Metabolic syndrome and obesity among users of second generation antipsychotics: A global challenge for modern psychopharmacology.

Second generation antipsychotics (SGAs), such as clozapine, olanzapine, risperidone and quetiapine, are among the most effective therapies to stabilize symptoms schizophrenia (SZ) spectrum disorders. In fact, clozapine, olanzapine and risperidone have improved the quality of life of billions SZ patients worldwide. Based on the broad spectrum of efficacy and low risk of extrapyramidal symptoms displayed by SGAs, some regulatory agencies approved the use of SGAs in non-schizophrenic adults, children and adolescents suffering from a range of neuropsychiatric disorders. However, increasing number of reports have shown that SGAs are strongly associated with accelerated weight gain, insulin resistance, diabetes, dyslipidemia, and increased cardiovascular risk. These metabolic alterations can develop in as short as six months after the initiation of pharmacotherapy, which is now a controversial fact in public disclosure. Although the percentage of schizophrenic patients, the main target group of SGAs, is estimated in only 1% of the population, during the past ten years there was an exponential increase in the number of SGAs users, including millions of non-SZ patients. The scientific bases of SGAs metabolic side effects are not yet elucidated, but the evidence shows that the activation of transcriptional factor SRBP1c, the D1/D2 dopamine, GABA2 and 5HT neurotransmitions are implicated in the SGAs cardiovascular toxicity. Polypharmacological interventions are either non- or modestly effective in maintaining low cardiovascular risk in SGAs users. In this review we critically discuss the clinical and molecular evidence on metabolic alterations induced by SGAs, the evidence on the efficacy of classical antidiabetic drugs and the emerging concept of antidiabetic polyphenols as potential coadjutants in SGA-induced metabolic disorders.

Tendencia del uso de benzodiazepinas en una muestra de consultantes en atención primaria / Trends in benzodiazepine use in primary care patients

BACKGROUND: Benzodiazepine use is associated to a risk of abuse of dependency. In Chile benzodiazepine abuse is a public health issue. In an attempt to overcome this problem, several restrictions in their prescription were implemented by the health authority. Despite these measures, inadequate use of benzodiazepines in primary care continues to be frequent. AIM: To study the frequency of benzodiazepine use among primary care patients. MATERIAL AND METHODS: Cross sectional survey done during two days, with seven physicians working in public primary care clinics. They applied a structured questionnaire about psychotropic medication use. RESULTS: One hundred eighty eight subjects aged 46.8 +/- 17.5 years, 66 per cent women, were interviewed. Thirty two percent were consuming a psychotropic drug and 82 per cent of these corresponded to benzodiazepines. General practitioners and psychiatrists prescribed the drug to 75 per cent and 13 per cent of subjects, respectively. A higher frequency of benzodiazepine use was observed in women and in urban areas. CONCLUSIONS: Benzodiazepine use continues to be highly prevalent in primary care patients, in spite of the nationwide implementation of controlled prescriptions.

[Periodicities in the longitudinal evaluation of affective status]. / Periodicidades en la evaluación longitudinal del estado afectivo.

Both circadian and infradian rythms in Affective State (AS) are reported in 12 subjects (10 with Affective Disorders, 2 without Mental Disorder). The segmented visual scale ESTA-III was used, which yields scores for two dimensions: Mood and Drive. Self-assessment of AS was carried out every 8 hours for about a month. The statistical procedure is underlined. Theoretical implications of findings are discussed.

[The ICD-10 and mood disorders]. / La CIE-10 y los trastornos del humor.

30 patients with affective disorders are evaluated by a Mental Health team following diagnostic criteria of ICD-10 and DSM-III-R. Results are compared. Significative aspects of ICD-10 and differences between both classifications are analyzed in this area.

La CIE-10 y los trastornos del humor / [The ICD-10 and mood disorders]

30 patients with affective disorders are evaluated by a Mental Health team following diagnostic criteria of ICD-10 and DSM-III-R. Results are compared. Significative aspects of ICD-10 and differences between both classifications are analyzed in this area.

Periodicidades en la evaluación longitudinal del estado afectivo. / [Periodicities in the longitudinal evaluation of affective status]

Both circadian and infradian rythms in Affective State (AS) are reported in 12 subjects (10 with Affective Disorders, 2 without Mental Disorder). The segmented visual scale ESTA-III was used, which yields scores for two dimensions: Mood and Drive. Self-assessment of AS was carried out every 8 hours for about a month. The statistical procedure is underlined. Theoretical implications of findings are discussed.

La CIE-10 y los trastornos del humor. / [The ICD-10 and mood disorders]

30 patients with affective disorders are evaluated by a Mental Health team following diagnostic criteria of ICD-10 and DSM-III-R. Results are compared. Significative aspects of ICD-10 and differences between both classifications are analyzed in this area.

ARIMA modelling of chronospsychometric self-evaluation of drive and mood.

The expanding study of biological rhythms requires the use of refined methods of time series analysis. We propose the use of ARIMA (Autoregressive Integrated Moving Averages) model, a powerful statistical tool of relatively recent development. A group of 5 patients with Affective Disorders (2 bipolars, 3 unipolars) and 1 patient with Adjustment Disorder self-assessed their AS every 8 hours for about a month. The affective state (AS) was estimated for 4 indicators: the two main constructs (Mood and Drive) of the segmented Visual Scale ESTA III and two bipolar items (Anxiety and Drowsiness). Mood and Drive are continuous variables, while Anxiety and Drowsiness are ordinal ones. Strictly speaking, ARIMA modelling is not valid with ordinal data. However, comparison of models of the two kinds of variables reveals no significant differences. This points out to a certain robustness of the method. Most of the series were non-stationary but could be transformed taking no more than two differences. The models made a very good fit of the data. Statistically significant coefficients on different lags may indicate the presence of circadian and infradian periodicities in the series. Further applications of ARIMA models to biological and psychological rhythmometry may be quite useful.