Eating disorders in sport. Update and proposal for an integrated approach.

Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.

Eating disorders in sport. Update and proposal for an integrated approach. / Trastornos de conducta alimentaria en la práctica deportiva. Actualización y propuesta de abordaje integral.

Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.

Influence of type of treatment on the well-being of Spanish patients with schizophrenia and their caregivers.

OBJECTIVE: This study aimed to investigate quality of life and burden on caregivers in Spanish outpatients with schizophrenia, treated with different antipsychotics. METHODS: Sociodemographic and clinical data were collected for 1865 patients diagnosed with schizophrenia. Patients answered the EuroQol-5D questionnaire and caregivers answered questionnaires assessing caregiver burden. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression of Severity (CGI-S), and clinician's satisfaction were also recorded. The same data were also collected at months 3 and 6. RESULTS: According to EQ-5D results, usual activities (29.6%) and anxiety/depression (31.1%) were the most relevant reported problems. Good overall scores (5-7) on EQ-5D were reported by 47/118 (39.8%) of risperidone long-acting injectable (LAI) patients compared to 52/218 (23.9%) for oral conventional antipsychotics, 51/194 (26.2%) for injectable conventional antipsychotics, and 332/1110 (29.9%) for oral atypical antipsychotics. Significant benefits of risperidone LAI vs. other types of antipsychotic were also found in caregiver burden and clinician-derived outcome measures. At months 3 and 6, retention was > 85%, and score on the EQ5D improved for the overall sample. CONCLUSIONS: In Spanish patients with schizophrenia, activities of daily living and anxiety/depression were more relevant reported problems. Risperidone LAI was associated with better quality-of-life outcomes and lower caregiver burden compared to other types of antipsychotic.

Adherence to treatment and therapeutic strategies in schizophrenic patients: the ADHERE study.

AIM: To assess the degree of compliance and adherence to treatment during the follow-up of schizophrenic outpatients after a new therapeutic strategy had been initiated. METHODS: A multicenter, retrospective, prospective, observational study of 1,848 outpatients with schizophrenia or schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was conducted. Patients were treated either with oral or injectable conventional or second generation antipsychotics, and were followed up for 3 months at mental health centers. Patient compliance with the pharmacological treatment was assessed by the use of questionnaires, scales, medication accountability, and the Medication Event Monitoring System. Patients were considered compliant if they reported a high compliance rate (> or = 80%). RESULTS: At baseline only 29% of patients on oral medication were compliant compared with 79% of patients on injectable medication (injection counting) (OR= 9.11; 95% CI 6.02-13.77; P<.0001). At the 3 month visit, 84% of patients had changed their treatment and in these, the compliance rate of those on injectable medication was 94% versus 87% of patients taking oral medication (OR= 2.47; 95% CI 1.21-5.05; P=.022). CONCLUSION: The use of long-acting injectable antipsychotics, which improves compliance rates and patient follow-up, should facilitate the management of Spanish patients with schizophrenia in mental health centers.

Experience with injectable long-acting risperidone in long-term therapy after an acute episode of schizophrenia: the SPHERE Study.

BACKGROUND: Risperidone long-acting injectable (RLAI) is the first long-acting formulation of an atypical antipsychotic introduced into clinical practice. RLAI combines the benefits of atypical antipsychotic agents with an extended duration of activity and is intended for long-term management of schizophrenia. This study evaluated the use of RLAI as part of a long-term management strategy in patients with an acute episode of schizophrenia. OBJECTIVES: The primary objective was to determine clinicians' approaches to the use of RLAI in patients with an acute exacerbation of schizophrenia by examining the prescribing patterns of antipsychotic and other psychotropic medications. Other objectives were to evaluate the overall safety of switching patients to RLAI from previous antipsychotic therapy and to determine patients', caregivers' and relatives' attitudes towards RLAI treatment. METHODS: The Safety and Profile of Handling and Employing of Risperdal Consta in Emergency/Acute Care Settings (SPHERE) study was an observational, non-interventional, multicenter, retrospective study involving a large cohort of patients with acute psychotic exacerbation who attended Spanish emergency/acute care facilities (between August and December 2003) and were treated with RLAI during hospitalization. RESULTS: A total of 1232 patients (70% men; mean age 37 years; median of 8 months since most recent admission) were included in the analyses; 79% had been receiving antipsychotic therapy prior to admission. All patients received RLAI post-stabilization. The main reasons for initiating RLAI were the need for long-term treatment (76%) and a low adherence to previous treatment (71%). RLAI doses administered during hospitalization were: 25 (26%), 37.5 (29%), 50 (42%) and 75-100 mg (3%). The mean number of injections per patient (2 +/- 1) and mean hospitalization time (25 +/- 16 days) indicated that RLAI was administered every 2 weeks as per the manufacturer's recommendations. All patients were discharged on RLAI treatment; 62% were prescribed concomitant therapy, mainly oral risperidone (39%), anxiolytics (25%), antiparkinsonians (15%), hypnotics (11%) and anticonvulsants (11%). Only 5.7% of patients reported adverse events, most commonly extrapyramidal symptoms (1.1%) and somnolence (0.9%). CONCLUSIONS: As part of a long-term management strategy aimed at improving treatment adherence in schizophrenic patients, RLAI was prescribed to a wide spectrum of patients with an acute episode of schizophrenia during hospitalization and at the time of discharge from emergency/acute care facilities. RLAI was well tolerated in the study population and the overall impression of patients, primary caregivers and relatives to RLAI therapy was positive.