Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study.

The results of previous cross-sectional studies suggest that free thyroxine (FT4) levels are associated with cognitive abilities (particularly attention/vigilance) during the early stages of psychosis. We aimed to explore whether hypothalamic-pituitary-thyroid hormones predict cognitive changes in a 1-year longitudinal study following first episodes of psychosis (FEP). We studied 36 FEP patients and a control group of 50 healthy subjects (HS). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Cognitive assessment was performed with the MATRICS Cognitive Consensus Cognitive Battery (MCCB). FEP patients were assessed twice (baseline and after 1year), whereas HS were assessed only once. We compared cognitive changes at 1year between three groups based on baseline FT4 levels: 1) lowest quartile (Q1, FT4<1.16ng/dL); 2) medium quartiles (Q2-Q3, FT4 1.16-1.54ng/dL); and 3) highest quartile (Q4, FT4>1.54ng/dL). No differences in TSH or FT4 levels were found between HS and FEP patients. All participants had FT4 levels within the normal range. HS outperformed FEP patients in all cognitive tasks. In relation to the relationship between FT4 levels and cognitive changes, a U-shaped pattern was observed: FEP patients from the middle quartiles (Q2-Q3) improved in attention/vigilance, whereas both extreme quartiles (Q1 and Q4) showed a worsening in this cognitive domain over time. Patients with lower FT4 (Q1) showed poorer baseline attention; therefore, lower baseline FT4 levels predicted a poorer prognosis in terms of attention performance. Our study suggests that baseline FT4 levels are associated with changes in attention and vigilance performance over one year in FEP patients.

Attempted and completed suicide: not what we expected?

BACKGROUND: Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS: Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. STATISTICAL ANALYSIS: Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS: Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS: Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS: Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.

Heart rate measured in the acute aftermath of trauma can predict post-traumatic stress disorder: a prospective study in motor vehicle accident survivors.

OBJECTIVE: To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries. METHODS: We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD. RESULTS: PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p<0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p=0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p=0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD. CONCLUSIONS: HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.

Venlafaxina retard en monoterapia en el tratamiento de episodios hospitalarios de depresión mayor / Venlafaxine extended release monotherapy in the treatment of episodes of major depression requiring hospitalization

Introducción: Se han publicado pocos estudios sobre las pautas de utilización de antidepresivos en las circunstancias reales de la práctica cotidiana en nuestras unidades de agudos hospitalarias. En especial, nuestro estudio pretende determinar la eficacia de la venlafaxina retard en monoterapia en el tratamiento de la depresión mayor en pacientes hospitalizados graves. Comparamos los resultados con otros tratamientos también en monoterapia. De forma paralela, se intentará determinar la rapidez de acción relativa de todos ellos. Material y métodos: Se trata de un estudio de cohortes de tipo retrospectivo y características observacionales. Se distinguen 3 grupos de sujetos tratados en monoterapia antidepresiva: pacientes hospitalizados diagnosticados de depresión mayor en episodio único o recurrente, con o sin síntomas psicóticos según criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV), en tratamiento con venlafaxina retard (grupo A); con antidepresivos del grupo de los inhibidores selectivos de la recaptación de serotonina (grupo B) o con antidepresivos tricíclicos (grupo C). Todos ellos ingresados en nuestra Unidad de Hospitalización de Agudos de Psiquiatría de la Corporació Sanitària Parc Taulí, Sabadell (Barcelona) en el período de enero de 2001 a enero de 2003, ambos incluidos. Resultados: Se detecta a 54 pacientes con depresión mayor tratados únicamente en monoterapia antidepresiva: 16 con venlafaxina retard (grupo A), 5 tratados con inhibidores selectivos de la recaptación de serotonina (grupo B) y 33 con antidepresivos tricíclicos (grupo C). No se observan diferencias en cuanto a las características sociodemográficas ni de gravedad entre los diferentes grupos. En lo referente a los síntomas, los pacientes tratados con antidepresivos tricíclicos presentan más síntomas psicóticos al inicio del tratamiento que en los otros 2 grupos. Se observa una diferencia a favor del grupo A respecto al B en cuanto a la duración del ingreso, en número de días, la Impresión Clínica Global (ICG) al alta, la ICG de mejoría al alta, y en cuanto a la rapidez de mejoría de la Escala de Evaluación de la Actividad Global (EEAG), diferencias no significativas. Se hallan diferencias significativas entre el grupo A y el C en cuanto a la ICG de gravedad al alta (p < 0,004), la ICG de mejoría al alta (p < 0,016) y la rapidez de mejoría de la ICG (p < 0,007) a favor del grupo A. Conclusiones: En nuestra muestra, la venlafaxina retard en monoterapia se muestra eficaz y rápida en el tratamiento de los episodios hospitalarios de depresión mayor

Introduction: Few studies have been published on patterns of utilization of antidepressants under real conditions of daily clinical practice in acute inpatient units in Spain. The aim of the present study was to determine the efficacy of venlafaxine extended release monotherapy in the treatment of inpatients with severe major depressive disorder (MDD) and to compare the results obtained with those of other treatments used as monotherapy. A further aim was to determine the relative speed of onset of antidepressant effect of these treatments. Material and methods: We performed a retrospective, observational, cohort study. There were three groups of patients who received antidepressant monotherapy: inpatients diagnosed with single-episode or recurrent MDD, with or without psychotic symptoms according to DSM-IV criteria, who received venlafaxine extended release, selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants. All patients were admitted to the Acute Psychiatric Inpatient Unit of the Corporació Sanitària Parc Taulí between January 2001 and January 2003, inclusive. Results: There were 54 patients with MDD who received antidepressant monotherapy alone: 16 received venlafaxine extended release (group A), 5 received SSRI (group B) and 33 received tricyclic antidepressants (group C). There were no differences in sociodemographic characteristics or severity among the three groups. Patients treated with tricyclic antidepressants had more psychotic symptoms at treatment initiation than did patients in the other two groups. A non-significant difference was observed in favor of group A compared with group B in the number of days of hospitalization, Global Clinical Impression (GCI)-severity scale at discharge, GCI-improvement at discharge and in speed of improvement on the Global Assessment of Functioning (GAF) scale. Significant differences were found between group A and group C in GCI-severity at discharge (p<.004), GCI-improvement at discharge (p<.016) and CGI-speed of improvement (p<.007) in favor of group A. Conclusions: In our sample, venlafaxine extended release monotherapy is effective and rapid in the treatment of episodes of major depression requiring hospitalization

Personalidad y dolor crónico / Personality and chronic pain

Objetivo: la propuesta de este estudio consistió en analizar si las características de personalidad del cuestionario de Cloninger eran variables que intervenían en el proceso del dolor crónico. Concretamente, el objetivo consistió en comprobar si las características de personalidad estaban relacionadas con la ansiedad, la depresión y el dolor que sufrían los pacientes. Método y material: se evaluó una muestra de 68 pacientes con dolor crónico en la clínica del dolor del Hospital Parc Taulí de Sabadell. Los instrumentos utilizados fueron: Cuestionario de Temperamento y Carácter (TCI) (10), Cuestionario de Ansiedad Estado y Rasgo (STAI) (18), Cuestionario para la Depresión de Beck (BDI) (19) y una Escala Analógica Visual (VAS) para medir la intensidad del dolor. Resultados: según los resultados obtenidos a través del cuestionario de Cloninger, los pacientes con dolor crónico se caracterizaron por presentar puntuaciones más altas en Evitación del Daño (HA), así como puntuaciones más bajas en Búsqueda de Novedad (NS), Persistencia (P) y Auto-Dirección (SD) con respecto a la población general. Las altas puntuaciones de HA y las bajas puntuaciones de SD correlacionaron con mayor nivel de malestar emocional (depresión y ansiedad). Finalmente, nuestros resultados indicaron que ninguna de las escalas del TCI afectan la intensidad del dolor. Sin embargo, observamos que la presencia de síntomas depresivos en nuestra muestra sí estaba relacionada con la intensidad del dolor. Conclusiones: considerando en conjunto las características de Temperamento y de Carácter de nuestra muestra con dolor crónico, podemos decir que ésta presenta un patrón de personalidad más desadaptativo o desajustado, que la población general. Es probable que este patrón de personalidad intervenga favoreciendo el inicio o mantenimiento del dolor crónico, aunque son necesarios más estudios de tipo prospectivo para poder afirmar esta incidencia con mayor seguridad

Objective: The purpose of the present study was to analyze whether personality characteristics as observed with the results of a Cloninger questionnaire couid be considered as variables in the chronic pain process. Our objective, in short, was to prove whether personality characteristics related to anxiety, depression or pain suffered by the patient. Materials and Methods: We evaluated a 68 chronic pain patient sample at the Pain Clinic in Parc Taulí Hospital, Sabadell. Instruments employed were Temperament and Character Inventory (TCI) (10), Anxiety State and Traits Inventory (STAI) (18), Beck Depression Inventory (BDI) (19) and a Visual Analogic Scale (VAS) to measure pain intensity. Results: The results of the Cloninger questionnaire point out that the chronic pain patient characteristically shows a higher score in the Harm Avoidance (HA) as well as a lower score in Novelty Seeking (NS), Persistence (P) and Self Directedness (SD) tests when compared to the general population. High HA and low SD scores correlate with a higher emotional indisposition level (depression and anxiety). Our results finally show that none of the TCI levels appear to affect pain intensity but that the presence of depressive symptoms do correlate with the same in our population. Conclusions: Character and temperament characteristics considered as a whole in our chronic pain patients seem to point to a more disadapted or unadjusted personality pattern when compared to the general population. It seems probable that such a personality pattern favors the onset of chronic pain or its maintenance, although more prospective studies are indicated to safely affirm such a coincidence

[Effectiveness and safety of topiramate in treatment-resistant bipolar disorder]. / Efectividad y seguridad del topiramato en el trastorno bipolar resistente.

INTRODUCTION: This study was conducted to evaluate the effectiveness and safety of topiramate as add-on therapy for treatment-resistant bipolar disorder. METHODS: Twenty-one DSM-IV bipolar patients, considered resistant to treatment with lithium, carbamazepine or valproate, gave informed consent to receive increasing doses of the novel anticonvulsant topiramate as adjunctive therapy for their manic (n= 9), depressive (n= 6), hypomanic (n= 3), mixed (n= 2) or schizoaffective manic (n= 1) symptoms. The dosage of other mood stabilizer drugs remained unchanged throughout the 6-week follow-up. Outcome measures included the YMRS, HDRS-17, and CGI scales. Fifteen out of 21 patients completed the 6-week follow-up. RESULTS: Six patients (40% of completers, 29% by intention-to-treat) were considered responders to topiramate (> 50% reduction in YMRS or HDRS-17 and a decrease of 2 points in CGI). The drug was less effective in intially depressed patients. Topiramate was well tolerated and only one patient discontinued due to side-effects. The most common adverse effect was paresthesia (n= 2). Ten patients experienced moderate weight loss during the follow-up. The mean topiramate dose at endpoint was 158 mg/day. CONCLUSIONS: These preliminary results suggest that topiramate may be a useful therapy for bipolar disorders, with promising results even in the most treatment-refractory patients.

[Factors associated to the development of Posttraumatic Stress Disorder]. / Factores asociados al desarrollo del trastorno por estrés post-traumático.

INTRODUCTION: Motor vehicle accidents appear to increase the risk of severe psychiatric morbidity in survivors. MATERIAL AND METHODS: We have studied retrospectively a population of 2,885 people who suffered an automobile accident in the city of Sabadell (Spain) in 1998. From these, we randomly selected a sample of fifty people who had developed PTSD, and a control group including the same amount of people. RESULTS: We reviewed the clinical and demographic differences in both samples and we found out that female gender and previous psychiatric morbidity are strongly related to the onset and course of PTSD.

Efectividad y seguridad del topiramato en el trastorno bipolar resistente / Effectiveness and safety of topiramate in treatment-resistant bipolar disorder

Introducción: Se describe un estudio abierto de serie de casos diseñado para evaluar la efectividad y seguridad de topiramato como tratamiento coadyuvante del trastorno bipolar fármacorresistente. Pacientes y método: Se reclutaron 21 pacientes con trastorno bipolar según criterios DSM-IV, considerados resistentes a litio, carbamacepina o valproico. Los pacientes dieron consentimiento informado para realizar el tratamiento coadyuvante con topiramato para su sintomatología maníaca (n= 9), depresiva (n= 6), hipomaníaca (n= 3), mixta (n= 2) o esquizoafectiva bipolar maníaca (n= 1). El estudio duró seis semanas durante las cuales el tratamiento eutimizante concomitante se mantuvo constante. Se evaluaron semanalmente a los pacientes con las escalas YMRS, HDRS-17 y CGI. Resultados: De los 21 pacientes iniciales, 15 completaron la totalidad del estudio. Seis pacientes (40 por ciento de los que terminaron el estudio, 29 por ciento por intención de tratar) fueron considerados como respondedores al tratamiento (reducción > 50 por ciento en la escala YMRS o HDRS-17 y disminución de dos o más puntos en la CGI). El tratamiento fue menos efectivo en aquellos pacientes con depresión inicial. El topiramato fue bien tolerado y sólo un paciente abandonó debido a efectos secundarios. El efecto adverso más frecuente fueron las parestesias (n= 2). Diez pacientes experimentaron descenso moderado de peso durante el estudio. La dosis media de topiramato al final del estudio fue de 158 mg/día. Conclusiones: Estos resultados preliminares sugieren que topiramato puede ser útil en el tratamiento del trastorno bipolar, con resultados prometedores incluso en los pacientes más refractarios a otras terapéuticas (AU)

Factores asociados al desarrollo del trastorno por estrés post-traumático / Factors associated to the development of Posttraumatic Stress Disorder

Introducción: Los accidentes de tráfico son un factor de riesgo de complicaciones psiquiátricas graves en los supervivientes. Material y métodos: Se realizó un estudio retrospectivo sobre una población de 2.885 personas que padecieron un accidente de automóvil en la ciudad de Sabadell (España) en 1998. De éstos, seleccionamos una muestra de cincuenta personas que habían desarrollado un Trastorno por Estrés Post Traumático (TEPT) y un grupo control del mismo número de personas. Resultados: Registramos las diferencias clínicas y demográficas que influían en el desarrollo del TEPT y encontramos que el sexo femenino y los antecedentes psiquiátricos previos estaban fuertemente relacionados con la aparición y el curso del TEPT (AU)