Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients.

BACKGROUND: Schizophrenia is a severe mental disorder that often manifests within the first three decades of life. Its prognosis is uncertain and may result in a prolonged treatment that could extend throughout the entire lifespan of the patient. Antipsychotic drugs are characterized by a high interindividual variability when considering therapeutic effect and emergence of adverse effects. Such interindividual variability is thought to be associated primarily with pharmacokinetic matters. OBJECTIVE: The objective of this study was to evaluate the economic impact of the application of the 5-Step Precision Medicine model (5SPM), an approach based on the pharmacogenetic analysis of the primary genes involved in the metabolism of the therapy for each patient, restructuring treatment as necessary. PATIENTS AND METHODS: One hundred eighty-eight psychiatry patients were analysed for single nucleotide polymorphisms on genes CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5 and ABCB1. Information on patients' diagnosis, pharmacotherapy, and hospitalizations was collected. RESULTS: We achieved a cost-benefit ratio of 3.31-3.59 with a reduction of direct cost (hospitalizations plus pharmacotherapy) with a reduction of total cost in 67% of the patients who underwent the clinical intervention. CONCLUSION: A rational Precision Medicine-based approach to psychiatric patients could result in a reduction on number of drugs required to control exacerbations, and the underlying pathologies, reducing the risk of adverse effects and improving adherence to treatment, leading to a potential decrease in direct costs. This methodology has been shown to be cost-dominant and, being based on a pharmacogenetic analysis, it has a lifelong nature, as the data obtained can be applied to other medical disciplines.

Case Report: Pharmacogenetics Applied to Precision Psychiatry Could Explain the Outcome of a Patient With a New CYP2D6 Genotype.

Precision medicine applied to psychiatry provides new insight into the promising field of precision psychiatry. Psychotic disorders are heterogeneous, complex, chronic, and severe mental disorders. Not only does the prognosis and the course of the disease vary among patients suffering from psychotic disorders, but the treatment response varies as well. Although antipsychotic drugs are the cornerstone of the treatment of schizophrenia, many patients only partially respond to these drugs. Furthermore, patients often experience adverse events which can lead to poor treatment adherence. Interindividual variability in drug response could be related to age, gender, ethnicity, lifestyle factors, pharmacological interactions, obesity, and genetics, all of which influence the process of drug metabolism. Commonly prescribed antipsychotics are metabolized by cytochrome P450 (CYP450) enzymes, and CYP450 genes are highly polymorphic. Pharmacogenetic testing is increasingly being used to predict a patient's drug response and could help to find the most appropriate therapy for an individual patient. In this report, we describe a psychotic patient who did not receive adequate clinical follow-up and subsequently presented adverse events, which could be explained by his pharmacogenetic profile and the drug interactions resulting from the polypharmacy prescribed.

Encefalopatía posterior reversible con disociación clinicorradiológica / Posterior reversible encephalopathy with clinicoradiological dissociation

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[Personality traits in patients with chronic migraine: a categorial and dimensional study in a series of 30 patients]. / Rasgos de personalidad en migraña crónica: estudio categorial y dimensional en una serie de 30 pacientes.

INTRODUCTION: The pathogenic role of personality in migraine has not yet been defined. It can be studied by means of dimensional or categorial measurement instruments, although there is no agreement as to the most suitable approach in this respect either. AIM: To analyse the personality of patients with chronic migraine from the dimensional and categorial point of view. PATIENTS AND METHODS: We used the Salamanca questionnaire as our categorial test and, as the dimensional test, we employed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Mood disorders were evaluated with the hospital anxiety and depression scale and the impact of migraine was determined by means of the Headache Impact Test-6 (HIT-6). RESULTS: We included 30 patients (26 females), with a mean age of 40.7 ± 9.6 years. One case (3.3%) presented criteria for depression and four (13.3%) for anxiety. In the Salamanca test, the most common personality traits were those included within cluster C: anankastic (n = 28; 93.3%), anxious (n = 18; 60%) and dependent (n = 7; 23.3%). On the MMPI-2, 16 patients (53.3%) fulfilled criteria for hypochondria; 7 (23.3%) for depression; and 10 (33.3%) for hysteria, which are traits included within the neurotic triad. A pattern called 'conversion V' was observed. No correlation was found between the personality traits and the length of time with chronic migraine, the intensity measured by HIT-6 or the excessive use of symptomatic medication. CONCLUSIONS: In the analysis of the personality in chronic migraine, what stood out from the dimensional point of view was neuroticism and as regards the categorial perspective, the obsessive-compulsive or anankastic trait was the most salient. More extensive series need to be conducted, together with comparisons with episodic migraine and population control.

TITLE: Rasgos de personalidad en migraña cronica: estudio categorial y dimensional en una serie de 30 pacientes.Introduccion. El papel patogenico de la personalidad en la migraña no esta definido. Para su estudio se pueden utilizar instrumentos de medida dimensional o categorial, sin que haya tampoco acuerdo acerca del abordaje mas adecuado. Objetivo. Analizar la personalidad de pacientes con migraña cronica desde el punto de vista dimensional y categorial. Pacientes y metodos. Como test categorial utilizamos el cuestionario Salamanca, y, como dimensional, el Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Evaluamos trastornos del animo con la escala de ansiedad y depresion hospitalaria y el impacto de la migraña mediante el Headache Impact Test-6 (HIT-6). Resultados. Incluimos 30 pacientes (26 mujeres), con una edad media de 40,7 ± 9,6 años. Un caso (3,3%) presentaba criterios de depresion, y 4 (13,3%), de ansiedad. En el test Salamanca, los rasgos de personalidad mas frecuentes fueron los integrados en el cluster C: anancastico (n = 28; 93,3%), ansioso (n = 18; 60%) y dependiente (n = 7; 23,3%). En el MMPI-2, 16 pacientes (53,3%) cumplian criterios de hipocondria; 7 (23,3%), de depresion, y 10 (33,3%), de histeria, rasgos integrados en la triada neurotica. Se objetivo una configuracion denominada 'conversiva V'. No hallamos correlacion entre los rasgos de personalidad y el tiempo de migraña cronica, la intensidad medida por el HIT-6 o el uso excesivo de medicacion sintomatica. Conclusiones. En el analisis de la personalidad en la migraña cronica destaca, desde el punto de vista dimensional, el neuroticismo, y respecto al categorial, el rasgo obsesivo-compulsivo o anancastico. Es necesario el estudio de series mas extensas y la comparacion con pacientes con migraña episodica y poblacion control.

Rasgos de personalidad en migraña crónica: estudio categorial y dimensional en una serie de 30 pacientes / Personality traits in patients with chronic migraine: a categorial and dimensional study in a series of 30 patients

Introducción. El papel patogénico de la personalidad en la migraña no está definido. Para su estudio se pueden utilizar instrumentos de medida dimensional o categorial, sin que haya tampoco acuerdo acerca del abordaje más adecuado. Objetivo. Analizar la personalidad de pacientes con migraña crónica desde el punto de vista dimensional y categorial. Pacientes y métodos. Como test categorial utilizamos el cuestionario Salamanca, y, como dimensional, el Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Evaluamos trastornos del ánimo con la escala de ansiedad y depresión hospitalaria y el impacto de la migraña mediante el Headache Impact Test-6 (HIT-6). Resultados. Incluimos 30 pacientes (26 mujeres), con una edad media de 40,7 ± 9,6 años. Un caso (3,3%) presentaba criterios de depresión, y 4 (13,3%), de ansiedad. En el test Salamanca, los rasgos de personalidad más frecuentes fueron los integrados en el cluster C: anancástico (n = 28; 93,3%), ansioso (n = 18; 60%) y dependiente (n = 7; 23,3%). En el MMPI-2, 16 pacientes (53,3%) cumplían criterios de hipocondría; 7 (23,3%), de depresión, y 10 (33,3%), de histeria, rasgos integrados en la tríada neurótica. Se objetivó una configuración denominada ‘conversiva V’. No hallamos correlación entre los rasgos de personalidad y el tiempo de migraña crónica, la intensidad medida por el HIT-6 o el uso excesivo de medicación sintomática. Conclusiones. En el análisis de la personalidad en la migraña crónica destaca, desde el punto de vista dimensional, el neuroticismo, y respecto al categorial, el rasgo obsesivo-compulsivo o anancástico. Es necesario el estudio de series más extensas y la comparación con pacientes con migraña episódica y población control (AU)

Introduction. The pathogenic role of personality in migraine has not yet been defined. It can be studied by means of dimensional or categorial measurement instruments, although there is no agreement as to the most suitable approach in this respect either. Aim. To analyse the personality of patients with chronic migraine from the dimensional and categorial point of view. Patients and methods. We used the Salamanca questionnaire as our categorial test and, as the dimensional test, we employed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Mood disorders were evaluated with the hospital anxiety and depression scale and the impact of migraine was determined by means of the Headache Impact Test-6 (HIT-6). Results. We included 30 patients (26 females), with a mean age of 40.7 ± 9.6 years. One case (3.3%) presented criteria for depression and four (13.3%) for anxiety. In the Salamanca test, the most common personality traits were those included within cluster C: anankastic (n = 28; 93.3%), anxious (n = 18; 60%) and dependent (n = 7; 23.3%). On the MMPI-2, 16 patients (53.3%) fulfilled criteria for hypochondria; 7 (23.3%) for depression; and 10 (33.3%) for hysteria, which are traits included within the neurotic triad. A pattern called ‘conversion V’ was observed. No correlation was found between the personality traits and the length of time with chronic migraine, the intensity measured by HIT-6 or the excessive use of symptomatic medication. Conclusions. In the analysis of the personality in chronic migraine, what stood out from the dimensional point of view was neuroticism and as regards the categorial perspective, the obsessive-compulsive or anankastic trait was the most salient. More extensive series need to be conducted, together with comparisons with episodic migraine and population control (AU)

Tuberculosis miliar con afectación pulmonar, meníngea y ósea / Miliary tuberculosis with pulmonary, meningeal and bone involvement

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Carcinoma microcítico de pulmón y elevación del marcador tumoral CA 19.9 / Small-cell Lung Cancer and Elevated CA 19.9 Tumor Marker Levels

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Estado nutricional y fractura de cadera / No disponible

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Digoxina, función renal y seguridad del paciente / Digoxin, renal function and patient safety

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Prescripción electrónica asistida, uso de medicamentos y seguridad del paciente / Computerized physician order entry, medication use and patient safety

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Interacciones farmacológicas en atención primaria y seguridad del paciente / Drug interactions in primary care and patient safety

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