Illness Insight and Medication Adherence Among Patients With Bipolar Disorder.

The aim of this study was to investigate the factors associated with illness insight and medication adherence in bipolar disorder (BD). This is a cross-sectional study (with a retrospective evaluation of longitudinal variables) and a secondary analysis of a BD database. The insight of 108 outpatients (age, 48.2 ± 14.1 years, 69% women, 33% euthymic) was measured with three items of the Association of Methodology and Documentation in Psychiatry scale. Their adherence was assessed through patients' and caregivers' reports, plus serum levels. We performed multivariate logistic regression analyses. Full insight was independently and directly associated with adherence, a social support score, and depressive symptoms and inversely associated with intensity of manic symptoms, problems ever with alcohol, and age at onset of the first symptoms. Medication adherence was independently and directly associated with insight, being married, and having had a psychiatric hospitalization and inversely with having suffered a high number of depressive episodes, intensity of manic symptoms, and heavy tobacco smoking.

Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial.

The use of alternative interventions, such as gluten-free and casein-free (GFCF) diets, is frequent due to limited therapies for Autism Spectrum Disorder (ASD). Our aims were to determine the influence of a GFCF diet on behavior disorders in children and adolescents diagnosed with ASD and the potential association with urinary beta-casomorphin concentrations. Thirty-seven patients were recruited for this crossover trial. Each patient consumed a normal diet (including gluten and casein) for 6 months and a GFCF diet for another 6 months. The order of the intervention (beginning with normal diet or with GFCF diet) was assigned randomly. Patients were evaluated at three time-points (at the beginning of the study, after normal diet and after GFCF diet). Questionnaires regarding behavior and autism and dietary adherence were completed and urinary beta-casomorphin concentrations were determined at each time-point. No significant behavioral changes and no association with urinary beta-casomorphin concentrations were found after GFCF diet. A 6-month GFCF diet do not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. Further studies with a long follow-up period similar to ours and including placebo and blinding elements are needed to identify better those respondents to GFCF diets.

Weight gain and increase of body mass index among children and adolescents treated with antipsychotics: a critical review.

We performed an updated review of the available literature on weight gain and increase of body mass index (BMI) among children and adolescents treated with antipsychotic medications. A PubMed search was conducted specifying the following MeSH terms: (antipsychotic agents) hedged with (weight gain) or (body mass index). We selected 127 reports, including 71 intervention trials, 42 observational studies and 14 literature reviews. Second-generation antipsychotics (SGAs), in comparison with first-generation antipsychotics, are associated with a greater risk for antipsychotic-induced weight gain although this oversimplification should be clarified by distinguishing across different antipsychotic drugs. Among SGAs, olanzapine appears to cause the most significant weight gain, while ziprasidone seems to cause the least. Antipsychotic-induced BMI increase appears to remain regardless of the specific psychotropic co-treatment. Children and adolescents seem to be at a greater risk than adults for antipsychotic-induced weight gain; and the younger the child, the higher the risk. Genetic or environmental factors related to antipsychotic-induced weight gain among children and adolescents are mostly unknown, although certain genetic factors related to serotonin receptors or hormones such as leptin, adiponectin or melanocortin may be involved. Strategies to reduce this antipsychotic side effect include switching to another antipsychotic drug, lowering the dosage or initiating treatment with metformin or topiramate, as well as non-pharmacological interventions. Future research should avoid some methodological limitations such as not accounting for age- and sex-adjusted BMI (zBMI), small sample size, short period of treatment, great heterogeneity of diagnoses and confounding by indication.

Magnesium and depression: a systematic review.

INTRODUCTION: The incidence of depression is increasing worldwide. Much is still unknown about the possible role of magnesium in depression prevention and treatment. Magnesium has an effect on biological and transduction pathways implicated in the pathophysiology of depression. The possible role of magnesium in depression prevention and treatment remains unclear. OBJECTIVES: We systematically reviewed the possible links between magnesium and depression in humans. METHODS: Twenty-one cross-sectional studies, three intervention trials, one prospective study, one case only study, and one case series study were included based on specific selection criteria. RESULTS: A higher intake of dietary magnesium seems to be associated with lower depression symptoms though reverse causality cannot be excluded. The results assessing the association between blood and cerebrospinal fluid magnesium and depression are inconclusive. DISCUSSION: Magnesium seems to be effective in the treatment of depression but data are scarce and incongruous. Disturbance in magnesium metabolism might be related to depression. Oral magnesium supplementation may prevent depression and might be used as an adjunctive therapy. However, more interventional and prospective studies are needed in order to further evaluate the benefits of magnesium intake and supplementation for depression.

Overweight and obesity in patients with bipolar disorder or schizophrenia compared with a non-psychiatric sample.

OBJECTIVE: Multiple studies suggest an association of overweight and obesity with bipolar disorder (BD) and schizophrenia. The goal of this paper was to determine the magnitude of this association and its relationship with previous course-of-illness and other variables of clinical interest. METHODS: The prevalence of overweight and obesity was compared among patients with BD (n=108), patients with schizophrenia (n=250) and a non-psychiatric control group (n=290). Moreover, within each group we analyzed the variables associated with overweight [including obesity, i.e., body mass index (BMI) ≥25] and obesity (BMI≥30) adjusting for a possible confounding effect of sex, age and educational level by logistic regression. RESULTS: In comparison with the non-psychiatric sample, a strong association of both BMI≥25 and obesity was observed with BD and schizophrenia (adjusted odds ratios between 3.4 and 4.6; P-values <0.001). Overweight was significantly associated with male sex and increasing age in both control and BD groups; and with female sex among schizophrenia patients. Moreover, for BD patients, earlier onset of first BD symptoms, presence of a non-psychiatric illness, current use of mood-stabilizing medication, and being a non-smoker were significantly associated with overweight; and male sex and the presence of a non-psychiatric illness, with obesity. Within the schizophrenia patients, obesity was significantly associated with female sex, intermediate age range and lower PANSS score. CONCLUSIONS: Among patients with BD or schizophrenia, the chronic course of their illness and their current treatment with psychotropic medication might be more relevant for becoming overweight or obese than the specific psychiatric illness.

Poor adherence to treatment associated with a high recurrence in a bipolar disorder outpatient sample.

BACKGROUND: We analyzed the association of previous course-of-illness and other variables of clinical interest with a high frequency of both depressive or (hypo)manic episodes controlling for the effect of socio-demographic characteristics. METHODS: A total of 108 outpatients with a DSM-IV diagnosis of bipolar disorder (BD) were recruited. A retrospective and naturalistic study was conducted to examine the number of affective episodes and their relationship with socio-demographic, clinical and course-of-illness variables, including adherence to medication, type of medication used and the use of addictive substances. The episode frequency was estimated as the number of "major instances" of depression, hypomania and mania during the illness. To classify the patients into two groups (higher and lower-episode frequency), we used the statistical criterion of median split. Results were analyzed with logistic regression models to control for the effects of potential confounders. RESULTS: A high episode frequency (nine or more episodes) was associated with age (36-55years), delay in diagnosis, poor adherence to medication and current use of antipsychotic medication. In addition, a high frequency of manic episodes (four or more) was associated with female sex, age (>36years) and a manic onset of the illness, whereas a high frequency of depressive episodes (five or more) was associated with delay in diagnosis and poor adherence to medication. LIMITATIONS: Cross-sectional study design. CONCLUSIONS: Avoiding delay in diagnosis and enhancing treatment adherence might be important targets for reducing recurrences in BD.

Nicotine dependence, use of illegal drugs and psychiatric morbidity.

The purpose of this study was to examine the association of smoking and nicotine dependence with psychiatric morbidity, controlling for the potential confounding effect of smoking on the relationship between the use of other substances and psychiatric morbidity. A sample of 290 adults were interviewed at a primary health centre (patients, 58%; patients' relatives, 34%; staff, 8%) to inquire about their tobacco, caffeine, alcohol, and illegal drug consumption. Psychiatric morbidity, defined by a score >6 on the General Health Questionnaire (GHQ-28), showed a strong direct association with nicotine dependence. The use of illegal drugs, but not of alcohol, was also strongly associated with psychiatric morbidity, after controlling for smoking. Both smoking and high nicotine dependence were also associated with use of caffeine, alcohol, cannabis and cocaine. High nicotine dependence may be considered as an expression of individual psychopathologic vulnerability. Tobacco may have a central facilitating role in the use of caffeine, alcohol, and illegal drug.

Tabaco y esquizofrenia / Smoking and schizophrenia

Numerosos estudios en distintos países demuestran repetidamente una asociación significativa entre la esquizofrenia y el fumar tabaco, relativamente independiente de factores socioculturales. En comparación con los fumadores de la población general, los fumadores con esquizofrenia presentan más frecuentemente una alta dependencia nicotínica; pero en esto la esquizofrenia no se distingue de otras enfermedades mentales graves. La elevada prevalencia de “alguna vez fumadores” entre los pacientes con esquizofrenia y el predominio del inicio del fumar antes del diagnóstico sugieren que quienes van a presentar esquizofrenia tienen mayor vulnerabilidad para comenzar a fumar. El efecto reforzante de la nicotina podría ser explicado por la liberación de dopamina, lo que permite enlazar con la teoría dopaminérgica de la esquizofrenia. Los hidrocarburos aromáticos policíclicos del humo del tabaco aumentan el metabolismo de la clozapina, la olanzapina y los antipsicóticos típicos. Algunos estudios, con pequeñas muestras, sugieren que los antipsicóticos típicos se asocian a mayor intensidad en el fumar y a dificultad para dejar de fumar; y que la clozapina se asocia a modestas disminuciones en el fumar. La hipótesis de la automedicación en la esquizofrenia propone que el fumar podría tener efectos cognitivos beneficiosos y reducir síntomas depresivos, ansiosos y psicóticos, así como reducir los efectos secundarios de los antipsicóticos y favorecer la interacción social; pero los estudios clínicos no parecen demostrar esos supuestos efectos beneficiosos. Conviene que los clínicos tengan un planteamiento flexible, de modo que, si la abstinencia no es posible, el objetivo pueda ser la reducción del fumar (AU)

Many studies across different countries demonstrate consistently an association between schizophrenia and current smoking. This association is relatively independent of sociocultural factors. Schizophrenia is found to be associated with high nicotine dependence when schizophrenic smokers are compared with smokers from the general population, but not when they are compared with smokers with other severe mental illnesses. The increased prevalence of ever smoking in schizophrenic patients and the higher rates of smoking initiation before schizophrenia starts suggest that people who are going to develop schizophrenia have some risk factors that make them more vulnerable to start smoking. The reinforcing nicotine properties may be associated with dopamine release, which may allow to make links with the dopamine hypothesis of schizophrenia. The polycyclic aromatic hydrocarbons in tobacco smoke are metabolic inducers of clozapine, olanzapine and typical antipsychotics. Limited and small studies suggest that typical antipsychotics may increase smoking and make it difficult to quit smoking, while clozapine treatment is associated with small smoking decreases. The selfmedication hypothesis in schizophrenia proposes that smoking would improve cognition, decrease depressive, anxious and positive symptoms, decrease antipsychotic side effects, and favor psychosocial interaction; but clinical studies do not appear to demonstrate these allegedly beneficial effects. Clinicians trying to help patients with schizophrenia quit smoking need to be flexible, so that if abstinence is not possible smoking reduction can be an appropriate goal (AU)