Aripiprazole for the treatment of schizophrenia: Recommendations of a panel of Spanish experts on its use in clinical practice.

OBJECTIVES: Aripiprazole is an antipsychotic with a partial agonism of dopamine D2 and D3 receptors. This differential mechanism implies a rigorous appraisal of the appropriate therapeutic strategies in certain situations. To answer currently unsolved clinical questions about the use of oral and long-acting injectable (LAI) aripiprazole, we present here an expert consensus from 12 Spanish psychiatrists and a pharmacologist with extensive experience in the use of this antipsychotic. METHODS: Through one face-to-face session and online collaboration, we reached consensus and established practical recommendations based on scientific evidence and clinical experience. We classified the available scientific literature according to SIGN system and attributed a level of evidence to each reviewed article. RESULTS: The recommendations were divided according to (i) chronological dimension (based on previous treatments, including patients naïve or not to antipsychotic treatment and maintenance regimen), and (ii) dimension related to therapeutic options, comprising switches to aripiprazole and the most used combinations with this antipsychotic. CONCLUSIONS: We recommend considering aripiprazole as first treatment option in the early stages of schizophrenia and in patients with affective symptoms and contemplating a switch to aripiprazole LAI in all candidate patients. Importantly, switches from other antipsychotics should consider previous antipsychotic history and exposure to aripiprazole. KEYPOINTSAripiprazole can be considered as first treatment option in early stages of schizophrenia and in patients with significant affective symptoms.Aripiprazole LAI shows better adherence than oral aripiprazole and could be considered in all candidate patients.Before switching to aripiprazole, detailed information about previous antipsychotic history should be gathered.Switch to aripiprazole should be managed differently for aripiprazole naïve and non-naïve patients.Rigorous and controlled studies on antipsychotics in real clinical practice should be carried out.

Psychiatric symptoms after temporal epilepsy surgery. A one-year follow-up study.

Psychiatric symptoms must be considered in patients with refractory temporal lobe epilepsy after epilepsy surgery. The main objectives of our study were to describe clinical and socio-demographical characteristics of a cohort of patients with pharmacoresistant temporal lobe epilepsy who underwent temporal lobe epilepsy surgery, and moreover, to evaluate possible risk factors for developing psychiatric symptoms. In order to achieve those goals, we conducted a prospective evaluation of psychopathology throughout the first year after surgery in a clinical sample of 72 patients, by means of three clinical rated measures; the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the Brief Psychiatric Rating Scale (BPRS). The psychopathological evaluations were performed by an experienced psychiatrist. A presurgical evaluation was done by a multidisciplinary team (that includes neurologist, psychiatrist, neurosurgeon, neurophysiologist, radiologists, and nuclear medicine specialist) in all patients. The decision to proceed to surgery was taken after a surgical meeting of all members of the Multidisciplinary Epilepsy Unit team. The psychiatrist conducted two postoperative assessments at 6months and 12months after surgery. The main finding was that past history of mental illness (patients who were receiving psychiatric treatment prior to the baseline evaluation) was a risk factor for anxiety, depression, and psychosis after temporal lobe epilepsy surgery.

Prevalencia y comorbilidad del Trastorno de Ansiedad Generalizada en una muestra española de escolares adolescentes / Prevalence and comorbidity of generalized anxiety disorder in a sample of spanish adolescent schoolchildren

Los datos epidemiológicos del Trastorno Ansiedad Generalizada (TAG) son relativamente escasos en niños y adolescentes. Este estudio pretende determinar la prevalencia y comorbilidad del TAG en una muestra de adolescentes escolares de la provincia de Valencia. La población evaluada, con edades comprendidas entre 12 y 16 años (14.04 ± 1.22), procedía de centros con Enseñanza Secundaria Obligatoria. Diseño transversal, empleando una entrevista diagnóstica (K-SADS) llevada a cabo por profesionales de salud mental, en una única intervención. La muestra definitiva, 962 participantes, presentaba una prevalencia global del TAG del 3% (2,4% varones; 3,7% mujeres). La prevalencia era máxima, para ambos grupos, a los 14 años de edad. El 58% de los participantes con TAG presentaban, al menos, otro diagnóstico psiquiátrico siendo el más frecuente el de otro trastorno de ansiedad (48,3%). Los niveles de prevalencia y comorbilidad obtenidos, en ausencia de datos previos en nuestro entorno, son similares a los descritos en otros medios; por ello, su detección precoz permitiría una intervención temprana

The epidemiological data on Generalized Anxiety Disorder (GAD) are relatively scant in children and adolescents. This study attempts to determine the prevalence and comorbidity of GAD in a sample of adolescent schoolchildren from the province of Valencia. The study population, aged from 12 to16 years(14.04 ± 1.22), came from a series of secondary schools. The study has a crossover design, using a diagnostic interview (K-SADS) conducted by mental health professionals with a single intervention. The prevalence rate for GAD in the final sample of 962 individuals was 3% (2.4% males; 3.7% females). Prevalence was highest for both groups at 14 years of age. Of the participants with GAD, 58% had at least one other psychiatric diagnosis, the most common being another anxiety disorder (48.3%). The prevalence and comorbidity rates found, in the absence of any prior data in our environment, are similar to those described in other settings; therefore, early detection would allow early intervention