Repercusión de vortioxetina sobre la función sexual frente a otros antidepresivos / Impact of vortioxetine on sexual function compared to other antidepressants

Objetivo Analizar la repercusión del antidepresivo vortioxetina sobre la función sexual, frente a inhibidores selectivos de la recaptación de serotonina (ISRS) e inhibidores selectivos mixtos de la recaptación de serotonina y noradrenalina (IRSN o Duales) en pacientes con depresión. Material y métodos Estudio analítico, observacional, longitudinal y prospectivo en el que se incluyeron hombres y mujeres mayores de 18años con trastorno depresivo y actividad sexual en pareja, separándolos en dos grupos: 1)de estudio: inician tratamiento con vortioxetina; 2)control: mantienen tratamiento con ISRS o Duales. Se realizaron tres visitas: inclusión, seguimiento a las 4semanas y final 3meses desde la inclusión. El periodo total de seguimiento fue de 3meses. Resultados Se incluyeron 87 pacientes (edad media, 46,85años). Al final del estudio se hallaron diferencias significativas (DS) en el valor medio de la suma de las puntuaciones de los dominios evaluadores de la respuesta sexual del cuestionario de Función Sexual de la Mujer (FSM-2) entre el grupo de estudio y el de control (22,42±4,39 y 16,13±7,76, respectivamente), con menor riesgo de disfunción sexual en las mujeres tratadas con vortioxetina. También menor riesgo de disfunción sexual en estas mismas mujeres en los dominios de deseo, lubricación, orgasmo, frecuencia sexual y satisfacción sexual. Estas diferencias no se hallaron al evaluar la función sexual masculina. Conclusiones Las mujeres tratadas con vortioxetina presentaron mejor función sexual que las tratadas con ISRS o Duales y menor riesgo de disfunción sexual (AU)

Objective To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. Material and methods Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. Results A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. Conclusions Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction (AU)

[Impact of vortioxetine on sexual function compared to other antidepressants]. / Repercusión de vortioxetina sobre la función sexual frente a otros antidepresivos.

OBJECTIVE: To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. MATERIAL AND METHODS: Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. RESULTS: A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. CONCLUSIONS: Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.

Consenso de la SEPG sobre la depresión en el anciano / Consensus of the SEPG on depression in the elderly

Antecedentes. La limitación del conocimiento clínico epidemiológico y de la evidencia sobre efectividad terapéutica en la depresión en los pacientes ancianos y muy ancianos genera una excesiva variabilidad de prácticas en la atención clínica a estos pacientes en nuestro sistema sanitario. La Sociedad Española de Psicogeriatría (SEPG) se plantea la necesidad de unificar criterios mediante un método estructurado de consenso profesional. Objetivos. Desarrollar un consenso experto de recomendaciones clínicas para optimizar el abordaje clínico de la depresión en el paciente anciano en España, bajo auspicio de la Sociedad Española de Psicogeriatría (SEPG).Métodos. Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con representantes de la especialidad; 3) encuesta postal en dos rondas con procesamiento intermedio de opinión ese informe a los panelistas; y 4) discusión de resultados en sesión presencial del comité científico. Resultados. 61 expertos consultados completaron las dos rondas de evaluación del cuestionario. En la primera rondase logran consensuar 39 de las 54 cuestiones analizadas. Tras la interacción del panel se aumenta el consenso hasta un total de 46 ítems de la encuesta (85% de los contenidos propuestos). En las 8 cuestiones restantes no se consigue un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones. Se presenta un amplio listado de criterios profesionales y recomendaciones clínicas que pretenden racionalizar el manejo de la depresión en el paciente anciano y reducir el exceso de variabilidad en la práctica clínica. Las recomendaciones se cualifican según el grado de acuerdo profesional en que se sustentan y pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background. The limitation of clinical-epidemiological know-how and evidence regarding therapeutic efficiency in depression among the elderly and extremely elderly patients has given rise to an excessive variety of practices in clinical care of these patients in the Spanish health system. The Spanish Society of Psychogeriatrics (SEPG) has raised the question of the need to unify criteria through a structured approach based on professional consensus. Objectives. To develop an expert consensus of clinical recommendations to improve the clinical treatment of depression in elderly patients in Spain, sponsored by the Spanish Society of Psychogeriatrics (SEPG). Methods. Modified Delphi Consensus, in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee, project promoter and responsible for bibliographic review and formulation of recommendations for discussion 2) constitution of a multicenter Panel of Experts with representatives from this specialist field 3) postal survey comprised of two rounds, with interim processing of opinions and a report for the experts and 4) discussion of results during an onsite meeting of the Scientific Committee. Results. The survey evaluation was completed by 61experts consulted, in two rounds. In the first round, consensus was reached in 39 of the 54 questions analyzed. Following interaction by the panel, this consensus was increased to a total of 46 survey items (85% of the proposed contents). It was impossible to obtain a sufficiently unanimous consensus on the remaining 8questions, either due to differences of opinion among the professionals or a lack of established criterion in most of the experts. Conclusions. A full list of criteria and clinical recommendations for the purpose of rationalizing the treatment of depression in elderly patients and reducing excessive variability in clinical practice is presented. The recommendations are qualified in accordance with the degree of consensus of the professionals endorsing the mand can be considered valid until new scientific information becomes available that justifies their review (AU)

Consensus of the SEPG on depression in the elderly.

BACKGROUND: The limitation of clinical-epidemiological know-how and evidence regarding therapeutic efficiency in depression among the elderly and extremely elderly patients has given rise to an excessive variety of practices in clinical care of these patients in the Spanish health system. The Spanish Society of Psychogeriatrics (SEPG) has raised the question of the need to unify criteria through a structured approach based on professional consensus. OBJECTIVES: To develop an expert consensus of clinical recommendations to improve the clinical treatment of depression in elderly patients in Spain, sponsored by the Spanish Society of Psychogeriatrics (SEPG). METHODS: Modified Delphi Consensus, in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee, project promoter and responsible for bibliographic review and formulation of recommendations for discussion 2) constitution of a multicenter Panel of Experts with representatives from this specialist field 3) postal survey comprised of two rounds, with interim processing of opinions and a report for the experts and 4) discussion of results during an on-site meeting of the Scientific Committee. RESULTS: The survey evaluation was completed by 61 experts consulted, in two rounds. In the first round, consensus was reached in 39 of the 54 questions analyzed. Following interaction by the panel, this consensus was increased to a total of 46 survey items (85% of the proposed contents). It was impossible to obtain a sufficiently unanimous consensus on the remaining 8 questions, either due to differences of opinion among the professionals or a lack of established criterion in most of the experts. CONCLUSIONS: A full list of criteria and clinical recommendations for the purpose of rationalizing the treatment of depression in elderly patients and reducing excessive variability in clinical practice is presented. The recommendations are qualified in accordance with the degree of consensus of the professionals endorsing them and can be considered valid until new scientific information becomes available that justifies their review.

Calidad de vida y funcionamiento social en pacientes con esquizofrenia en monoterapia con olanzapina: estudio naturalístico de 1 año de seguimiento / Quality of life and social functioning in schizophrenic patients treated with olanzapine: 1 year follow-up naturalistic study

Objetivo. Evaluar la calidad de vida relacionada con la salud (CVRS) y funcionalidad social de los pacientes esquizofrénicos tratados en monoterapia con olanzapina en condiciones de práctica clínica habitual. Métodos. Se reclutaron pacientes ambulatorios diagnosticados de esquizofrenia que iniciasen tratamiento en monoterapia con olanzapina, quetiapina, risperidona o antipsicóticos típicos orales. Se recogieron las variables sociodemográficas del paciente. En cada visita (basal, 3, 6, 12 meses) se administró el cuestionario genérico de CVRS EuroQoL-5D (EQ-5D) y la Escala de Funcionamiento Social. Resultados. Se siguieron un total de 1.198 pacientes. La edad media (DE) era de 38,6 (13,3) y un 62,9 % era hombres. Según el cuestionario EQ-5D basalmente las dimensiones más afectadas fueron ansiedad/depresión (76 %) y actividades cotidianas (73,6 %). A los 12 meses la cohorte tratada con olanzapina presentó una mejor CVRS en la dimensión de cuidado personal respecto al resto de tratamientos (p < 0,05) y un porcentaje menor en las dimensiones de dolor/malestar, ansiedad/ depresión y actividades habituales respecto al grupo tratado con quetiapina o risperidona (p < 0,05). Según la Escala Visual Analógica (EVA) del cuestionario EQ-5D la cohorte tratada con olanzapina presentó mejor estado de salud a los 12 meses que los tratados con quetiapina o risperidona (p<0,05). La Escala de Funcionamiento Social demostró una mejora a los 12 meses en los pacientes tratados con olanzapina en las tres dimensiones estudiadas: aislamiento y relaciones sociales respecto a los tratados con risperidona (p<0,05), comunicación interpersonal respecto a los tratados con risperidona o quetiapina (p < 0,05) e independencia de ejecución respecto al resto de tratamientos (p<0,05). Conclusión. La mejora en la CVRS y funcionamiento social al año de seguimiento es mayor en aquellos pacientes tratados con olanzapina que con otros antipsicóticos

Objective. To measure health related quality of life (HRQL) and social functioning in schizophrenic patients treated with olanzapine under regular clinical practice conditions. Methods. Out-patients diagnosed of schizophrenia and beginning treatment with olanzapine, quetiapine, risperidone or typical oral antipsychotics were included. Information on socio-demographic characteristics was obtained and in each visit (baseline, 3, 6 and 12 months) they were administered the generic HRQL questionnaire Euro- QoL-5D (EQ-5D) and the Social Functioning Scale (SFS). Results. A total of 1,198 patients were followed-up for 12 months. Mean age (SD) was 38.6 (13.3) years and 62.9 % of them were men. In basal conditions the most affected dimensions of EQ-5D were anxiety/depression (76 %), and daily activities (73.6 %). After 12 months treatment the cohort of patients treated with olanzapine showed a better HRQL in the self-care dimension compared to all other treatments (p < 0.05), and in the dimensions of pain/discomfort, anxiety/depression and usual activities compared to the group treated with quetiapine and risperidone (p < 0.05). The Visual Analogue Scale (VAS) of the EQ-5D questionnaire showed a better health state after 12 months in the group treated with olanzapine compared to the groups of quetiapine or risperidone (p < 0.05). The SFS showed a better improvement in the cohort of olanzapine in the three studied dimensions after 12 months: isolation and social relationships in comparison to the risperidone group (p < 0.05), interpersonal communication in comparison to the risperidone and quetiapine group (p < 0.05) and independence performance in comparison to all the other treatments (p < 0,05). Conclusion. Schizophrenic patients treated with olanzapine for one year show a better improvement in HRQL and social functioning than those treated with other antipsychotics

[Once weekly fluoxetine, tolerability and safety according to use patterns in the psychiatric clinical practice]. / Fluoxetina semanal. Tolerabilidad y seguridad según patrones de uso en la práctica clínica psiquiátrica.

INTRODUCTION: Treatment with selective serotonin reuptake inhibitors (SSRI) has become generalized in all the medical setting although its efficacy and good tolerability may be affected by long term non-compliance. Once weekly fluoxetine could improve compliance due to the comfort of its use. The objective is to evaluate the safety, tolerability and efficacy of once weekly fluoxetine (90 mg) in a sample of out-patients, following naturalistic criteria in the usual clinical practice. METHOD: A total of 46 patients (age: 41.89 +/- 1.85) who received once weekly fluoxetine for at least 3 months (mean time: 135.24 days) were analyzed retrospectively. Clinical Global Impression of Severity (CGI-S) at the onset and end of the period evaluated, presence of adverse events, drop-out index and impression of patient's satisfaction with the treatment and use pattern were used. RESULTS: The mean of the final CGI-S was 2.09, compared with the onset 3.09 (p < 0.02), indicating significant improvement in the efficacy with once weekly fluoxetine. The most frequent adverse effects were: anxiety (10.87 %), headache (8.69 %) and restlessness (8.69 %) related with once weekly fluoxetine. Compliance was very high at the onset (99 %) and at the end (96 %). Ten patients dropped-out of the treatment (27.74 %), 6 due to appearance of undesirable effects (anxiety, headache and insomnia), three due to voluntary wish and only one due to lack of efficacy. The CGI of satisfaction of clinical global efficacy on the final visit was 1.43 (satisfied-very satisfied) and the CGI of satisfaction for the treatment pattern was 1.17 (very satisfied). CONCLUSION: Change to once weekly fluoxetine generally improves satisfaction of treatment efficacy and its use pattern, although some patients return to the initial regime after adverse effects appear.

Tratamiento de mantenimiento: la clave del éxito en la terapia de las depresiones / Maintenance treatment: the key to success in antidepressant therapy

Las depresiones son enfermedades recurrentes o crónicas que conllevan un gran impacto sociosanitario. Se estima que, a largo plazo, la recaída es del 75-80 por ciento, y los factores asociados a riesgo de recurrencia son el elevado número de episodios previos, el corto plazo entre episodios, los antecedentes familiares, la edad elevada, la enfermedad somática concomitante y el mal cumplimiento del tratamiento. En la actualidad, el objetivo principal del tratamiento es que no se abandone cuando se ha logrado la estabilización. Se estima que el 30-40 por ciento de pacientes abandonan el tratamiento en las primeras semanas, y alrededor del 60 por ciento lo abandonan durante el tratamiento de mantenimiento, pese a las recomendaciones de sus médicos. Para mejorar la adherencia se han propuesto diversas medidas, como utilizar fármacos mejor tolerados, pautas sencillas de administración, ayuda de las familias, sistemas de recordatorio diversos, psicoeducación, etc. La mayoría de los antidepresivos pueden ser usados a largo plazo, pero la experiencia con inhibidores de la recaptación de serotonina es más extensa y fiable que con los demás. La utilización de fármacos de acción prolongada, que permiten una disminución del número de tomas, es importante, y en este sentido la experiencia con fluoxetina semanal aporta resultados muy favorables, con tasas de buen cumplimiento a medio y largo plazo del 80-90 por ciento. Dado que el abandono de los tratamientos es la primera causa de recaídas en muchas enfermedades recurrentes o crónicas, lo que tiene graves implicaciones sociosanitarias, es importante promover y facilitar los tratamientos de mantenimiento a largo plazo, y para ello es necesario disponer de fármacos eficaces y seguros, con formas de administración sencillas y cómodas (AU)

Utilidad de sildenafilo en el tratamiento de la disfunción eréctil secundaria a antidepresivos / Use of viagra as treatment for erectile dysfunction as a side-effect of anti-depresant

No disponible

[Utility of quetiapine in tardive dyskinesia]. / Utilidad de la quetiapina en la discinesia tardía.

INTRODUCTION: Neuroleptic induced tardive dyskinesia is a late appearing extrapyramidal disorder of involuntary, choreoatetoid movements. It may appear during chronic treatment with classical neuroleptics or a short time after its prolonged administration is interrupted. At present, there is no agreement on what would be the best way to treat dyskinesias. Clozapine is an alternative treatment to take into account, although the risk of agranulocytosis may be excessive to use it when there is a mild or moderate form of dyskinesia. Cases of improvement of dyskinesias both with olanzapine as well as with risperidone, although in a lower number, have been reported. Due to its receptor profile, quetiapine is the atypical antipsychotic that is most similar to clozapine, which leads us to consider it for the treatment of dyskinesias. METHODS: The first patient is a 66 year old woman with schizoaffective disorder of 16 years of evolution who has received many classical neuroleptics and who presents a picture or orolingual dyskinesias with a score of 28 on the AIMS scale. Treatment was substituted with Quetiapine until reaching a dose of 400 mg/day over 4 months, obtaining a decrease in the AIMS score up to 9. The second patient is a 60 year old woman diagnosed of bipolar disorder under treatment since 26 years of age with delusional jealousy ideation. Different atypical antipsychotics were used, all of them causing dyskinetic symptoms in the orolingual region, that disappeared with low doses of quetiapine, with good stabilization of her psychopathology. The third patient is a 33 old male diagnosed of paranoid schizophrenia when he was 18 years old. He was under maintenance treatment with haloperidol, biperiden and lorazepam, until 27 years of age, when the treatment was changed to risperidone, after presenting an orofacial tardive dyskinesia with masticatory type movements and lingual protrusion, with a 19 score on the AIMS scale. The change to quetiapine 600 mg/day reduced the score on the AIMS scale to 3. DISCUSSION: Our experience, based on 3 cases, shows an early and lasting improvement of the tardive dyskinesia with quetiapine. This experience is reinforced by other investigators with similar cases. In all, we have 12 cases that support the efficacy of quetiapine in the treatment of tardive dyskinesias.

Utilidad de sildenafilo en disfunciones sexuales secundarias a patología psiquiátrica y psicofármacos / Usefulness of sildenafil in sexual dysfunctions secondary to psychiatric disorders and psychotropic drugs

No disponible

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients.

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

[Implication of lead poisoning in psychopathology of Vincent van Gogh]. / Implicación del saturnismo en la psicopatología de Vincent van Gogh.

The authors, by means of documental research, study the possibility that the physical and psychic symptoms of Vincent van Gogh may have been due to chronic lead poisoning. The technique and materials used by Van Gogh are analysed as the cause of repeated exposure to lead as well as the possible means of penetration of the metal. Through historical-biographical analysis, the progressive symptoms of the illness are compared with those of lead poisoning. The authors conclude that the excessive and continuous use by Van Gogh of pigments which were highly toxic due to their high lead content, such as white lead (lead carbonate) and yellow chrome (lead chromium), could have penetrated his organism by digestive system (primarily) in minimal daily amounts, giving rise to a clinical condition of chronic lead poisoning. This type of poisoning coincides with the clinical symptoms Van Gogh describes in his autographed letters: initial debilitation, stomatitis with loss of teeth, recurring abdominal pains, anaemia (with a "plumbic" skin tone), neuropathy of the radial and saturnine encephalopathy including epileptic crises, progressive character changes and periods of delirium. The clinical symptoms shown by Van Gogh meet present criteria for diagnosis of Organic Mental Disorder due to cerebral lesion or somatic illness (F.06; CIE-10) (DSM-IV-R), and Organic Character Disorder (F.07; CIE-10) (DSM-IV-R).

[Aggressiveness and the teaching function]. / Agresividad y función docente.

The authors study aggression with the "Instrument I to measure aggression of Ledesma Jimeno, Rodrigues Isidoro and Izquierdo de la Torre" in a sample of teachers (N = 48) made up of 15 university professors and 33 non-university professors (primary school, secondary school and professional training). The teacher sample is compared with a control sample of 479 men. The group of non-university professors showed more self-aggression and less aggression toward others than the control sample and university sample did. Both groups of teachers showed high levels of "technical intelligence". The aggression of the university professors was very similar to the control group and showed special peculiarities giving high values of intrapsychic incoherence that made their conduct more unforeseeable, with higher creative dispositions and a higher risk to their mental health than the other two groups studied.