[Evaluation of the combination of psychosocial and pharmacological treatment in schizophrenic patients]. / Evaluación de la combianación de los tratamientos psicosocial y farmacológico en pacientes con esquizofrenia.

INTRODUCTION: The present treatment of schizophrenia should initially focus on bringing psychotic symptoms under control with the use of antipsychotic medication, but it also should include the psychosocial management of the illness, with the implementation of psychosocial treatment. The purpose of the present study is to describe the results of the comparison of two groups (experimental and control) of schizophrenic out-patients of The National Institute of Psychiatry Ramón de la Fuente in Mexico City. The experimental group received a combination of psychosocial and pharmacological treatment, while the control group received the pharmacological treatment alone. MATERIAL AND METHODS: A quasi-experimental design which included the two groups under study, experimental (n=25) and control group (n=22), was used. Both groups were assessed at the beginning and at the end of a one-year interventions considering variables such as: symptomatology, psychosocial functioning, global functioning, compliance with antipsychotic medication, relapses, rehospitalizations, therapeutic non-compliance, and adherence. RESULTS: Experimental patients, in comparison with control patients, improved their symptomatology, psychosocial functioning and global functioning considerably. They also presented the following: lower relapse frequency - 12% versus 31,8% of the controls as well as low rehospitalizacion rate - 0% versus 13.6% of the control patients, higher antipsychotic medication compliance (90%) when compared with patients under the control condition (80%), a reduced rate of therapeutic non-compliace (19.3%) and a higher degree of adherence (80.7%). On the other hand, control patients remained stabilized in their symptomatology, but did not improved in any of the psychosocial variables. CONCLUSIONS: The results show that the combination of psychosocial and pharmacological therapy is a more effective form of treatment in comparison with the other approach of pharmacotherapy alone. It may be concluded that there is sound evidence that indicates that combined psychosocial and pharmacological therapy combined report beneficial effects for the patients; therefore, it should be considered as an important therapeutic alternative in the treatment of schizophrenic patients.

Plasma concentrations of endogenous benzodiazepine-receptor ligands in patients with hepatic encephalopathy: a comparative study.

OBJECTIVE: Hepatic encephalopathy (HE) is a complex neuropsychiatric disorder secondary to acute or chronic liver failure. Although the exact causes of HE have not been clarified, enhanced central nervous system inhibition at the gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex, mediated by increased levels of endogenous benzodiazepine-receptor ligands (BZRL), has been proposed. Research exploring this hypothesis has yielded contradictory findings. This study evaluated the presence and levels of BZRL in plasma from patients with HE and 3 comparison groups. DESIGN: Cross-sectional study. PATIENTS: Twenty-four patients with HE, 10 patients with liver cirrhosis without encephalopathy (LC), 4 patients with uremic encephalopathy (UE), and 9 healthy subjects. INTERVENTIONS: Radio-receptor assay of plasma samples from patients and controls. MAIN OUTCOME MEASURES: Plasma levels of BZRL. RESULTS: The patients in the HE group had significantly higher plasma BZRL levels than the patients with UE and the healthy subjects, but not than those with LC, in whom these compounds were also detected in significant concentrations. When patients were classified according to the severity of HE, plasma of BZRL showed a modest correlation with stage of severity (r = 0.37). Interestingly, approximately one-third of the patients with HE did not have detectable levels of BZRL. CONCLUSION: Endogenous BZRL may play a role in the pathogenesis of HE, although neuropsychiatric symptoms in HE are difficult to explain in terms of these compounds alone.

Treatment of inhalant-induced psychotic disorder with carbamazepine versus haloperidol.

OBJECTIVE: The efficacy and adverse effects of carbamazepine and haloperidol were compared in the treatment of inhalant-induced psychotic disorder. METHODS: Forty male patients admitted to an acute psychiatric unit for treatment of inhalant dependence and inhalant-induced organic mental disorder, as diagnosed by DSM-III-R, were randomly assigned to receive five weeks of treatment with carbamazepine or haloperidol in identical-appearing capsules. The Brief Psychiatric Rating Scale and the DiMascio Extrapyramidal Symptoms Scale were administered weekly. RESULTS: Both treatment groups improved significantly over time. A reduction of symptom severity of 48.3 percent in the carbamazepine group and 52.7 percent in the haloperidol group was observed. Approximately half the patients in each group were considered treatment responders at the end of the study. Adverse effects were significantly more common and more severe in the haloperidol group. CONCLUSIONS: Carbamazepine appears to have comparable efficacy but fewer adverse effects than haloperidol for the treatment of inhalant-induced psychotic disorder.

Measurement of depression in Mexican patients with rheumatoid arthritis: validity of the Beck Depression Inventory.

OBJECTIVE: To validate a Spanish version of the Beck Depression Inventory (BDI) in Mexican patients with rheumatoid arthritis (RA). METHODS: Thirty-five patients with RA seen in our outpatient clinic were included. A semistructured psychiatric interview was applied, and the following instruments were administered: the BDI, the Hospital Anxiety and Depression Scale (HAD), and the Health Assessment Questionnaire Disability Index. Diagnostic properties of the BDI for both full-length and smaller versions taking out somatic items were compared against a gold standard. The gold standard for comparison was the diagnosis of depression according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised Criteria. RESULTS: Thirty-seven percent of RA patients had a diagnosis related to depression, most of which were major depression or dysthymia. The original BDI showed a high sensitivity (92%) and a high correlation with the HAD (r = 0.83). Exclusion of somatic items in modified versions of the BDI had a similar performance. CONCLUSIONS: The original BDI is a suitable instrument to detect depression in Mexican RA patients. Nevertheless, shorter versions without some of the somatic items also show an adequate performance.

A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.

Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.

Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine.

A double-blind clinical trial was carried out to evaluate the efficacy of S-adenosyl-L-methionine (SAMe) in speeding the onset of action of imipramine (IMI). SAMe is a naturally occurring substance that has been shown to possess antidepressant activity with a rapid mode of onset and minimal side effects. Sixty-three outpatients with moderate to severe depression were included in the study. After an initial 1-week placebo period, only 40 patients entered the active treatment phase. During the first 2 weeks of the trial, half of these patients received 200 mg/day of SAMe intramuscularly, while the other half received placebo. Simultaneously, oral IMI was administered to all patients at a fixed dose of 150 mg/day. The onset of clinical response was determined by evaluating patients every second day. By the end of week 2, the parenteral treatment was suppressed and IMI was adjusted according to individual needs. Depressive symptoms decreased earlier in the patients who were receiving the SAMe-IMI combination than in those who were receiving the placebo-IMI combination.

The effect of total sleep deprivation on plasma melatonin and cortisol in healthy human volunteers.

Twelve healthy volunteers were included in this study. Baseline curves for melatonin and cortisol were obtained after one night of adaptation to laboratory conditions. From 10:00 p.m. to 6:00 a.m., blood samples were drawn every hour. On the third night, the subjects were kept awake at the sleep unit. Curves for the two hormones were then obtained after 36 h of total sleep deprivation (SD). The levels of these hormones were evaluated by calculating the area under the curve at each hour in both situations (basal and after sleep deprivation). It was found that the melatonin levels were increased after sleep deprivation, whereas the cortisol levels remained the same. These results suggest a mechanism by which a reset of abnormal rhythms can occur in depression.