A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot Randomized Controlled Clinical Trial.

BACKGROUND: Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia. METHODS: We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups. RESULTS: Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008). CONCLUSION: A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.

A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients.

ABSTRACT: The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention ( n = 24) or control group ( n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17-2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.

Prevalencia del síntoma ansiedad en pacientes con demencia en una unidad de psicogeriatría y tratamiento farmacológico asociado / No disponible

La ansiedad es uno de los síntomas que aparece frecuentemente en los pacientes con demencia, si bien su prevalencia varía en función del tipo y fase de la misma, del sexo del individuo e incluso del grado de autonomía funcional. La ansiedad suele tener una repercusión importante sobre la calidad de vida del enfermo y sus cuidadores, lo que justifica la instauración de medidas no farmacológicas y a menudo, también farmacológicas. Ahora bien, la utilización de medicamentos en la población geriátrica y particularmente en los dementes es compleja, por la mayor sensibilidad a los fármacos y mayor susceptibilidad de padecer efectos no deseados. La instauración de tratamientos farmacológicos necesariamente conlleva a una revisión crítica y sistemática de su beneficio/riesgo de acuerdo a los objetivos terapéuticos que han sido predefinidos (AU)

Anxiety is a symptom that occurs frequently in patients with dementia, although their prevalence varies depending on the type and stage of it, the sex of the individual and even the degree of functional autonomy. Anxiety often has a significant impact on the quality of life of patients and their caregivers, which justifies the introduction of non-pharmacological measures and often also drugs. However, the use of drugs in the elderly, particularly in dementia is complex, because has a greater drug sensitivity and susceptibility to unwanted effects. The introduction of drug therapies necessarily leads a systematic critical review of the benefit/risk according therapeutic goals that have been predefined (AU)