Brief day hospital mentalization based group psychotherapy for schizophrenia spectrum disorders: A feasibility study.

BACKGROUND: Mentalization-based therapy (MBT), a manualized psychodynamically and developmentally oriented psychotherapy, has been proven effective in controlled studies in non-psychotic patients with severe mental disorders. Although MBT is currently being used to treat schizophrenia spectrum disorders (SSD), to date no prospective studies have evaluated outcomes and treatment-related adverse effects. Brief mentalization-based group psychotherapy (B-MBGT) is a 12-week program based on the explicit mentalizing techniques of MBT. The study was conducted at a day hospital (DH) and the main objective was to examine the feasibility of B-MBGT to treat patients with SSD. METHOD: Open study to assess the safety of B-MBGT in 72 patients who met DSM-IV criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, or unspecified psychotic disorder. All patients underwent both B-MBGT and Integrated Psychological Therapy (IPT). Consequently, a secondary aim was to compare these two therapies in terms of acceptance and subjective efficacy. RESULTS: Adverse reactions were scarce and the most common of the reported ones, discomfort during the group treatment session, was considered mild in most cases. Compared to IPT, B-MBGT yielded significant higher scores on four subjective efficacy parameters. CONCLUSION: B-MBGT in DH is both feasible and safe in SSD patients and most patients in this study considered B-MBGT to be beneficial. Controlled studies are needed to determine the effectiveness of B-MBGT.

Psicoterapia de grupo breve basada en la mentalización en hospital de día para trastornos del espectro esquizofrénico: Un estudio de viabilidad / Brief day hospital mentalization based group psychotherapy for schizophrenia spectrum disorders: A feasibility study

INTRODUCCIÓN: La terapia basada en la mentalización (TBM), una psicoterapia manualizada de orientación psico-dinámica y en la teoría del desarrollo, ha demostrado efectividad en estudios controlados en pacientes con trastornos mentales graves no psicóticos. Aunque la TBM se utiliza en el tratamiento de los trastornos del espectro esquizofrénico (TEE), hasta la fecha no se han realizado estudios prospectivos para evaluar los resultados y los efectos adversos. La terapia de grupo breve basada en la mentalización (B-TGBM) es un programa de 12 semanas basado en las técnicas de mentalización explícita de la TBM. El estudio se realizó en un hospital de día (HD) y el objetivo principal fue examinar la viabilidad de la B-TGBM en pacientes con TEE. MÉTODO: Estudio abierto para evaluar la seguridad de la B-TGBM en 72 pacientes que cumplían criterios DSM-IV de esquizofrenia, trastorno esquizofreniforme, trastorno esquizoafectivo o trastorno psicótico no especificado. Todos los pacientes realizaron B-TGBM y terapia psicológica integrada (IPT). Consecuentemente, un objetivo secundario fue compa-rar la aceptación y la eficacia subjetiva de estas dos terapias. RESULTADOS: Las reacciones adversas fueron escasas y la más común de las registradas, malestar durante la sesión de grupo, se consideró leve en la mayoría de los casos. Comparada con la IPT, la B-TGBM presentó puntuaciones significativamente superiores en cuatro de los parámetros de eficacia subjetiva. CONCLUSIÓN: La B-TGBM en HD es viable y segura en pacientes con TEE y la mayoría de los pacientes en este estudio la consideraron beneficiosa. Se necesitan estudios controla-dos para determinar la efectividad de la B-TGBM

BACKGROUND: Mentalization-based therapy (MBT), a manualized psychodynamically and developmentally orient-ed psychotherapy, has been proven effective in controlled studies in non-psychotic patients with severe mental disorders. Although MBT is currently being used to treat schizo-phrenia spectrum disorders (SSD), to date no prospective studies have evaluated outcomes and treatment-related adverse effects. Brief mentalization-based group psychotherapy (B-MBGT) is a 12-week program based on the explicit mentalizing techniques of MBT. The study was conducted at a day hospital (DH) and the main objective was to examine the feasibility of B-MBGT to treat patients with SSD. Method. Open study to assess the safety of B-MBGT in 72 patients who met DSM-IV criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, or unspecified psychotic disorder. All patients underwent both B-MBGT and Integrated Psychological Therapy (IPT). Consequently, a secondary aim was to compare these two therapies in terms of acceptance and subjective efficacy. RESULTS: Adverse reactions were scarce and the most common of the reported ones, discomfort during the group treatment session, was considered mild in most cases. Compared to IPT, B-MBGT yielded significant higher scores on four subjective efficacy parameters. CONCLUSION: B-MBGT in DH is both feasible and safe in SSD patients and most patients in this study considered B-MBGT to be beneficial. Controlled studies are needed to determine the effectiveness of B-MBGT

Reducción en la concentración sérica del ácido valproico secundaria a la toma de ibuprofeno como ejemplo de autoinducción metabólica del ácido valproico / Reduction in serum concentration of valproic acid secondary to the intake of ibuprofen as an example of valproic acid auto-induction metabolism

Introducción. En 1998, se comunicó una inexplicada interacción farmacológica entre el ácido valproico (AVP) e ibuprofeno. El AVP se ha considerado un inhibidor moderado de varias enzimas metabólicas, pero recientemente se han descrito propiedades inductivas que incluyen la posibilidad de auto-inducción. Ibuprofeno puede desplazar el AVP de las proteínas plasmáticas, aumentando su concentración plasmática libre y consecuentemente sus acciones farmacológicas, incluyendo la auto-inducción. El objetivo de este artículo es describir un caso similar y contribuir a clarificar los mecanismos farmacocinéticos subyacentes. Metodología. En un varón caucásico español de 29 años con esquizofrenia se siguieron durante 5 años las concentraciones plasmáticas de AVP y clozapina, incluyendo 3 ensayos con ibuprofeno. La variable de resultado principal fue la concentración-dosis (C/D) ratio, una medida de la capacidad para eliminar un fármaco. La prueba de U-Mann-Whitney para muestras independientes se utilizó para comparar las C/D ratios. Resultados. Cinco C/D ratios de AVP, contaminadas por auto-inducción de AVP durante o poco después de los dos últimos ensayos con ibuprofeno, fueron significativamente inferiores (p<0.001) que las restantes C/D ratios de AVP. Con la mayor de las dosis de ibuprofeno del tercer ensayo, el paciente tuvo dos C/D ratios de clozapina muy bajas que fueron significativamente inferiores a las restantes C/D ratios de clozapina (p=0,021). Conclusiones. La reducción de las concentraciones plasmáticas totales de AVP puede explicarse porque ibuprofeno desplaza el AVP de las proteínas plasmáticas, incrementando el AVP libre. Éste puede inducir el metabolismo del AVP (y de clozapina) y consecuentemente disminuir su concentración plasmática total

Introduction. In 1998, an unexplained drug-drug interaction between valproic acid (VPA) and ibuprofen was reported. VPA has been considered a moderate inhibitor of several metabolic enzymes, but recently its inductive properties have been described, including the possibility of auto-induction. Ibuprofen can displace VPA from the plasmatic protein, increasing its serum free concentration, and subsequently its pharmacological actions, including auto-induction. The objective of this article is to describe a similar case and to contribute to the clarification of the underlying pharmacokinetic mechanisms. Methods. A 29-year-old Spanish Caucasian male with schizophrenia was followed with steady-state trough serum concentrations of VPA and clozapine for 5 years, including 3 ibuprofen trials. The main outcome variable was the concentration-to-dose (C/D) ratio, a measure of the ability to eliminate a drug. Independent sample Mann-Whitney U tests were performed to compare C/D ratios. Results. Five VPA C/D ratios, contaminated by VPA auto-induction occurring during or shortly after the two latter ibuprofen trials, were significantly lower (p<0.001) than the other 34 VPA C/D ratios of VPA not contaminated by auto-induction. During the highest ibuprofen dose in the third trial, the patient had two very low clozapine C/D ratios, which were significantly lower than the other 26 clozapine C/D ratios (p=0.021). Conclusions. Reduction in total VPA concentrations could be explained by ibuprofen displacing VPA from the plasma proteins, increasing the serum free VPA. This may induce the metabolism of VPA (and clozapine) and subsequently decrease their serum total concentrations

Reduction in serum concentration of valproic acid secondary to the intake of ibuprofen as an example of valproic acid auto-induction metabolism.

INTRODUCTION: In 1998, an unexplained drug-drug interaction between valproic acid (VPA) and ibuprofen was reported. VPA has been considered a moderate inhibitor of several metabolic enzymes, but recently its inductive properties have been described, including the possibility of auto-induction. Ibuprofen can displace VPA from the plasmatic protein, increasing its serum free concentration, and subsequently its pharmacological actions, including auto-induction. The objective of this article is to describe a similar case and to contribute to the clarification of the underlying pharmacokinetic mechanisms. METHODS: A 29-year-old Spanish Caucasian male with schizophrenia was followed with steady-state trough serum concentrations of VPA and clozapine for 5 years, including 3 ibuprofen trials. The main outcome variable was the concentration-to-dose (C/D) ratio, a measure of the ability to eliminate a drug. Independent sample Mann-Whitney U tests were performed to compare C/D ratios. RESULTS: Five VPA C/D ratios, contaminated by VPA auto-induction occurring during or shortly after the two latter ibuprofen trials, were significantly lower (p<0.001) than the other 34 VPA C/D ratios of VPA not contaminated by auto-induction. During the highest ibuprofen dose in the third trial, the patient had two very low clozapine C/D ratios, which were significantly lower than the other 26 clozapine C/D ratios (p=0.021). CONCLUSIONS: Reduction in total VPA concentrations could be explained by ibuprofen displacing VPA from the plasma proteins, increasing the serum free VPA. This may induce the metabolism of VPA (and clozapine) and subsequently decrease their serum total concentrations.

Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study.

BACKGROUND: Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce. METHODS: The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months. RESULTS: The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables - the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits - improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups. CONCLUSION: Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.