If you feel you can't, you won't: the role of subjective and objective cognitive competence on psychosocial functioning in depression.

BACKGROUND: The purpose of this exploratory study is to examine the role of sociodemographic, clinical, and cognitive - both objective and subjective - factors in overall and in specific domains of psychosocial functioning, in patients with depression at different clinical states of the disease (remitted and non-remitted). METHODS: A sample of 325 patients with major depressive disorder, 117 in remission and 208 in non-remission, were assessed with a semi-structured interview collecting sociodemographic, clinical, cognitive (with neuropsychological tests and the Perceived Deficit Questionnaire), and functional (Functioning Assessment Short Test) characteristics. Backward regression models were conducted to determine associations of global and specific areas of functioning with independent factors, for both clinical states. RESULTS: Residual depressive symptomatology and self-appraisal of executive competence were significantly associated with psychosocial functioning in remitted patients, in overall and some subdomains of functioning, particularly cognitive and interpersonal areas. While depressive symptoms, executive deficits and self-appraisal of executive function were significantly related to functional outcomes in non-remitted patients, both in overall functioning and in most of subdomains. DISCUSSION: This study evidences the strong association of one's appraisal of executive competence with psychosocial functioning, together with depressive symptoms, both in remitted and non-remitted patients with depression. Therefore, to achieve full recovery, clinical management of patients should tackle not only the relief of core depressive symptoms, but also the cognitive ones, both those that are objectified with neuropsychological tests and those that are reported by the patients themselves.

Psychopathological profile before and after bariatric surgery.

Presurgical psychopathological assessment usually focuses on detecting severe mental disorders. However, mild intensity psychopathology and eating behaviour pattern may also influence postsurgical outcomes. The aim was to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery. A cohort of 32 patients seeking bariatric surgery in a university hospital between March 2016 and March 2017 were evaluated with Personality Assessment Inventory (PAI), 36-item EDE-Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included. The PAI presurgical psychometric profile suggested a mild mixed adjustment disorder focused on somatic complaints. After surgery, patients improved in somatic complaints (p < 0.001), and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p < 0.001) and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p < 0.001). In our cohort ready for bariatric surgery a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery. Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery.

Dealing with heterogeneity of cognitive dysfunction in acute depression: a clustering approach.

BACKGROUND: Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. METHODS: In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. RESULTS: Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). CONCLUSIONS: The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.

Role of the FKBP5 polymorphism rs1360780, age, sex, and type of surgery in weight loss after bariatric surgery: a follow-up study.

BACKGROUND: Emerging evidence suggests that the FK506 binding protein 51 (FKBP5/FKBP51), encoded by the FKBP5 gene, influences weight and metabolic regulation. The T allele of a functional polymorphism in FKBP5 (rs1360780), has been associated with the expression of FKBP51 and weight loss after bariatric surgery. OBJECTIVE: To examine the role of the FKBP5 rs1360780 polymorphism in relation to age, sex, and type of surgery in weight loss after bariatric surgery in patients with severe obesity. SETTING: University Hospital in Spain METHODS: A cohort of 151 obese patients submitted to Roux-en-Y gastric bypass (62.3%) and sleeve gastrectomy (37.7%) were followed-up during 24-months (t24m; loss to follow-up: 0%). During the postoperative period body mass index (BMI) and percentage of excess and total weight loss were evaluated. RESULTS: The BMI analysis showed an effect of the interaction FKBP5 genotype by sex (P = .0004) and a tendency to the interaction genotype by surgery (P = .048), so that men carrying the T allele had higher BMI at t24m than those without the T allele, and T-allele carriers that underwent sleeve gastrectomy had higher BMI at t24m than the noncarriers. Additionally, we found an interaction between FKBP5 and age for the percentage of excess weight loss and BMI (P = .0005 and P = 1.5e-7, respectively), whereby individuals >48 years with the T allele displayed significant differences for the analyzed variables at t24m compared with the homozygotes for the alternate C allele showing lower weight loss. CONCLUSION: FKBP5 rs1360780 genotype has specific effects on weight loss outcomes after bariatric surgery depending on sex, age, and type of surgery, suggesting worse results in older males carrying the T allele who have undergone sleeve gastrectomy.

Effectivity and Cost-effectivity of the Maintenance Electroconvulsive Therapy: A mirror naturalistic analysis.

INTRODUCTION: Maintenance Electroconvulsive Therapy (mECT) is a biological long-term treatment in which patients receive ECT on periods from 2 to 4 weeks, during a variable period of time, usually for more than 6 months. Recent studies showed the efficacy of mECT in prevention of relapse and recurrences. Our study wants to demostrate the effectivity and cost-effectivity of this therapy in the naturalistic conditions of our area. DESIGN: Retrospective longitudinal study, with mirror analysis in naturalistic conditions. SUBJECTS: Patients attended at the Corporació Sanitària Parc Taulí (Sabadell, Catalonia), and included in the mECT program during more than six months. We performed diagnostic following DSM-IV criteria, subdividing the sample in three groups: patients affected of Recurrent Major Depression, Bipolar Disorder and Schizophrenia and Related Disorders. MEASURES: Number and duration of hospitalizations for the previous three years before the beginning of mECT, compared with the same data for the next three years following the beginning of mECT. Comparative analysis of direct hospitalization costs, costs of the mECT and pharmacologic costs. Statistic: Descriptive and non- parametric tests. RESULTS: Sample of 35 patients (1997-2008). There is a significative reduction the number of hospitalizations and days of hospitalization in the total sample and also in each of the three subgroups. The direct total cost decreased but it was only significant in the Bipolar Disorder subgroup, due to the increased pharmacological costs. CONCLUSIONS: mECT in our area is an effective and costeffective treatment with a great impact on the reduction of clinical decline and hospitalizations.

Efectividad y Coste-Efectividad de la Terapia Electroconvulsiva de Mantenimiento: un análisis naturalístico en espejo / Effectivity and Cost-effectivity of the Maintenance Electroconvulsive Therapy: A mirror naturalistic analysis

Introducción. La Terapia Electroconvulsiva de Mantenimiento (TECm) es un régimen de tratamiento biológico a largo plazo en el cual los pacientes reciben TEC en intervalos habitualmente de 2 a 4 semanas y a lo largo de un período variable según los casos y normalmente de más de seis meses. Estudios recientes han demostrado la eficacia de TECm en la prevención de recaídas y recurrencias. Nuestro estudio pretende averiguar su efectividad y coste-efectividad en nuestro medio. Metodología. Diseño: Estudio retrospectivo longitudinal, con análisis en espejo en condiciones naturalísticas. Sujetos: Pacientes atendidos en la Corporació Sanitària Parc Taulí (Sabadell, Cataluña), en programa de TECm durante más de seis meses. Realizamos los diagnósticos según criterios DSM-IV, subdividiendo la muestra en tres subgrupos: Depresión Mayor Recurrente, Trastorno Bipolar y Esquizofrenia y trastornos Relacionados. Medidas: Análisis comparativo respecto al número de ingresos y duración en los tres años previos al inicio de la TECm y los 3 años posteriores. Análisis comparativo paralelo de los costes directos: ingresos hospitalarios, TECm y costes farmacológicos. Estadística: Descriptiva y pruebas no paramétricas. Resultados. Muestra de 35 pacientes (1997-2008). Existe una disminución significativa de los días y número de ingresos en el total de la muestra y en cada uno de los subgrupos diagnósticos. El coste total directo disminuye, pero, debido al incremento de los costes farmacológicos, sólo es significativo en el caso del subgrupo de Trastorno Bipolar. Conclusiones. La TECm en nuestro medio es un tratamiento efectivo y coste-efectivo con un importante impacto en la reducción de agudizaciones e ingresos hospitalarios (AU)

Introduction. Maintenance Electroconvulsive Therapy (mECT) is a biological long-term treatment in which patients receive ECT on periods from 2 to 4 weeks, during a variable period of time, usually for more than 6 months. Recent studies showed the efficacy of mECT in prevention of relapse and recurrences. Our study wants to demostrate the effectivity and cost-effectivity of this therapy in the naturalistic conditions of our area. Methodology. Design: Retrospective longitudinal study, with mirror analysis in naturalistic conditions. Subjects: Patients attended at the Corporació Sanitària Parc Taulí (Sabadell, Catalonia), and included in the mECT program during more than six months. We performed diagnostic following DSM-IV criteria, subdividing the sample in three groups: patients affected of Recurrent Major Depression, Bipolar Disorder and Schizophrenia and Related Disorders. Measures: Number and duration of hospitalizations for the previous three years before the beginning of mECT, compared with the same data for the next three years following the beginning of mECT. Comparative analysis of direct hospitalization costs, costs of the mECT and pharmacologic costs. Statistic: Descriptive and non- parametric tests. Results. Sample of 35 patients (1997-2008). There is a significative reduction the number of hospitalizations and days of hospitalization in the total sample and also in each of the three subgroups. The direct total cost decreased but it was only significant in the Bipolar Disorder subgroup, due to the increased pharmacological costs. Conclusions. mECT in our area is an effective and cost-effective treatment with a great impact on the reduction of clinical decline and hospitalizations (AU)

Esquizofrenia familiar y esporádica: un estudio clínico comparativo / Family and sporadic schizophrenia: a compared clinical research

Introducción: La esquizofrenia es una enfermedad complejaclínica y etiológicamente que a pesar de la combinaciónde diferentes factores genéticos y ambientales sepresenta con una sintomatología similar. Numerosos estudioshan intentado establecer diferencias clínicas entreenfermos esquizofrénicos con antecedentes familiares ysin antecedentes llegando a resultados poco concluyentes.El objetivo de nuestro estudio es el de establecerdiferencias clínicas entre la esquizofrenia familiar y laesporádica utilizando grupos homogéneos a través decriterios de selección estrictos.Material y Método: Se estudió una serie consecutiva de148 pacientes diagnosticados de Esquizofrenia o TrastornoEsquizoafectivo según criterios DSM-IV, que se clasificaronen Esquizofrenia Familiar o Esporádica segúnla presencia o no de antecedentes familiares. Obteniéndoseuna muestra final de 25 pacientes con Esquizofrenia familiar,30 con Esquizofrenia esporádica y descartándose93 pacientes que no cumplían criterios de uno ni otrogrupo. Se recogieron variables sociodemográficas, clínicas,historia de factores de riesgo pre y perinatales ehistoria familiar de enfermedades psiquiátricas, y se realizóun análisis comparativo de las variables recogidasentre los dos grupos.Resultados: La esquizofrenia familiar se asoció a mayorfrecuencia de complicaciones obstétricas, a la adquisiciónde un nivel educativo más bajo y a una mayor puntuaciónde sintomatología negativa, en periodo de estabilidadclínica, medida por la PANS.Conclusiones: El estudio muestra que existen diferenciasclínicas entre los enfermos afectos de esquizofrenia segúnla presencia o no de antecedentes familiares. Ademáslos resultados van a favor de que la utilización demuestras homogéneas puede ser una metodología fiablepara establecer estas diferencias clínicas

Introduction: Schizophrenia is a clinical and etiologicallycomplex disease that regardless of the combination ofdifferent genetic and environmental factors presents a similarsymptomatology. Many studies have tried to establishclinical differences between schizophrenic inpatients withor without family schizophrenic background reachinginconclusive results. The aim of this study is determiningclinical differences between the familiar schizophreniaand the sporadic one by using homogeneous groupsformed with strict selection criteria.Material and method: A consecutive sequence of 148inpatients with diagnosis of Schizophrenia or SchizoaffectiveDisorder was studied. The diagnosis criteria ofDSM-IV were used. Inpatients were classified in threegroups: 25 with familial schizophrenia, 30 with sporadicschizophrenia and 93 discarded from the sample becausethey followed neither familial nor sporadic criteria. Wegathered socio-demographic and clinical information,obstetric complications record and psychiatric familydiseases background. A comparative analysis betweenthe two groups was made.Results: Familial schizophrenia is associated with higherrates of obstetric complications, with a lower educationallevel and with higher negative symptomatology score inthe PANSS scale during stable clinical periods.Conclusions: The study showed the existence of clinicaldifferences between schizophrenic inpatients dependingon the presence or not of familial background. Additionally,it was proved that using homogeneous samples ofinpatients can be a reliable methodology to identify theseclinical differences