Undertreatment of human immunodeficiency virus in psychiatric inpatients: a cross-sectional study of seroprevalence and associated factors.

BACKGROUND: The aims of this study were to evaluate the prevalence of HIV and its associated demographic and clinical factors among psychiatric inpatients of a general hospital. METHODS: This was a single-center, observational, cross-sectional study that included patients consecutively admitted to our unit aged 16 years or older and with no relevant cognitive problems. The patients were evaluated using a semistructured interview and an appropriate test for HIV infection. RESULTS: Of the 637 patients who were screened, 546 (86%) who consented to participate were included in the analyses. Twenty-five (4.6%, 95% confidence interval [CI] 3.0-6.8) patients were HIV-positive. The prevalence was higher among patients with substance misuse (17.4%, 95% CI 9.7-28.8). All except one of the 25 patients knew of their seropositive condition prior to participation in the study. Only 14 (56%) of the 25 seropositive patients had previously received pharmacological treatment for their infection. According to the multiple logistic regression analysis, the likelihood of HIV infection was lower in patients with higher levels of education and higher among patients who were single, had history of intravenous drug use, and had an HIV-positive partner, particularly if they did not use condoms. Among the patients with HIV infection, 18 (72%) had a history of suicide attempts compared with 181 (34.7%) of the patients without HIV infection (relative risk 2.1, 95% CI 1.6-2.7; P<0.001). CONCLUSION: HIV infection is highly prevalent in patients admitted to a psychiatric unit, especially those with a diagnosis of substance misuse. Seropositive patients show very poor treatment adherence. The risk of suicide seems to be very high in this population. Implementing interventions to reduce the suicide risk and improve adherence to antiretroviral therapy and psychotropic medications seems crucial.

Disminución de la actividad noradrenérgica durante el tratamiento en pacientes bipolares: independencia de los polimorfismos de la COMT / Reduction of noradrenergic activity during treatment in bipolar patients independent from COMT polymorphisms

Introducción: Los estudios más recientes apoyan la idea de que la fisiopatología del síndrome bipolar se sustenta en diversas interacciones de varios sistemas de neurotransmisión. Datos clínicos y preclínicos sugieren también que la actividad noradrenérgica está elevada en estos pacientes antes del tratamiento. Método: En nuestro estudio se ha medido la concentración plasmática del 3-metoxi-4-hidroxifenilglicol (MHPG), principal metabolito de la noradrenalina (NA), en 50 pacientes bipolares tipo I, 29 varones y 21 mujeres, diagnosticados según el Diagnostic and Statistical Manual of Disorders (DSM-IV). También se determinaron los polimorfismos Val108/158Met de la catecol-O-metiltransferasa (COMT). Los pacientes se trataron con olanzapina, a la que posteriormente se añadió litio. Resultados y conclusiones: El tratamiento demostró ser eficaz, tanto en pacientes psicóticos como en no psicóticos; y no se encontró una relación significativa entre los polimorfismos estudiados de la COMT y la respuesta clínica medida por la escala de Young para la manía. Sí se puso de manifiesto una correlación significativa y positiva entre los valores plasmáticos de MHPG antes del tratamiento y después de 3 días de tratamiento con la respuesta a éste

Introduction: Recent studies support the notion that the pathophysiology of bipolar disorder is probably mediated through multiple interactions among neurotransmitter pathways. Preclinical and clinical data also suggest an elevated noradrenergic activity in the brains of these patients before treatment. Methods: We measured the plasma concentration of 3-methoxy-4 hydroxyphenylglycol (MHPG), the principal metabolite of norepinephrine, and determined the Val108/158Met polymorphism of catechol-O-methyltransferase (COMT) in 50 patients (29 men and 21 women) diagnosed with bipolar I disorder according to DSM-IV criteria. The patients were treated with olanzapine with subsequent addition of lithium. Results and conclusions: Overall the treatment was efficacious in both psychotic and non-psychotic patients. No significant associations were found between COMT polymorphism and treatment response (assessed with the Young scale for mania). However, a significant and positive correlation was found between plasma MHPG levels before treatment (and after 3 days of treatment) and clinical outcomes

Anomalías físicas congénitas y sus implicaciones sobre el origen de la esquizofrenia / Psysical and congenital abnormalities and onset of schizophrenia

No disponible