. They included measures related to patient safety, maintenance and follow-up of treatment, therapeutic adherence, and adequacy of hospital admissions. After the pilot study, 5 indicators demonstrated potential in the automatic generation of results, with 3 of them related to treatments (clozapine in schizophrenia, lithium for bipolar disorder, and valproate in women of childbearing age). CONCLUSIONS: Indicators support the monitoring of the quality of treatment of patients with major depression, schizophrenia, or bipolar disorder. Based on this proposal, each care setting can draw up a balanced scorecard adjusted to its priorities and care objectives, which will allow for comparison between centers.

Psicosis lúpica: revisión de la literatura a propósito de un caso / Lupus psychosis: presentation of a case and a literature review

El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria crónica autoinmune que afecta al tejido conectivo de múltiples órganos. Las alteraciones neuropsiquiátricas en el LES son habituales y definitorias, con prevalencias de hasta el 95% según algunos estudios. Sin embargo, la psicosis lúpica es poco común, con prevalencias que oscilan entre el 2 y el 11%. Se presenta el caso de una mujer de 30 años con 2 hospitalizaciones psiquiátricas previas por clínica psicótica y actualmente en tratamiento antipsicótico, que ingresa por cuadro compatible con síndrome hemolítico urémico. Dados los resultados de la batería de pruebas complementarias efectuada, se diagnostica de LES y se postula de forma retrospectiva la impresión diagnóstica de una psicosis lúpica. Esta revisión recalca el valor de la realización de pruebas complementarias como baterías de autoinmunidad con anticuerpos antinucleares y técnicas de neuroimagen en los primeros episodios psicóticos para descartar etiologías orgánicas, como la psicosis lúpica

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that affects the connective tissue in multiple organs. The neuropsychiatric changes in SLE are common and well-defined, with prevalences up to 95% according to some studies. However, lupus psychosis is uncommon, with prevalences that vary between 2% and 11%. The case is presented of a 30 year-old woman with 2 previous psychiatric hospital admissions due to a clinical picture of psychosis. She was currently on anti-psychotic treatment, and was admitted due to a clinical picture compatible with Uraemic Haemolytic Syndrome. Given the results of the battery of complementary tests carried out, she was diagnosed with SLE, and retrospectively a lupus psychosis was diagnosed. This review re-assesses the value of carrying out batteries of complementary tests of autoimmunity with antinuclear antibodies and neuro-imaging techniques in the primary psychotic episodes in order to rule organic origins, such as lupus psychosis

Formación en investigación durante el mir / Training in research as part of the specialist training programme

No disponible

Efectos adversos de antipsicóticos atípicos, diferencias según sexo / Gender differences in the adverse effects of atypical antipsychotic drugs

Los efectos adversos de los antipsicóticos atípicos varían en función del sexo de los pacientes. Las mujeres tienen un peso medio inferior al de los hombres, y además, a nivel farmacocinético tienen un menor aclaramiento de algunos antipsicóticos como la clozapina y olanzapina. Entre los efectos secundarios más frecuentes en mujeres, cabe destacar el incremento del intervalo QT corregido. También el riesgo metabólico es mayor en mujeres: estas tienen más probabilidades de aumentar el peso tras tratamientos prolongados, sobre todo con clozapina y olanzapina. La prolactina se incrementa más en las mujeres que en los varones tras tratamiento antipsicótico. Este efecto secundario es más frecuente con amisulpride, risperidona y paliperidona. Entre los efectos secundarios extrapiramidales, la acatisia es también más frecuente en mujeres. En el futuro es necesario tener en cuenta la variable género al hacer el cálculo de la dosis y valoración de efectos secundarios tras el tratamiento antipsicótico (AU)

The adverse effects of atypical antipsychotic drugs vary depending on the sex of the patients. Females have a lower mean body weight than males, thus, at pharmacokinetic level, they have a lower clearance of some antipsychotics such as, clozapine and olanzapine. Among the most common adverse effects is highlighted the increase in corrected QT interval. Metabolic risks are also greater in females, with these being more likely to increase the weight after prolonged treatments, particularly with clozapine and olanzapine. Prolactin is increased more in females than in males after antipsychotic treatment. This adverse effect is more common with amisulpride, risperidone and paliperidone. Among the extrapyramidal secondary effects, akathisia is also more common in females. Gender variability should be taken into account in the future when calculating the dose, as well as when evaluating the adverse effects after antipsychotic treatment (AU)

A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania.

BACKGROUND: This randomized controlled trial compares the efficacy and safety of olanzapine vs haloperidol, as well as the quality of life of patients taking these drugs, in patients with bipolar mania. METHODS: The design consisted of 2 successive, 6-week, double-blind periods and compared flexible dosing of olanzapine (5-20 mg/d, n = 234) with haloperidol (3-15 mg/d, n = 219). RESULTS: Rates of remission (Young-Mania Rating Scale score of < or =12 and 21-item Hamilton Rating Scale for Depression score of < or =8 at week 6) were similar for olanzapine- and haloperidol-treated patients (52.1% vs 46.1%, respectively; P =.15). For the subgroup of patients whose index episode did not include psychotic features, rates of remission were significantly greater for the olanzapine group compared with the haloperidol group (56.7% vs 41.6%, P =.04). Relapse into an affective episode (mania and/or depression) occurred in 13.1% and 14.8% of olanzapine- and haloperidol-treated patients, respectively (P =.56). Switch to depression occurred significantly more rapidly with haloperidol than with olanzapine when using survival analysis techniques (P =.04), and significantly more haloperidol-treated patients experienced worsening of extrapyramidal symptoms, as indicated by several measures. Weight gain was significantly greater in the olanzapine group compared with the haloperidol group (2.82 vs 0.02 kg, P<.001). The olanzapine group had significant improvement in quality of life on several dimensions compared with the haloperidol group. CONCLUSIONS: These data suggest that olanzapine does not differ from haloperidol in achieving overall remission of bipolar mania. However, haloperidol carries a higher rate of extrapyramidal symptoms, whereas olanzapine is associated with weight gain.