EDUCA study: Psychometric properties of the Spanish version of the Zarit Caregiver Burden Scale.

OBJECTIVES: The Zarit Caregiver Burden Scale, translated and validated into Spanish, is sensitive to the application of a Psychoeducational Intervention Program (PIP) for the prevention and reduction of burden in caregivers of Alzheimer's disease (AD) patients (EDUCA study). The data obtained in EDUCA was used to reanalyse its psychometric properties and the cut-off points of the Zarit scale. METHODS: The scale was administered to 115 caregivers of patients with AD who were randomised to receive a PIP or standard care for four months. Internal reliability and a factorial analysis of principal components were assessed, and the impact of PIP on each of the subscales was evaluated. A cut-off point was defined for the Zarit scale to identify the caregivers most sensitive to receiving a PIP. RESULTS: A good internal reliability (Cronbach alpha coefficient of 0.92) was obtained, with three principal components (burden, competency and dependence) explaining 54.75% of the variance. The application of PIP showed statistically significant differences versus standard care for the dependence subscale (p = 0.0082) (p = 0.062 for the burden scale). The Zarit scale cut-off points which combine better sensitivity and specificity were 56/57 and 59/60, for the 5/6 and 6/7 cut-off points of the General Health Questionnaire (GHQ-28) scale, respectively. CONCLUSIONS: This study confirms the good psychometric properties of the Zarit scale found in previous studies. The dependence component appeared to be most influenced by the application of a PIP in the clinical trial. Caregivers with a Zarit scale score of 60 or more benefit most from the PIP.

[Executive function in patients with late onset depression]. / Disfunción ejecutiva en pacientes con depresión de inicio tardío.

BACKGROUND: Depression is the most frequent psychiatric disorder in the elderly. Some authors consider late onset depression as a partially different phenomenological entity from that of the adult depression. The reason is its frequent association to dysexecutive cognitive impairment and cardiovascular risk factors. OBJECTIVE: This study aimed to analyze cognitive performance in neuropsychological screening tests in a group of late onset depression patients and non-depressed older adults. METHODS: Data was analyzed from 20 adults >or= 60 years old with late-life depression in partial or total remission and 10 individuals with the same characteristics but without previous affective disorders. Data was gathered on age, gender, education level, medical and psychiatric history and pharmacological history. Overall cognitive functions, executive performances, depressive symptoms, vascular risk factors and comorbid medical illness were measured using standardized test such as the Mini-mental State Examination (MMSE), Executive Interview (EXIT-S), Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale (CIRS). The differences between groups were analyzed with Analysis of Variance (ANOVA). RESULTS: Patients with late-onset depression had statistically significant greater executive difficulties regarding the control group on the EXIT-S scale. CONCLUSIONS: Executive dysfunction can be considered a biological marker of late-life depression, although studies in larger samples of patients are needed.

Disfunción ejecutiva en pacientes con depresión de inicio tardío / Executive function in patients with late onset depression

Introducción. La depresión es la enfermedad psiquiátrica más frecuente en ancianos. La depresión de inicio tardío (DIT) se considera una entidad fenomenológica parcialmente diferente de la depresión del adulto, debido a su frecuente asociación a disfunción cognitiva de características disejecutivas y a factores de riesgo cerebrovasculares. Objetivos. Analizar el rendimiento cognitivo en pruebas neuropsicológicas de cribado de un grupo de pacientes con DIT respecto de un grupo de ancianos no deprimidos. Métodos. Se evaluaron 20 individuos mayor o igual a 60 años con antecedentes personales de DIT, GDS < 7, y 10 individuos de las mismas características sin antecedentes de trastorno afectivo. Se recogieron datos como edad, sexo, nivel educativo, historial médico, psiquiátrico y farmacológico. El funcionamiento cognitivo global, las funciones ejecutivas, los síntomas depresivos, los factores de riesgo vascular y las enfermedades médicas comórbidas fueron medidos utilizando: el Mini-Examen Cognoscitivo (MEC), el Executive Interview Scales (EXIT-S), la Cumulative Illness Rating Scale (CIRS) y la Escala de depresión geriátrica (GDS). Las diferencias entre los grupos fueron analizadas mediante ANOVA. Resultados. Los pacientes con DIT presentaron mayores dificultades ejecutivas medidas a través de la escala EXIT-S respecto del grupo control. Conclusiones. La alteración en pruebas de cribado de funciones ejecutivas podría ser un marcador biológico de los pacientes con DIT, si bien son necesarios estudios con muestras más amplias de pacientes (AU)

Background. Depression is the most frequent psychiatric disorder in the elderly. Some authors consider late onset depression as a partially different phenomenological entity from that of the adult depression. The reason is its frequent association to dysexecutive cognitive impairment and cardiovascular risk factors. Objective. This study aimed to analyze cognitive performance in neuropsychological screening tests in a group of late onset depression patients and non-depressed older adults. Methods. Data was analyzed from 20 adults ≥ 60years old with late-life depression in partial or total remission and 10 individuals with the same characteristics but without previous affective disorders. Data was gathered on age, gender, education level, medical and psychiatric history and pharmacological history. Overall cognitive functions, executive performances, depressive symptoms, vascular risk factors and comorbid medical illness were measured using standardized test such as the Mini-mental State Examination (MMSE), Executive Interview (EXIT-S), Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale (CIRS). The differences between groups were analyzed with Analysis of Variance (ANOVA).Results. Patients with late-onset depression had statistically significant greater executive difficulties regarding the control group on the EXIT-S scale. Conclusions. Executive dysfunction can be considered a biological marker of late-life depression, although studies in larger samples of patients are needed (AU)

Antidepressant combinations: epidemiological considerations.

OBJECTIVE: To evaluate the treatment options in patients who do not respond appropriately to a single antidepressant alone. METHOD: The medical literature was reviewed. RESULTS: A number of strategies are available if a patient fails to respond adequately to initial antidepressant treatment, including the combination with another psychoactive drug. Evidence published to date appears to suggest that benzodiazepines are the drugs most frequently combined with antidepressants. The combination of two antidepressants together is less common, occurring in approximately 5-15% of cases showing a poor initial response. The key figures involved in such co-prescription are psychiatrists. CONCLUSION: There appears to be considerable variability in the data concerning combined prescription of antidepressants, with differences arising depending on the type of physician, the type of patient or illness and the geographical area. It is also unclear how closely research findings parallel with what doctors do in everyday practice.

Neuropharmacological basis of combining antidepressants.

OBJECTIVE: To review the neuropharmacological basis of antidepressant combination therapy. METHOD: Literature searches and other relevant material were obtained and reviewed. RESULTS: The overall clinical aim of combining antidepressants is to increase the efficacy whilst minimizing the side effects. Although such prescriptions are frequently based on the previous experience and knowledge, a sound neuropharmacological basis to support these combinations is desirable. When combining antidepressants, it is important to combine mechanisms of action, rather than simply one drug with another, and to aim for synergistic effects. The possibilities of combining mechanisms of action should also be exploited to the full if necessary, and the potential exists for combining two independent actions that have synergistic effects on the serotonergic, noradrenergic and even the dopaminergic systems. CONCLUSION: Unfortunately, there are still, as yet, insufficient data to categorically justify choosing one or other combination based only on the neuropharmacological evidence.

Combined antidepressants: clinical experience.

OBJECTIVE: To review the current literature on the use of combinations of antidepressive agents. METHOD: Literature searches were undertaken and reviewed on the use of combinations of antidepressants. RESULTS: Data sources included surveys, analyses of prescription records, decision algorithms, clinical reports, and studies comparing the monotherapy with combination therapy. More recent surveys recommend combining different selective serotonin reuptake inhibitors (SSRIs), an SSRI plus bupropion or dual action antidepressants plus an SSRI. Decision algorithms recommend an SSRI plus tricyclic antidepressant (TCA) and more recently bupropion plus venlafaxine or mirtazapine. Few controlled clinical trials comparing the combined therapy with monotherapy have been conducted. Beneficial effects have been reported with combinations of TCAs plus mianserin or SSRIs plus mirtazapine. CONCLUSION: Adding or combining antidepressant medications has advantages for the speed of onset and maintaining the existing response. More rigorous clinical trials comparing combination therapy with monotherapy and for the development of rational treatment guidelines are required.

Potentiation strategies for treatment-resistant depression.

OBJECTIVE: To review the pharmacological basis of antidepressant potentiation in combination therapy and the clinical evidence for its efficacy. METHOD: Literature searches were undertaken and the results reviewed. RESULTS: Treatment-resistant depression is common (15-30%). Various strategies exist for dealing with resistant depression, including pharmacological potentiation, i.e. adding a treatment that itself does not have antidepressant actions but that enhances the efficacy of the original treatment. Lithium, triiodothyronine (T3) and buspirone are the best studied potentiating drugs, although other options include pindolol, dopaminergic agents, second-generation antipsychotics, psychostimulants, hormones and anticonvulsants. CONCLUSION: Several pharmacological potentiation strategies exist. Whilst good evidence exists for lithium combined with antidepressants, although good results have also been reported with augmentation strategies involving T3 or buspirone.

Use of antidepressant combinations: which, when and why? Results of a Spanish survey.

OBJECTIVE: The present study uses the data from a large survey conducted to examine the general practice of Spanish psychiatrists on the use of antidepressant combinations in the treatment of depressive disorders. METHOD: The sample was drawn from specialists and psychiatric residents practicing in Spain who were respondents to a questionnaire distributed during an annual national psychiatry meeting and sent by mail. RESULTS: A total of 1032 questionnaires were collected; following the data-filtering, 831 were analysed. Most psychiatrists (89%) believe that many patients do not respond to the first treatment; in such cases of non-response, 58% choose a combination of antidepressants as the next treatment option. Reasons for using the combined treatments include greater efficacy (57%), overcoming resistance to the first antidepressant (27%), faster onset of action (21%) and avoidance of side effects (17%). The most sought after pharmacological profile was serotonergic-noradrenergic (96%) and the most popular combinations were selective serotonin reuptake inhibitor (SSRI) + mirtazapine, SSRI + reboxetine and SSRI + tricyclic antidepressant. CONCLUSION: Antidepressant combinations are frequently used in clinical practice. Pharmacological profiles are always considered and SSRIs + mirtazapine is the option usually chosen.

Asociaciones de antidepresivos: resultados de una encuesta de opinión de psiquiatras españoles / Antidepressant combinations: results of an opinion survey among Spanish psychiatrists

ANTECEDENTES: La utilización de asociaciones de antidepresivos es una práctica habitual en psiquiatría, aunque se ha estudiado poco su frecuencia y fundamentos neurobiológicos. A menudo se utiliza como recurso para resolver depresiones resistentes, eliminar síntomas residuales, aumentar la rapidez de acción, evitar efectos adversos, etc. Los datos disponibles sobre la frecuencia de uso son escasos y poco fiables, y las opiniones sobre su utilidad y seguridad son variables. Según este contexto, parece interesante estudiar en profundidad la cuestión para la cual se ha realizado una encuesta a fin de conocer las opiniones de psiquiatras y residentes españoles. METODOLOGíA: Se elaboró una encuesta sobre frecuencia, tipos, utilidades y riesgos de las diferentes posibilidades de asociación, que fue ofrecida para su cumplimentación voluntaria y anónima en un Congreso Nacional de Psiquiatría y por correo. Se recogieron 1.032 encuestas de todo el país, de las cuales se incluyeron para el análisis, tras la depuración de datos, 831. El 30 por ciento fue respondido por residentes de psiquiatría y el 70 por ciento por especialistas. Estuvieron representados de forma uniforme todos los rangos de edad, de profesionales en activo y tipos de asistencia pública y privada. RESULTADOS: La mayoría de los psiquiatras (89 por ciento) opina que muchas depresiones no responden a un solo antidepresivo, y en ese caso el 58 por ciento elige la asociación de otro antidepresivo como el primer método de potenciación, lo cual sería necesario en el 25 por ciento de los casos. Las situaciones clínicas que motivan su utilización son: conseguir más eficacia (5 por ciento), salvar la resistencia del primer antidepresivo (27 por ciento), aumentar la rapidez de acción (21 por ciento) y evitar efectos secundarios (17 por ciento). El momento de inicio de la asociación suele ser tras el período de latencia antidepresiva (50-82 por ciento). El perfil farmacológico más buscado es la potenciación noradrenérgicaserotoninérgica (96 por ciento). Las asociaciones de fármacos más frecuentes varían según los diferentes motivos de uso pero, en general, las más utilizadas son: ISRS + mirtazapina, ISRS + ADT, ISRS + reboxetina, y otras. CONCLUSIONES: La mayoría de los psiquiatras encuestados opina que la combinación de antidepresivos es una práctica frecuentemente utilizada. De los datos de la encuesta se desprende que su uso es más habitual de lo que se pensaba, se suelen tener en cuenta los perfiles farmacológicos y lo más frecuente es la potenciación 5HT-NA (ISRS más otro fármaco), especialmente la asociación de ISRS con mirtazapina (AU)

Informe global del grupo de investigadores en el área de envejecimiento del encuentro Mahón-2000 / Global Report of the Investigator Group in the Area of Aging of the Mahon Meeting 2000

No disponible

No disponible

[Validation of the Spanish version of PRIME-MD: a procedure for diagnosing mental disorders in primary care]. / Validación de la versión española del PRIME-MD: un procedimiento para el diagnóstico de trastornos mentales en atención primaria.

INTRODUCTION: Psychiatric disorders occurs in at least 20% of patients attending Primary Care settings, however, only 50% of them are detected by primary care physicians. Therefore a tool is required which can help primary care physicians to detect and diagnose psychiatric disorders. PRIME-MD (Primary Care Evaluation of Mental Disorders) is a questionnaire designed with this aim. In this article the results of the validation study of the Spanish version of this questionnaire are presented. MATERIALS AND METHODS: 312 patients were interviewed by primary care physicians using PRIME-MD and by psychiatrists using SCAN (Schedules for Clinical Assessment in Neuropsychiatry). RESULTS: The time most frequently spent in questionnaire application by the physician was 10 minutes. PRIME-MD detected the presence of at least one psychiatric disorder in 44.3% of patients. PRIME-MD diagnoses agree well with SCAN diagnoses for mood disorders (coefficient of agreement: 0.50) and for anxiety disorders (coefficient of agreement: 0.35), but not for somatoform disorders or alcohol-related disorders. CONCLUSIONS: The Spanish version of PRIME-MD questionnaire in a useful tool to identify and diagnose mood and anxiety disorders in Primary Care settings.

[Bilateral synchronous adrenal metastasis of renal adenocarcinoma]. / Metástasis suprarrenales bilaterales sincrónicas de adenocarcinoma renal.

Contribution of one case of renal adenocarcinoma with synchronous metastasis in both adrenal glands. Treatment was radical surgery with palliative resolution and steroid replacement therapy. Brief comments on this uncommon clinical situation and review of other author's experience.

[Prognostic implications of urological complications in the renal transplantation]. / Implicaciones pronósticas de las complicaciones urológicas en el trasplante renal.

We describe the urological complications occurred in 302 patients undergoing first cadaveric renal transplantation in 16 years in the University Hospital. two series can be distinguished: "Historical" (1976-86) and "Actual" (1986-92). Thirty patients (10%) presented 33 (11%) urological complications: 73% urinary fistula and 27% ureteral stenosis. The vast majority (80%) were early complications (before 90 days). No statistical difference was observed in the survival rates of both the patients and grafts presenting or not urinary complications, except in the last series. A multivariate analysis was performed to examine the influence of prognostic factors. These analysis revealed that cold ischemia time and organ retrieval were the technical variables significantly related with urologic complications among historical and global series. Only recipient age was associated with urologic complications in actual series.

[Errors in the clinical staging of prostatic cancer]. / Errores en el estadiaje clínico del cáncer de próstata.

The relationship between the clinical and pathological stages of clinically localized prostate cancer (PCa) was analyzed in 68 patients. All of then underwent ilio-obstructive lymphadenectomy and node affectation was found in 16 patients (23%). Out of 64 patients undergoing radical prostatectomy, 23 (36%) presented invasion of prostate capsule and/or seminal vesicle infiltration. Of the total 68 patients, 28 (41%) showed local dissemination and/or nodular affectation. A direct correlation was seen between clinical stage and both incidence of local dissemination and nodular affectation. Pre-operative PSA and tumoral grade were correlated to the pathological stage.

["De novo" malignant tumors in kidney transplant receptors]. / Tumores malignos "de novo" en receptores de trasplante renal.

Presentation of the "de novo" tumours developed in two series of renal transplant receptors over the last 16 years. The first series, Historic, comprises the group of 178 patients who were given Azathioprin or Cyclophosphamide plus Prednisone for immunosuppression. The second series, Current, includes 129 patients who received immunosuppressive therapy with Cyclosporin A. Overall incidence of these "de novo" malignant tumours was 4% (13/307), 9 of which corresponded to the Historic Series (incidence, 5%) and 4 to the Current Series (incidence, 3%). Mean time interval from transplantation to diagnosis was 87.3 months (range, 9-177) in the Historic Series and 34.5 (range, 8-67) in the Current Series, the difference being statistically significant (p = 0.02). By locations, skin and lip tumours represent 38.5%, followed in frequency by lymphoma (23%) and lung carcinoma (15%). No urological tumours were recorded.

[Adjusted survival of the graft in renal transplantation. Multivariate analysis of prognostic factors]. / Supervivencia ajustada del injerto en el trasplante renal. Analisis multivariado de los factores pronóstico.

Three hundred and seven first corpse transplantations performed in the Clínica Universitaria of Navarra since 1976 are analyzed. The cases are divided in two series, Current and Historic, depending on whether the immunosuppressive protocol included cyclosporin A. First, actual survival curves from both series were compared, obtaining a significantly improved survival in the cyclosporin A series (p). Then, the most influential prognostic features in each series are analyzed for the various post-transplantation periods. With regard to adjusted graft survival in the Historic Series, both initial function and the number of rejections have influence during the first post-transplantation year. HLA A + B identities and the donor's age influence during the immediate one-to-three months period. In the Current Series, time of cold ischaemia and number of rejections act during the earliest (first month) and the latest (between one to three years) periods. The donor's cause of death and the recipient's age influence during the first month of evolution. The initial function and the presence of surgical complications influence between the first month and the first year.

[Multivariate analysis of the factors influencing the occurrence of surgical complications in renal transplantation]. / Análisis multivariado de los factores influyentes en la aparición de las complicaciones quirúrgicas en el trasplante renal.

Study of 307 renal corpse transplants performed in our centre, gathered in two series according to the immunosuppressive approach used, with and without cyclosporin A (Current and Historic Series, respectively). The surgical complications encountered are assessed and divided into urinary, vascular and other. Using a multivariate analysis, the factors influencing the occurrence of each of them are examined. In the Historic Series, the prognostic factors for the occurrence of urinary complications are the type of extraction and the duration of cold ischaemia. Regarding vascular complications, these factors are the type of anastomosis and the receptor's age. With respect to all other complications, the single influential factor is the initial delayed function. In the Current Series, the prognostic factors relative to urinary complications are the receptor's age, the duration of cold ischaemia, and the donor's age. No multivariate analysis is made of vascular complications due to their small number. The remaining complications are related, as in the other series, to the initial delayed function.

[Potentiation of cytotoxicity of electromagnetic shock waves by suramin, "in vitro" study]. / Potenciación de la citotoxicidad de las ondas de choque electromagnéticas por la Suramina, estudio "in vitro".

The objective of this experimental study is to assess the inhibition of tumoral cells growth induced by electromagnetic shockwaves at different energy levels in PC-3, the human prostate adenocarcinoma cell line. Also, an assessment is made of the inhibition of cell growth caused by adding Suramin to the growth medium and the enhancement of cytotoxicity when associated to that produced by electromagnetic shockwaves. Cells viability is determined by life staining exclusion methods and nucleoside incorporation. Cytotoxic action of electromagnetical shockwaves in the PC-3 cell line is dose dependent (p < 0001). Suramin significantly inhibits cell viability (p < 0001). The association of both therapeutical approaches enhances significantly their individual cytotoxicities (p < 0001).

[Urachal cyst: an unusual cause of intestinal obstruction]. / Quiste de uraco: causa inusual de obstrucción intestinal.

Contribution of one case of urachal cyst in a patient initially diagnosed with intestinal obstruction due to a probable colon-sigma neoplasia. The patient underwent discharge colostomy after finding an extension of the likely tumour to abdominal wall, bladder and right ureter. Later, the patient was reassessed and the CT showed a mass in the bladder's anterior edge with disclosure of purulent material and inflammatory cytology through the PAAF. The treatment performed was partial cystectomy, closure of colostomy and rectum-sigma re-anastomosis. Histological diagnosis was urachal cyst, abscess and pyogenic membranes, with no evidence of tumoral tissue. The idiosyncrasy of this urachal cyst is the simulation of an intestinal obstructive process of tumoral origin. Differential diagnosis in these intestinal processes rarely includes urachal cyst.

[Inhibition of tumor cell growth by the action of high-energy sources]. / Inhibición del crecimento celular tumoral por acción de las fuentes de alta energía.

In vitro comparison of the cytotoxic action of high-energy shockwave and megavoltage radiotherapy on tumoral cells. The inhibitory action these two therapeutic approaches have on cell viability is determined both singly and jointly, through life staining exclusion and nucleoside uptake tests. High energy shockwaves have a cytotoxic action significantly greater than low- and medium-energy levels of megavoltage radiation. The cytotoxic effect from megavoltage radiation is significantly greater than that resulting from high levels of high-energy shockwave as shown by the life staining exclusion tests. However, the nucleoside uptake test shows that cytotoxicity from either type of energy is no significantly different. When measuring the cumulative cytotoxic action of high energy shockwaves plus megavoltage radiation, the level of cytotoxicity is greater than the individual inhibitory actions on cell viability, but the degree of cytotoxicity induced cannot be comparable to that produced by higher energy levels from both sources separately.