Prevalence of depression in type 2 diabetes mellitus. / Prevalencia de la depresión en la diabetes mellitus tipo 2.

BACKGROUND: The relationship between depression and diabetes has been widely documented but there have been methodological limitations such as the failure to conduct a diagnostic interview of the depressive condition. We have estimated the prevalence of depression in patients with type 2 diabetes mellitus (DM2) and its relationship with sociodemographic, lifestyle and clinical variables. PATIENTS AND METHODS: This was a cross-sectional, randomized study (stratified by sex and age) of patients with DM2 treated in a healthcare area with approximately 3000 eligible patients. The depressive symptoms were assessed using the Beck Depression Inventory (depression defined as a BDI score>16) and a psychiatric interview. We used a multivariate logistic regression model to evaluate the association between depression and DM2, after adjusting for known risk factors. RESULTS: We examined 275 patients with DM2 (mean age, 64.5 years; men, 56.4%). The prevalence of depression was calculated at 32.7% (95% CI 27.4-38.5) and increased with age. A greater prevalence of depression was found in women, widowers, patients with obesity, those with poor compliance with the prescription, those with poor glycemic control and those who developed complications from diabetes. Thirty-five percent (95% CI 26.4-45.8) of the patients who scored>16 on the BDI scale had not been diagnosed with depression. CONCLUSIONS: Depression is highly prevalent in patients with DM2, especially in women. For approximately one-third of the patients, a diagnosis of depression had not been reached.

[Effectiveness and tolerability of addition of risperidone in obsessive-compulsive disorder with poor response to serotonin reuptake inhibitors]. / Efectividad y tolerancia de la adición de risperidona en el trastorno obsesivo-compulsivo con mala respuesta terapéutica a inhibidores de la recaptación de serotonina.

INTRODUCTION: The addition of typical and atypical antipsychotics in patients with obsessive-compulsive disorder (OCD) resistant to serotonin reuptake inhibitors (SRI) has been reported as a useful augmentation strategy. Although antipsychotic monotherapy has been associated with ineffectiveness and even increase of psychotic symptoms (especially in psychotic patients), antipsychotics as concomitant medications have proven to be effective in several case series and pilot clinical trials. The objective of this case series was to evaluate effectiveness of risperidone as add on therapy to current SRIs treatment in OCD refractory to treatment patients. MATERIAL AND METHOD: Risperidone add on therapy in moderate and severe treatment resistant OCD patients was reviewed. Case reports were patients fulfilling the following criteria: a) treatment follow-up of at least 12 weeks; b) SRI adequate doses, y c) Y-BOCS score higher than 16 score before starting treatment. A three month follow-up period was reviewed. Risperidone starting dose was low (mean 1.5 mg/day) and was increased following clinical criteria. Therapeutic response and tolerability were evalated with the following scales: Y-BOCS, CGI of change, UKU (neurological subscale) and spontaneous reported adverse events. Response criteria were the following: at least 35% of reduction in Y-BOCS from basal score and final score less than 16 and CGI-C "much improved" or "very much improved" (score 1 or 2). Intention to treat analysis was performed (patients who reported at least one risperidone dose and effectiveness measure). RESULTS: 31 patients had at least one effectiveness evaluation and 21/31 patients (67.8 %) were considered treatment responders. Mean risperidone dose was 3.8 mg/day. In general, risperidone was well tolerated: serious or unexpected adverse event were not reported. CONCLUSION: Risperidone as add on therapy to SRI in moderate-severe, refractory to treatment OCD patients, may be an effective and safe strategy.

Efectividad y tolerancia de la adición de risperidona en el trastorno obsesivo-compulsivo con mala respuesta terapéutica a inhibidores de la recaptación de serotonina / Effectiveness and tolerability of addition of risperidone in obsessive-compulsive disorder with poor response to serotonin reuptake inhibitors

Introducción. Existen algunas series de casos publicadas que sugieren la posible efectividad de los antipsicóticos, tanto típicos como atípicos, asociados a los antidepresivos inhibidores de la recaptación de serotonina (IRS) en el tratamiento del trastorno obsesivo-compulsivo (TOC) con mala respuesta terapéutica, aunque el uso en monoterapia de estos antipsicóticos no parece eficaz o incluso puede exacerbar síntomas obsesivos, sobre todo en pacientes psicóticos. El objetivo de esta recogida de datos fue evaluar la efectividad de la adición de risperidona al tratamiento habitual con IRS en una muestra más amplia de pacientes con TOC con mala respuesta al tratamiento.Material y métodos. Se trata de una recogida de casos en la que se describen pacientes con criterios de TOC moderado-severo y resistente al tratamiento con un IRS en los que se añadió risperidona como tratamiento concomitante. Los casos recogidos fueron pacientes con: a) duración del tratamiento de al menos 12 semanas; b) dosis adecuadas de IRS, y c) puntuación basal superior a 16 en la escala Y-BOCS. Se tomaron datos de la evolución durante 3 meses. La risperidona se administró inicialmente a dosis bajas (media: 1,5 mg/día) y posteriormente la dosis se ajustaba según criterios clínicos. Clínicamente se evaluó la respuesta terapéutica y la tolerancia con las siguientes medidas: Y-BOCS, ICG de cambio, escala UKU modificada y reacciones adversas comunicadas espontáneamente. Se consideraron como criterios de respuesta: descenso de un 35% o más en la puntuación de la escala Y-BOCS respecto al inicio y puntuación final inferior a 16 e ICG de cambio «bastante o muy mejorado» (puntuación de 1 o 2). Se realizó un análisis por intención de tratar, incluyendo aquellos pacientes con al menos una toma de dosis y al menos una evaluación de efectividad.Resultados. En 31 pacientes existía al menos una valoración de efectividad. Veintiún pacientes de estos 31 (67,8%) se consideraron respondedores al tratamiento. La dosis media de risperidona usada fue de 3,8 mg/día. La tolerancia fue en general buena: no se recogieron efectos adversos graves ni inesperados.Conclusión. La adición de risperidona al tratamiento habitual con IRS en casos de TOC moderado-severo con mala respuesta terapéutica al IRS parece una alternativa efectiva y bien tolerada

Introduction. The addition of typical and atypical antipsychotics in patients with obsessive-compulsive disorder (OCD) resistant to serotonin reuptake inhibitors (SRI) has been reported as a useful augmentation strategy. Although antipsychotic monotherapy has been associated with ineffectiveness and even increase of psychotic symptoms (especially in psychotic patients), antipsychotics as concomitant medications have proven to be effective in several case series and pilot clinical trials. The objective of this case series was to evaluate effectiveness of risperidone as add on therapy to current SRIs treatment in OCD refractory to treatment patients.Material and method. Risperidone add on therapy in moderate and severe treatment resistant OCD patients was reviewed. Case reports were patients fulfilling the following criteria: a) treatment follow-up of at least 12 weeks; b) SRI adequate doses, y c) Y-BOCS scorehigher than 16 score before starting treatment. A three month follow-up period was reviewed. Risperidone starting dose was low (mean 1.5 mg/day) and was increased following clinical criteria. Therapeutic response and tolerability were evalated with the following scales: Y-BOCS, CGI of change, UKU (neurological subscale) and spontaneous reported adverse events. Response criteria were the following: at least 35% of reduction in Y-BOCS from basal score and final score less than 16 and CGI-C «much improved» or «very much improved» (score 1 or 2). Intention to treat analysis was performed (patients who reported at least one risperidone dose and effectiveness measure).Results. 31 patients had at least one effectiveness evaluation and 21/31 patients (67.8 %) were considered treatment responders. Mean risperidone dose was 3.8 mg/day. In general, risperidone was well tolerated: serious or unexpected adverse event were not reported.Conclusion. Risperidone as add on therapy to SRIs in moderate-severe, refractory to treatment OCD patients, may be an effective and safe strategy

Efectividad y tolerancia de la adición de risperidona en el trastorno obsesivo-compulsivo con mala respuesta terapéutica a inhibidores de la recaptación de serotonina (IRS) / Effectiveness and tolerability of risperidone augmentation therapy in obsessive-compulsive disorder with poor response to serotonin reuptake inhibitors

Introducción: Hay algunas series de casos publicadas que sugieren la posible efectividad de los antipsicóticos, tanto típicos como atípicos, asociados a los antidepresivos inhibidores de la recaptación de serotonina (IRS) en el tratamiento del trastorno obsesivo-compulsivo (TOC) con mala respuesta terapéutica; aunque el uso en monoterapia de estos antipsicóticos no parece eficaz o, incluso, puede exacerbar síntomas obsesivos, sobre todo en pacientes psicóticos. El objetivo de esta recogida de datos fue evaluar la efectividad de la adición de risperidona al tratamiento habitual con IRS en una muestra más amplia de pacientes con TOC con mala respuesta al tratamiento. Material y métodos: Se trata de una recogida de casos en la que se describen pacientes con criterios de TOC moderado-severo y resistente al tratamiento con un IRS en los que se añadió risperidona como tratamiento concomitante. Los casos recogidos fueron pacientes con: a) duración del tratamiento de, al menos, 12 semanas; b) dosis adecuadas de IRS; c) puntuación basal > 16 en la escala Y-BOCS (Yale-Brown Obsessive Compulsive Scale). Se tomaron datos de la evolución durante 3 meses. La risperidona se administró inicialmente a dosis bajas (media, 1,5 mg/día) y posteriormente la dosis se ajustaba según criterios clínicos. Clínicamente se evaluó la respuesta terapéutica y la tolerancia con las siguientes medidas: Y-BOCS, impresión clínica global (ICG) de cambio, escala UKU modificada y reacciones adversas comunicadas espontáneamente. Se consideraron como criterios de respuesta: descenso de un 35% o más en la puntuación de la escala Y-BOCS respecto al inicio y puntuación final < 16 e ICG de cambio "bastante o muy mejorado" (puntuación de 1 o 2). Se realizó un análisis por intención de tratar, en el que se incluyeron los pacientes con al menos una toma de dosis y al menos una evaluación de efectividad. Resultados: En 31 pacientes existía al menos una valoración de efectividad. De estos 31 pacientes, 21 (67,8%) se consideraron respondedores al tratamiento. La dosis media de risperidona usada fue de 3,8 mg/día. La tolerancia fue en general buena, no se recogieron efectos adversos graves ni inesperados. Conclusión: La adición de risperidona al tratamiento habitual con IRS en casos de TOC moderado-grave con mala respuesta terapéutica al IRS parece una alternativa efectiva y bien tolerada

Introduction: The addition of typical and atypical antipsychotics in patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitors (SRI) has been reported to be a useful augmentation strategy. Although antipsychotic monotherapy has been associated with ineffectiveness and even exacerbation of psychotic symptoms (especially in psychotic patients), antipsychotics as concomitant medications have proven to be effective in several case series and pilot clinical trials. The objective of this case series was to evaluate the effectiveness of risperidone as an augmentation strategy to current SRI treatment in patients with OCD refractory to treatment. Material and Methods: Risperidone add-on therapy in patients with moderate and severe OCD refractory to SRI treatment was reviewed. Cases were patients fulfilling the following criteria: a) Treatment follow-up of at least 12 weeks. b) Adequate SRI doses. c) Yale-Brown obsessive-compulsive scale (Y-BOCS) score higher than 16 before starting treatment. A 3-month follow-up period was reviewed. The risperidone starting dose was low (mean 1.5 mg/day) and was increased according to clinical criteria. Effectiveness and safety were evaluated through the following scales: Y-BOCS, Clinical Global Impression of Change (CGI-C), Udvalg for Kliniske Undersgelser (UKU) (neurological subscale) and spontaneously reported adverse events. Response criteria were the following: a reduction of at least 35% in the Y-BOCS from baseline score and a final score of less than 16, and a CGI-C of "much improved" or "very much improved" (score 1 or 2). An intention-to-treat analysis was performed (patients that reported at least one risperidone dose and effectiveness measure). Results: At least one effectiveness measure was available in 31 patients. Of the 31 patients, 21 (67.8%) were considered treatment responders. The mean risperidone dose was 3.8 mg/day. In general, risperidone was well tolerated: no serious or unexpected adverse events were reported. Conclusion: Risperidone as augmentation strategy of SRI in patients with moderate-severe OCD refractory to SRI treatment may be a safe and effective strategy