[Evaluation of the social care program for persons with severe mental disorders: a Delphi study]. / Valoración del programa social de atención a personas con trastorno mental grave: un estudio Delphi.

BACKGROUND: In January 2005 the Government of Navarre approved the "Care Program for Persons with Severe Mental Disorder" (PA-TMG). This article is intended to ascertain the opinion of experts regarding the PA-TMG. To identify the elements of agreement in the evaluation of positive aspects and aspects that can be improved. To make recommendations on the basis of their opinions. METHODS: A Delphi study was designed with 34 experts in health or social care of mentally ill persons. By means of repeated questionnaires, ideas that achieved a consensus of (3)90% were identified and a level of priority was assigned. The percentages of agreement and descriptive statistics of priority were presented, and the recommendations of analysis of the areas of consensus were drawn up. RESULTS: Out of the 34 participating experts, 25 (71.4%) completed the study: 1 sociologist, 5 social workers, 3 psychiatrists, 5 psychologists, one representative of the families, 3 occupational therapists, 1 technician in social integration and 6 family doctors. Sixty-four percent evaluated the Plan positively, and 72% were of the opinion that it was drawn up without sufficient professional participation. All thought that it could be improved by widening the participation of experts. CONCLUSIONS: The principal ideas on which there was consensus were: socio-health care must be guaranteed by the public administration; good systems of information and evaluation must be established; the Plan must have its own budget; professional follow-up of the patient by the different mechanisms must be guaranteed; a lot of the decision making must be decentralised; access to social benefits for these patients must be universalised.

Valoración del programa social de atención a personas con trastorno mental grave: un estudio Delphi / Evaluation of the social care program for persons with severe mental disorders: a Delphi study

Fundamento. En enero de 2005 el Gobierno de Navarra aprobó el “Programa de Atención a Personas con Trastorno Mental Grave” (PA-TMG). El objetivo del presente trabajo es conocer la opinión de expertos acerca del PA-TMG. Identificar los elementos de acuerdo en la valoración de aspectos positivos y aspectos mejorables. Realizar recomendaciones a partir de su opinión. Material y métodos. Se diseñó un estudio Delphi con 34 expertos en la atención sanitaria o social de enfermos mentales. Mediante cuestionarios repetidos se identificaron las ideas que alcanzaran un consenso >=90%, y se asignó un nivel de prioridad. Se presentan los porcentajes de acuerdo, estadísticos descriptivos de la prioridad, y se elaboran las recomendaciones de análisis de las áreas de consenso. Resultados. De los 34 expertos participantes, finalizaron el estudio 25 (71,4%): 1 socióloga, 5 trabajadoras sociales, 3 psiquiatras, 5 psicólogos, 1 representante de las familias, 3 terapeutas ocupacionales, 1 técnico en integración social y 6 médicos de familia. Valoran positivamente el Plan el 64% y 72% opinan que se ha elaborado sin suficiente participación profesional. Todos piensan que podría mejorarse si se amplia la participación de expertos. Conclusiones. Las principales ideas consensuadas han sido que: la atención socio-sanitaria debe garantizarse por los poderes públicos; se deben establecer buenos sistemas de información y de evaluación; el Plan debe tener presupuesto propio; debe garantizar el seguimiento profesional del paciente por los diferentes dispositivos; se deben descentralizar muchas tomas de decisiones; se debe universalizar el acceso a un catálogo de prestaciones sociales para estos enfermos

Background. In January 2005 the Government of Navarre approved the “Care Program for Persons with Severe Mental Disorder” (PA-TMG). This article is intended to ascertain the opinion of experts regarding the PA-TMG. To identify the elements of agreement in the evaluation of positive aspects and aspects that can be improved. To make recommendations on the basis of their opinions. Methods. A Delphi study was designed with 34 experts in health or social care of mentally ill persons. By means of repeated questionnaires, ideas that achieved a consensus of >=90% were identified and a level of priority was assigned. The percentages of agreement and descriptive statistics of priority were presented, and the recommendations of analysis of the areas of consensus were drawn up. Results. Out of the 34 participating experts, 25 (71.4%) completed the study: 1 sociologist, 5 social workers, 3 psychiatrists, 5 psychologists, one representative of the families, 3 occupational therapists, 1 technician in social integration and 6 family doctors. Sixty-four percent evaluated the Plan positively, and 72% were of the opinion that it was drawn up without sufficient professional participation. All thought that it could be improved by widening the participation of experts. Conclusions. The principal ideas on which there was consensus were: socio-health care must be guaranteed by the public administration; good systems of information and evaluation must be established; the Plan must have its own budget; professional follow-up of the patient by the different mechanisms must be guaranteed; a lot of the decision making must be decentralised; access to social benefits for these patients must be universalised

Serotonergic polymorphisms and psychotic disorders in populations from North Spain.

There is strong biological evidence relating alterations in the serotonergic system with mental disorders. These alterations may be originated at the DNA level by sequence mutations that alter the functioning of serotonin receptors and transporter. To test this hypothesis we investigated three genetic variants of the 5-HT2A receptor (-1438G/A, 102T/C and His452Tyr) and two variants of the serotonin transporter (a VNTR in the second intron and a 44 bp insertion/delition in the promoter region of the gene) in a clinical sample recruited in a human isolate and in surrounding areas in Northern Spain (N = 257) and in ethnically matched controls (N = 334). No clear association was found between 5-HT2A variants and psychosis. However, marginal associations were observed between the 5-HTT LPR and VNTR variants and psychosis (P < or = 0.05) indicating a minor contribution to psychosis of genetic alterations in this gene.

[Influence of serotonergic transmission on response to olanzapine]. / Influencia de la transmisión serotoninérgica en la respuesta a olanzapina.

INTRODUCTION: This study aimed to investigate associations between the response to olanzapine and genetic variations (polymorphisms) in serotonergic transmission related genes in a sample of prospectively studied schizophrenic patients treated with this drug. METHODOLOGY: A total of 51 non-related patients with a DSM-IV diagnosis of schizophrenia were treated with olanzapine (mean dose: 12 mg/day; range: 5-25 mg) and followed-up for at least three months. Response to olanzapine was measured by the difference between baseline and post-treatment scores on the PANSS and GAS scales. The following polymorphisms were studied: serotonin receptor 5-HT2A (102-T/C, His452Tyr), serotonin receptor 5-HT2C (Cys23Ser, -330-GGT/-244-CT), and serotonin transporter (VNTR, 5-HTTLPR). RESULTS: Global clinical improvement, measured with both the GAS and PANSS total scores, was observed. When patients were divided into responders and non-responders, the distribution of genotypic and allelic frequencies was similar to the one observed in previous studies with clozapine. When regression analyses were undertaken, polymorphism 330-GT/-244-CT of the 5-HT2C serotonin receptor and 5-HTTLPR of the serotonin transporter showed a tendency towards the association to olanzapine response. CONCLUSIONS: The present study provides preliminary evidence of the important role of variations in serotonin transmission related genes in determining clinical response to olanzapine. Considering previous studies, it can also be concluded that olanzapine and clozapine may have similar affinities to serotonin receptors.

Influencia de la transmisión serotoninérgica en la respuesta a olanzapina / Influence of serotogenic transmission on response to olanzapine

Introducción. El objetivo de este trabajo fue estudiar posibles asociaciones entre la respuesta a la olanzapina y variaciones genotípicas (polimorfismos) en gener implicados en la transmisión serotoninérgica, en una muestra de pacientes esquizofrénicos en tratamiento con este fármaco estudiados prospectivamente. Metodología. Un total de 51 pacientes sin relación familiar, con un diagnóstico de esquizofrenia (DSM-IV) fueron tratados con olanzapina (dosis media; 12 mg/día, rango: 5-25) y seguidos durante un período de al menos tres meses. La respuesta a la olanzapina se midió mediante las diferencias entre las puntuaciones basales y post-tratamiento en la escala PANSS y GAS. Se estudiaron los siguientes polimorfismos: receptor de serotonina 5-HT2C (Cys23Ser, -330-GT/-244-CT), y transportador de serotonina (VNTR, 5-HTTLPR). Resultados. Se observó una mejoría clínica global medida tanto con la escala GAS como con la PANSS. La distribución de frecuencias genotípicas y alélicas de cada polimorfismo al diferenciar los pacientes entre respondedores y no respondedores fue similar a la observada en estudios previos con clozapina. En los análisis de regresión, el polimorfismo -330-GT/-244-CT de la 5-HT2C y el 5-HTTLPR del transportador de serotonina mostraron una tendencia hacia la asociación con la respuesta a la olanzapina. Conclusiones. En nuestro estudio, se observaron indicios para creer que las variaciones en los genes relacionados con la transmisión serotoninérgica pueden desempeñar un papel importante enla determinación de la respuesta clínica a la olanzapina. Considerando estudios previos, también podemos concluir que la olanzapina y la clozapina pueden tener4 afinidades similares por los receptores serotoninérgicos (AU)

Evolución de los patrones de tratamiento de los pacientes esquizofrénicos / Evolution of treatment patterns of schizophrenic patients

En la actualidad el pilar básico sobre el que se asienta el tratamiento de la esquizofrenia la constituye la psicofarmacología, y más concretamente los neurolépticos. Hasta hace pocos años, este tipo de fármacos tenía el inconveniente de provocar frecuentes y molestos efectos secundarios además de no actuar sobre los llamados síntomas negativos de la enfermedad. La reciente aparición de varios neurolépticos atípicos, denominados así por su diferente mecanismo de acción a nivel de receptores cerebrales, ha abierto una puerta a la esperanza en relación al tratamiento de los pacientes esquizofrénicos debido precisamente a los escasos efectos secundarios que producen y a la posible acción sobre los síntomas negativos. En el presente trabajo se analiza la evolución en el patrón de tratamiento de los pacientes esquizofrénicos a la luz de la aparición de estos fármacos en una muestra de pacientes cuya enfermedad se inició cuando únicamente uno de estos neurolépticos atípicos estaba comercializado aunque con un uso limitado. A la luz de los resultados se concluye que los neurolépticos atípicos se van asentando en el tratamiento de la esquizofrenia aunque de momento sin desplazar a los neurolépticos convencionales. Por otro lado, nuestros datos sugieren que se necesitan nuevos estudios encaminados a optimizar la elección del neuroléptico adecuado para cada paciente, así como el fomento de medidas encaminadas a la rehabilitación ocupacional de estos pacientes (AU)

Serum iron in catatonic and noncatatonic psychotic patients.

BACKGROUND: Since low serum iron has been reported in a variety of neuropsychiatric motor disorders, this study was conducted to examine serum iron in patients with a catatonic disorder. METHODS: Forty catatonic and 40 noncatatonic psychotic patients were studied in relation to serum iron levels. The association of serum iron with other clinical variables was also examined. RESULTS: Catatonics had significantly lower mean serum iron than noncatatonics. Ferropenia (serum iron < 50 micrograms/dL) was significantly more prevalent in the catatonic (35%) than in the noncatatonic (7.5%) group. Severity of catatonic symptoms was inversely correlated with level of serum iron, this being due to the negative catatonic symptoms (r = -.34, p = .002). CONCLUSIONS: A subgroup of catatonic patients had ferropenia. Lower serum iron level was associated with both the presence of a categorically defined catatonic syndrome and the severity of the negative catatonic symptoms.