Efficiency of cognitive rehabilitation with REHACOP in chronic treatment resistant Hispanic patients.

INTRODUCTION: Cognitive rehabilitation in schizophrenia has been proved to benefit cognition depending on the severity of the illness and the cognitive deficits. Nevertheless studies of efficiency with chronic patients, refractory to additional treatment interventions, have not yet been published. DESIGN: Ninety three patients with schizophrenia were recruited from the Treatment Resistant Schizophrenia Unit in Alava (Spain). All subjects underwent a baseline and a 3 months assessment including cognition, clinical symptoms and functional capacity. Patients were randomly assigned to receive either neuropsychological rehabilitation or occupational therapy for 3 months in addition to treatment as usual (TAU). RESULTS: Patients at the Rehacop group showed significantly greater improvements at 3 months in most areas of cognition evaluated including speed of processing, language, memory and executive functioning, compared to the occupational therapy group (group x time interactions p< 0.001). The Rehacop group also showed significant improvement in positive symptoms, functional and insight measures. Although data was not statistically significant, the Rehacop group showed a tendency to also improve negative symptoms compared to controls. CONCLUSIONS: Despite to their limited respond to TAU, our data suggest that chronic refractory patients can improve their cognitive performance after neuropsychological rehabilitation with the Rehacop. These findings support the feasibility of integrating neuropsychological rehabilitation into TAU programs for patients with lower responses to other treatment plans.

Bupropión: Eficacia y seguridad en el tratamiento de la depresión / No disponible

No disponible

El tiempo de psicosis no tratada como factor predictivo y pronóstico en el curso de los primeros episodios psicóticos / Duration of untreated psychosis as predictive and prognostic factor in the course of first episode psychosis

Introducción. El tiempo de psicosis no tratada ha estado en el punto de mira de numerosos artículos que intentan clarificar si podría resultar ser uno de los factores que condicionaría el pronóstico final de la enfermedad psicótica. Material y métodos. Presentamos un estudio realizado en 90 pacientes con un primer episodio psicótico que no habían tomado medicación previamente en el que se evaluaron los posibles factores pronósticos que influirían en la evolución de la enfermedad. A tal efecto se utilizó un protocolo que incluía las siguientes escalas: PANSS, escala de valoración global de estrés psicosocial (DSM IIIR), evaluación de actividad global (GAF-EEAG), impresión clínica global (ICG), escala de Montgomery-Asberg para la depresión, escala de manía de Young, escala de movimientos anormales, escala UKU para síntomas extrapiramidales y la escala de ajuste premórbido (Cannon-Spoor). El seguimiento se realizó durante 1 año con evaluaciones cada 3 meses. Resultados. Tras el análisis estadístico de los datos se concluyó que un tiempo de psicosis prolongado no se asociaba en nuestra muestra a una peor evolución de la enfermedad. Los únicos factores relacionados con dicho pronóstico resultaron ser el ajuste premórbido y el tipo de comienzo de la enfermedad. Así, pacientes con un mejor ajuste premórbido y un inicio de enfermedad agudo presentaban una mejor evolución. Conclusiones. Nuestro trabajo muestra una evidencia más en favor de la independencia del pronóstico final y el tiempo de psicosis sin tratar

Introduction. Recently, many studies have focused on the duration of untreated psychosis (DUP) in order to clarify if DUP could be one of the factors that would influence prognosis of psychotic disease. Material and methods. We present a one year follow - up study with 90 medication native, first episode psychotic patients. The likely prognosis factors that could influence in the outcome of the disease were measured. Therefore, we used a protocol including the following scales: PANSS, Psychosocial Stress Global Assessment scale (DSM IIIR), Global Assessment of Functioning scale (GAF-EEAG), Clinical Global Impression (CGI), Montgomery-Asberg scale for the depression, Young mania rating scale, abnormal involuntary movements scale, UKU scale for extrapyramidal symptoms and Premorbid Adjustment scale (Cannon-Spoor). Assessments were made every three months for 1 year. A statistical analysis of data was performed. Results. As a result, it was concluded that there was no relationship between a long duration untreated psychosis and a worse outcome of the illness in our sample. The only related factors with the prognosis were premorbid adjustment and the type of disease onset. Hence, the patients with a better premorbid adjustment and an acute onset of psychosis had a better outcome. Conclusion. Our study represents more evidence in favor of the independence of DUP and disease outcome

[Controversies about duration of untreated psychosis as independent prognostic variable of the evolutive course of schizophrenic psychoses]. / Controversias en torno al tiempo de psicosis no tratada como variable pronóstica independiente del curso evolutivo de las psicosis esquizofrénicas.

This study reviews recent literature on duration of untreated psychosis (DUP) and its most relevant characteristics and controversial issues, such as: a) why DUP has been pointed out as a main variable in first-episode psychosis research, and b) the role of DUP in designing intervention programs for the design and different action strategies in early intervention programs in psychoses. The authors also present data from a 2 year follow-up study of 231 patients with a diagnosis of schizophrenia and/or schizophreniform disorder (according to DSM-IV criteria). Results are included, analyzing DUP as prognostic factor for clinical outcome. Our conclusions suggest that DUP is a risk marker but not an independent prognostic factor determining follow-up in schizophrenic psychoses. Therefore, DUP's role in early intervention programs should be redefined.

Olanzapina y consumo de cocaína en programas de mantenimiento con metadona: nuevos resultados / Olanzapine and cocaine consumption in methadone maintenance programs: new results

OBJETIVO: Evaluar el uso de olanzapina como tratamiento de reducción del uso de cocaína en programas de mantenimiento con metadona. PACIENTES Y MÉTODO: Se ha aplicado un diseño de cuadrado latino sobre 45 sujetos adscritos a tres programas de mantenimiento con metadona. Se utilizaron dos variables de bloqueo; la dosis de dispensación de metadona (con tres concentraciones: 81 mg/día) y la frecuencia de consumo de cocaína durante los 3 meses previos al inicio del tratamiento (también con tres concentraciones: sin consumo, 21 por ciento de determinaciones en orina positivas). La variable independiente dosis de olanzapina (con tres niveles: 0, 5 y 10 mg/día) se aplicó según el protocolo del diseño. Los sujetos recibían, junto a su dosis diaria de metadona, el tratamiento de olanzapina correspondiente a su asignación en el diseño. La variable resultado fue el porcentaje de consumos de cocaína estimado por control de orinas mediante inmunoanálisis, durante los 3 meses posteriores al inicio del tratamiento. Durante este período se recogió una prueba de orina semanal; en 37 sujetos se hicieron 12 controles y en 8 casos 13. RESULTADOS: El análisis de la varianza por descomposición de las fuentes de variación propio de un diseño de cuadrado latino ha ofrecido un efecto significativo para el tratamiento (F(2,36) = 17,19; p < 0,001) y para un efecto de interacción (F(2,36) = 12,47; p < 0,001). La proporción media de controles positivos entre los sujetos sin tratamiento ha sido del 22,6 por ciento, y entre los que han recibido tratamiento con olanzapina ha sido del 4,2 por ciento en los sujetos con dosis de 5 mg/día, y de 3,8 por ciento entre los tratados con 10 mg/día. CONCLUSIONES: Se evidencia un efecto significativo del tratamiento con olanzapina en la reducción del consumo de cocaína en usuarios participantes en un programa de mantenimiento con metadona. No obstante, la presencia de efectos de interacción obliga a ser cautos en la valoración de los resultados, y sería conveniente que se realizaran nuevos diseños que permitieran un mayor control de los efectos de las variables intervinientes (AU)

[Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study]. / Tratamiento precoz con risperidona de primeros episodios psicóticos: dos años de seguimiento.

INTRODUCTION: The main goals of any antipsychotic pharmacological treatment are the improvement of negative, positive, behavioral, affective and cognitive symptoms related to psychotic disorders, a good side-effects profile and again an improvement in patients quality of life and social - environmental relationships. The development of new atypical antipsychotic drugs has opened new therapeutical bias. Nevertheless only a few clinical studies have been developed studying new atypical antipsychotic role on first psychotic episodes. MATERIALS AND METHODS: We developed an open, observational, multicenter and prospective study in order to evaluate effectiveness, tolerability and security of early treatment with risperidone in patients affected by a first psychotic episode (DSM IV diagnostic criteria) and the long-term effect of this treatment on the clinical evolution of these patients. We recruited 436 patients (age 18-65) who had never before received any antipsychotic drug. RESULTS: The most prevalent diagnosis was schizophrenia and other psychotic disorders no substance abuse related (90.6%). The average dosage of risperidone used during this study was 5.12 mg/d and most of the patients remained on risperidone monotherapy. We observed a statistically significant improvement in psychopathological scale PANSS (total; positive, negative and general subescales), Global Activity Scale (EEAG) and Clinical Global Impression Scale (CGI) scores from first month treatment on. This improvement was maintained during the two-year follow up period. We also observed an improvement in Young Mania Scale and Hamilton Depression Scale scores sustained from first month up to the end of the study. The number of patients hospitalized importantly decreased and most of them (95.9%) were ambulatory patients at the end of the study. We also observed a decrease on UKU neurological side-effects scale scores (including parkinsonism) from sixth month up to the end of the study and from basal to final evaluation. Other side effects related were amenorrhea (2.1%) and weight gain (1.6%). Investigators' opinion about risperidone efficacy and tolerability was good or very good in 84.4% and 91.6% respectively. DISCUSSION: This study concludes that risperidone is an effective, well tolerated an secure antipsychotic drug in the treatment of patients with a first psychotic episode, and in our opinion is a first rank therapeutical alternative in these kind of patients.

Ecstasy-induced psychotic disorder: six-month follow-up study.

OBJECTIVE: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. DESIGN: Observational study with a 6-month follow-up. METHOD: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. RESULTS: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. CONCLUSIONS: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.

Tratamiento precoz con risperidona de primeros episodios psicóticos: dos años de seguimiento / Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study

Introducción. Entre los objetivos de todo tratamiento antipsicótico se encuentran la mejoría tanto de los síntomas psicóticos positivos y negativos como de los síntomas conductuales, afectivos y cognitivos que acompañan a la mayor parte de las psicosis, todo ello con la menor incidencia posible de efectos adversos y con la intención de mejorar la calidad de vida del paciente y sus relaciones con el entorno. Con el advenimiento de los nuevos antipsicóticos atípicos se ha venido a ampliar el horizonte del tratamiento farmacológico de las psicosis. Sin embargo, se han realizado pocos estudios clínicos prospectivos sobre los efectos de los fármacos antipsicóticos en pacientes afectados por un primer episodio psicótico. Material y método. Nuestro objetivo era mediante un estudio multicéntrico, observacional, abierto y prospectivo valorar la efectividad, tolerabilidad y seguridad del tratamiento precoz con risperidona en pacientes afectados por un primer episodio psicótico (criterios DSM IV), así como evaluar a largo plazo (dos años) el efecto de dicho tratamiento en la evolución clínica de estos pacientes. Se incluyeron 436 pacientes de entre 18 y 65 años a los que se instauró tratamiento antipsicótico por primera vez. Resultados. El diagnóstico realizado con mayor frecuencia fue el de esquizofrenia y otros trastornos psicóticos no inducidos por sustancias (90,6 por ciento). La dosis media de risperidona utilizada a lo largo del estudio fue de 5,12 mg/día, permaneciendo la mayoría de los pacientes en monoterapia con dicho fármaco. La mejoría de estos pacientes en las escalas PANSS (psicopatología total y subescalas positiva, negativa y general), de actividad global del paciente (EEAG) e impresión clínica global (ICG) fue estadísticamente significativa a partir del primer mes del tratamiento y mantenida durante los dos años de seguimiento. También se observó una mejoría en las escalas de manía de Young y de depresión de Hamilton de forma sostenida desde el primer mes y durante los dos años de evaluación. Se redujo significativamente el número de pacientes hospitalizados, manteniéndose en régimen ambulatorio un 95,9 por ciento de los pacientes a los dos años de tratamiento y en la escala UKU de efectos adversos de tipo neurológico se observó una disminución significativa de la puntuación de los síntomas parkinsonianos a partir del sexto mes de tratamiento y entre la visita basal y final. Otros efectos adversos notificados fueron la amenorrea (2,1 por ciento) y el aumento de peso (1,61 por ciento), siendo la opinión global del investigador sobre la eficacia y la tolerancia de la risperidona buena o muy buena en el 84,4 por ciento y 91,6 por ciento de los casos respectivamente. Discusión. Según los resultados obtenidos en el presente estudio podemos concluir que la risperidona es un antipsicótico que presenta un buen perfil de efectividad clínica, de tolerancia y de seguridad en el tratamiento de los primeros episodios psicóticos, constituyendo una alternativa farmacológica de primera línea en este tipo de trastornos (AU)

Nuevos y viejos antipsicóticos / New and old antipsychotics

No disponible

Gypsies and drug addictions. Study of the adherence to treatment.

AIMS: To compare the retention in a Naltrexone Maintenance Programme (NMP) between a gipsy and a 'paya' (non-gypsy) population in the province of Alava (Basque Country, Spain). HYPOTHESIS: The exposure factor 'to be a gypsy' is no different from the factor 'to be "payo" (non-gypsy)' with regard to the response in the continuation of treatment with opiate antagonists. DESIGN AND PARTICIPANTS: Based on a retrospective follow-up study, two cohorts were considered based on the ethnic group to which one belonged. The cohort of gypsies was made up of 52 cases, for whom by means of a matching process 52 'payo' (non-gypsy) subjects were selected to form the other cohort. The matching variables were age, sex, the family support, and HIV+ status. After a period of detoxification, all the subjects participated in a NMP and the retention in this programme was evaluated. FINDINGS: The survival analysis showed a continuation probability that was higher for the non-gypsy group than for the gypsy group, even though the differences were not significant but they did show a tendency (p < 0.06). The post- hoc tests showed differences between the continuations shown by both cohorts between 4 and 8 weeks, with this not being observed at other times. A subsequent proportional risks regression analysis showed a strong influence of the previous treatments variable, the effect of which was greater in the gypsy group, with this finally causing a correction in the continuation curves that reduced the differences. CONCLUSIONS: The results are discussed with regard to the context of the gypsy ethnic group, and suggestions are made with regard to the need for establishing preventive and informative measures that manage to reach the idiosyncrasy of the gypsy culture.

A randomized trial of adding fluoxetine to a naltrexone treatment programme for heroin addicts.

AIMS: The purpose of the study was to assess whether fluoxetine would enhance retention in a naltrexone (NTX) treatment programme. DESIGN: Randomized clinical trial. SETTING: The clinical trial was conducted in two Drug Dependence Centres (DCs) of the Basque Country, Spain over a 1-year period. These DCs routinely used naltrexone as part of their treatment. PARTICIPANTS: A total of 112 heroin addicts included in a naltrexone treatment programme were randomly allocated to two groups of 56 patients each. INTERVENTION: One group received 20 mg/24 h of fluoxetine for the first 6 months, while the remaining 56 patients were used as controls. No placebo was used. MEASUREMENTS: Retention rates and hazard functions were estimated. The risk difference and relative risk were also calculated at 6 and 12 months. FINDINGS: The survival functions showed significantly higher retention rates in the fluoxetine group than among the controls. The risk difference at both 6 months (RD6 = 0.23, CI 95% = 0.06-0.42) and 12 months (RD12 = 0.21, CI 95% = 0.09-0.39) favoured the fluoxetine group, with a greater dropout risk at both times among the controls (RR6 = 1.81, CI 95% = 1.11-2.94; RR12 = 1.46, CI 95% = 1.04-2.04). CONCLUSIONS: The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo-controlled trials are warranted to assess how far this reflects a specific pharmacological effect.

Psychological and behavioural factors associated with relapse among heroin abusers treated in therapeutic communities.

The authors carried out a comparative study on two groups of heroin abusers treated in several therapeutic communities: One group consumed heroin on at least three occasions between the fifth and sixth months of treatment (n = 130), and the other continued without consuming heroin after 7 months of treatment (n = 130). The instruments used for data collection were a structured interview and urine analysis. The relapsed group includes older patients with more medical problems, lower educational and occupational level, and major chronicity in heroin consumption. The collection of retrospective data referring to the treatment period shows that relapsed patients more frequently consumed alcohol, hashish, cocaine, and amphetamines; suffered more heroin cravings; used fewer coping strategies to overcome the craving; and justified the craving or the heroin consumption in more situations than those who abstained. The last heroin craving during the treatment period arose in different temporal, social, and physical contexts in the two groups, and it was accompanied more frequently by inadequate responses in the relapsed group: psychophysiological alterations, depressed feelings, negative thoughts, and coping behaviours. The two groups are different in their attitudes toward heroin abstinence. The authors discuss the findings from a cognitive-behavioural perspective and come to the conclusion that various models need to be integrated.

[Factors associated with the failure to use condoms among a population of parenteral drug addicts]. / Factores asociados a la no utilización de preservativos en una población de adictos a drogas por vía parenteral.

Use of condom in sexual intercourse by intravenous drug users has been assessed among a clinical population (n = 139). The multiple logistic regression results show that being a female (OR = 5.1, 95% CI = 2.0-13.2), on drug dependence for a 5-year period or more (OR = 3.0; 95% CI = 1.3-6.9) correlates with non-condom use. Less than 25% of females use condom in their sexual contacts. On the contrary a higher educational level seems to protect subjects against non-condom use (R = 0.3; 95% CI = 0.1-0.8). The most parsimonious model fitting to data at hand includes such variables as sex, educational level, partnership and frequency of sexual intercourse, as well as years on addiction. Other set of variables such as living and working status, age, and previous sexually-transmitted diseases experience are not required for the final model. Emphasis is placed on the need for developing programs aimed at modifying the high risk behavior intravenous drug users resort to in their sexual intercourse, stressing that the main dissemination cause of the human immunodeficiency virus among such a population is due to their sharing drug injections equipment.

Factores asociados a la no utilización de preservativos en una población de adictos a drogas por vía parenteral. / [Factors associated with the failure to use condoms among a population of parenteral drug addicts]

Use of condom in sexual intercourse by intravenous drug users has been assessed among a clinical population (n = 139). The multiple logistic regression results show that being a female (OR = 5.1, 95

CI = 2.0-13.2), on drug dependence for a 5-year period or more (OR = 3.0; 95

CI = 1.3-6.9) correlates with non-condom use. Less than 25

of females use condom in their sexual contacts. On the contrary a higher educational level seems to protect subjects against non-condom use (R = 0.3; 95

CI = 0.1-0.8). The most parsimonious model fitting to data at hand includes such variables as sex, educational level, partnership and frequency of sexual intercourse, as well as years on addiction. Other set of variables such as living and working status, age, and previous sexually-transmitted diseases experience are not required for the final model. Emphasis is placed on the need for developing programs aimed at modifying the high risk behavior intravenous drug users resort to in their sexual intercourse, stressing that the main dissemination cause of the human immunodeficiency virus among such a population is due to their sharing drug injections equipment.

Factores asociados a la no utilización de preservativos en una población de adictos a drogas por vía parenteral. / [Factors associated with the failure to use condoms among a population of parenteral drug addicts]

Use of condom in sexual intercourse by intravenous drug users has been assessed among a clinical population (n = 139). The multiple logistic regression results show that being a female (OR = 5.1, 95

CI = 2.0-13.2), on drug dependence for a 5-year period or more (OR = 3.0; 95

CI = 1.3-6.9) correlates with non-condom use. Less than 25

of females use condom in their sexual contacts. On the contrary a higher educational level seems to protect subjects against non-condom use (R = 0.3; 95

CI = 0.1-0.8). The most parsimonious model fitting to data at hand includes such variables as sex, educational level, partnership and frequency of sexual intercourse, as well as years on addiction. Other set of variables such as living and working status, age, and previous sexually-transmitted diseases experience are not required for the final model. Emphasis is placed on the need for developing programs aimed at modifying the high risk behavior intravenous drug users resort to in their sexual intercourse, stressing that the main dissemination cause of the human immunodeficiency virus among such a population is due to their sharing drug injections equipment.