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Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc.

OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

Antisocial personality disorder (ASPD) is characterized by disregard for, and violation of the rights of others that begins in childhood and continues into adulthood (American Psychiatric Association, 2000). ASPD has been associated with childhood abuse and neglect (Luntz & Widom, 1994), victimization and increased vulnerability for additional psychiatric and personality disorders (Compton, Conway, Stinson, Colliver, & Grant, 2005;Robins, Tipp, & Przybeck, 1991). One of the strongest findings in ASPD research is its male preponderance, with a 3:1 ratio of men to women (Compton et al., 2005). Research on sex differences in early risk factors of antisocial behavior showed similar rates of neurocognitive deficits and family adversity in antisocial males and females (Moffitt, Caspi, Rutter, & Silva, 2001). However, much less is known about sex differences in childhood maltreatment among individuals with ASPD. Although higher rates of childhood maltreatment have been reported in women versus men in the general population (Keyes et al., 2012), it is unclear whether this is true in a general population sample of individuals with ASPD. In data from the early 1980s (Robins et al., 1991) men with DSM–III ASPD were more likely to have a history of multiple traffic offenses and arrests, whereas females with ASPD were more likely to have had multiple sexual partners. Among more recent clinical (Goldstein et al., 1996) and community (Mikulich-Gilbertson, Salomonsen-Sautel, Sakai, & Booth, 2007) samples of individuals with ASPD and comorbid substance use disorders, data suggest that women are more likely to have run away from home, to be impulsive, and to lack remorse, whereas men are more likely to report aggressive behaviors such as initiating fights, using weapons, being cruel to animals, setting fires, and meeting the criterion of reckless disregard for safety of others. Since previous research has relied on localized and small samples of drug users limiting the generalization of its findings, examination of sex differences in antisocial behavior and ASPD criteria in a general population sample of ASPD individuals is warranted. Goldstein et al. (1996) also found that women presented with greater psychiatric comorbidity than their male counterparts in the clinical sample of individuals with SUD and comorbid ASPD. In addition, two recent studies using a general population sample examined clinical characteristics of antisocial syndromes and reported sex by antisocial syndrome interactions for comorbid psychiatric disorders and family history of psychopathology among subsamples limited to those with drug use disorders (DUD; Goldstein, Compton et al., 2007) or alcohol use disorders (AUD; Goldstein, Dawson et al., 2007). Among those with DUD and comorbid ASPD, more women than men reported family history of DUD and higher prevalence of lifetime mood, anxiety, and additional personality disorders, but almost identical patterns of ASPD criteria (Goldstein, Compton et al., 2007). Among those with AUD and comorbid ASPD, no sex differences in ASPD symptomatology or psychiatric comorbidity patterns were observed (Goldstein, Dawson et al., 2007). Overall, existing information on sex differences on psychiatric comorbidity is limited by use of treatment-seeking samples (Goldstein et al., 1996) or subsamples of individuals with alcohol or drug use disorders (Goldstein, Compton et al., 2007; Goldstein, Dawson et al., 2007; Mikulich-Gilbertson et al., 2007). Finally, previous studies have failed to examine important clinical correlates such as disability, stress levels, and social support in men and women with ASPD. Information regarding differential levels of impairment and need are relevant to the development and implementation of strategies in the management of ASPD in men and women. The present study aims to fill these gaps in our knowledge, and to respond to the American Psychiatric Association, which has called attention to the critical importance of sex in the presentation of psychiatric disorders (Narrow, First, Sirovatka, & Regier, 2007). We therefore present a comprehensive picture of sex differences in childhood adverse events (CAE) and adult adverse events (AAE), lifetime psychiatric comorbidity, clinical presentation, and other clinical correlates of DSM–IV ASPD. We investigated these sex differences in ASPD using data from a large, nationally representative sample of the U.S. adult population. Specifically, the goals of this study were: (1) to compare men and women in the general population with ASPD on the prevalence of childhood individual and parent-related adverse events and adulthood adverse events; (2) to compare lifetime comorbidity patterns in men and women with ASPD; (3) to identify sex differences in reported antisocial behaviors and DSM–IV ASPD criteria met among individuals diagnosed with ASPD; and (4) to investigate social support, disability, and stress levels in men and women with ASPD.

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self‐control, underpinned by inferior fronto‐striatal deficits. Real‐time functional magnetic resonance neurofeedback (rtfMRI‐NF) allows participants to gain self‐control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms, no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region‐specificity, an active control group received rtfMRI‐NF of the left parahippocampal gyrus (lPHG). Thirty‐one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks. Feedback was provided through a video‐clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof‐of‐concept study demonstrates for the first time feasibility, safety, and shorter‐ and longer‐term efficacy of rtfMRI‐NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190–3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Resumen Introduccion Los estudios en pacientes bipolares adultos han demostrado una discapacidad asociada al trastorno bipolar, incluso en pacientes eutimicos, pero apenas hay datos en poblacion anciana. Material y metodo Estudio transversal y multicentrico, en una muestra de pacientes bipolares (criterios DSM-IV-TR) ambulatorios, consecutivos, con edad igual o superior a 65 anos. Se recogieron datos retrospectivos y transversales sociodemograficos y clinicos, ademas de la gravedad clinica global (ICG-BP-M) y el grado de discapacidad mediante la Escala de Discapacidad de la OMS (WHO/DAS). Se valoro la discapacidad global y por areas. Se considero variable dependiente la presencia de discapacidad de moderada a maxima frente a discapacidad de nula a ligera. Resultados El 43,6% de la muestra presento una discapacidad global entre moderada y maxima. Por areas, el funcionamiento ocupacional resulto el area mas frecuentemente afectada y la de cuidado personal la menos afectada. Las unicas variables con las que se relaciono la discapacidad fueron la presencia de comorbilidad medica (p = 0,01), una edad mayor (0 = 0,005) y la gravedad clinica global (p = 0,0001) y en el polo depresivo (p = 0,03). El subtipo clinico, la duracion de la enfermedad, el numero de episodios previos, el numero de hospitalizaciones y otras variables clinicas no mostraron asociacion con el grado de discapacidad. Conclusiones Estos datos subrayan la necesidad de establecer estrategias terapeuticas especificas para abordar los sintomas depresivos y la comorbilidad medica, con el fin de minimizar la discapacidad de los pacientes bipolares ancianos. Dada la escasez de datos actual, seria necesario realizar nuevos estudios con muestras amplias y grupos control.

BACKGROUND: Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. METHODS: Design: Cross-sectional. Participants: Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. Measurements: Short sleep was defined by self-assessment as ≤5h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. Statistical analyses: Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. RESULTS: Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. LIMITATIONS: Sleep duration was assessed only by self-report. CONCLUSIONS: The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs. Language: en

Background: Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. Methods: Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Results: The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. Conclusion: Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc. Language: en

Objective: Psychometrical questionnaires such as the Barrat's impulsiveness scale version 11 (BIS-11) have been used in the assessment of suicidal behavior. Traditionally, BIS-11 items have been considered as equally valuable but this might not be true. The main objective of this article is to test the discriminative ability of the BIS-11 and the international personality disorder evaluation screening questionnaire (IPDE-SQ) to predict suicide attempter (SA) status using different classification techniques. In addition, we examine the discriminative capacity of individual items from both scales. Materials and methods: Two experiments aimed at evaluating the accuracy of different classification techniques were conducted. The answers of 879 individuals (345 SA, 384 healthy blood donors, and 150 psychiatric inpatients) to the BIS-11 and IPDE-SQ were used to compare the classification performance of two techniques that have successfully been applied in pattern recognition issues, Boosting and support vector machines (SVM) with respect to linear discriminant analysis, Fisher linear discriminant analysis, and the traditional psychometrical approach. Results: The most discriminative BIS-11 and IPDE-SQ items are ''I am self controlled'' (Item 6) and ''I often feel empty inside'' (item 40), respectively. The SVM classification accuracy was 76.71% for the BIS-11 and 80.26% for the IPDE-SQ. Conclusions: The IPDE-SQ items have better discriminative abilities than the BIS-11 items for classifying SA. Moreover, IPDE-SQ is able to obtain better SA and non-SA classification results than the BIS-11. In addition, SVM outperformed the other classification techniques in both questionnaires.

Resumen Introduccion Este estudio evalua la salud fisica de los pacientes con esquizofrenia y analiza el cambio en el porcentaje de pacientes con evaluaciones en los conocidos predictores de diabetes y riesgo cardiovascular antes y 6 meses despues de la difusion del «Consenso Espanol sobre la Salud Fisica del Paciente con Esquizofrenia». Material y metodos Se trata de un estudio epidemiologico de corte transversal no intervencionista, en que 229 psiquiatras evaluaron 1.193 historias clinicas de pacientes diagnosticados de esquizofrenia segun CIE-10, atendidos en las consultas de psiquiatria programadas primero en enero y posteriormente en septiembre de 2007. Los resultados del estudio se analizaron mediante estadistica descriptiva. Resultados Se incluyeron 1.193 pacientes evaluables, con una edad media de 39,7±11,6 anos, diagnosticados de esquizofrenia desde hacia 15,0±10,3 anos, y un 65,90% eran hombres. La presencia de enfermedades concomitantes fue del 39,98%, siendo hipercolesterolemia (46,33%), hipertrigliceridemia (33,54%) e hipertension arterial (26,00%) las mas frecuentes. Tras la difusion del Consenso, aumento en un 13,75% el porcentaje de pacientes a los que se realizaron todas las mediciones de salud fisica. El 48,5% de los psiquiatras se consideraron conocedores del Consenso. El porcentaje de evaluaciones realizadas fue superior entre los psiquiatras conocedores del Consenso (17,32%) que entre aquellos que no lo conocian (10,33%). Conclusiones Los resultados de este estudio muestran un aumento del control de la salud fisica de los pacientes con esquizofrenia tras la difusion del Consenso, que mejoraria el abordaje integral de estos pacientes para garantizar una esperanza de vida, calidad de vida y funcionamiento similares a los de la poblacion general.

Objective—Prior research has consistently documented a strong association between generalized anxiety disorder (GAD) and substance use disorder (SUD). GAD and SUD comorbidity (GAD-SUD) represents clinical challenges as the patients’ symptoms are often more severe and are frequently prolonged making their management more complex when compared with individuals with GAD only. The purpose of this study was to examine whether individuals with GAD-SUD differ meaningfully from individuals with GAD and no SUD comorbidity (GAD-NSUD) in terms of demographic characteristics, risk factors, psychiatric comorbidity and clinical correlates. Methods—Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N=43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Results—We found that the lifetime prevalence rate of GAD-SUD is about 2.04% while that of GAD-NSUD is of 2.10%. Individuals with GAD-SUD showed higher psychiatric comorbidity rates than those with GAD-NSUD. Treatment seeking rates for GAD are equally low in GAD-SUD and GAD-NSUD. Both groups were as likely to receive pharmacological treatment for anxiety. Conclusion—The findings of our study indicate that individuals of GAD-SUD constitutes half of the lifetime prevalence of GAD and that GAD-SUD is associated with high overall vulnerability for additional psychopathology, particularly in the externalizing spectrum, higher disability and higher use of alcohol and drugs to relieve anxiety symptoms.

Introduction This study evaluates the physical health of patients with schizophrenia and analyzes the change in the percentage of patients with evaluations in the known diabetes and cardiovascular risk predictors before and 6 months after the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”. Material and methods This is an epidemiological non-interventional and transversal study, in which 229 psychiatrists evaluated 1,193 clinical records of patients with a diagnose of schizophrenia according to ICD-10, attended in the psychiatry consultations planned in January and September of 2007. Study results were analyzed using descriptive statistics. Results 1,193 evaluable patients were included, with a mean age of 39.7 ± 11.6 years, diagnosed of schizophrenia 15.0 ± 10.3 years ago, and a 65.90% were men. The presence of concomitant diseases was 39.98%, being hypercholesterolemia (46.33%), hypertriglyceridaemia (33.54%) and arterial hypertension (26.00%) the most frequent. After the dissemination of the Consensus, the percentage of patients who had all the physical measurements taken increased by 13.75%. Forty eight per cent of the psychiatrists were considered as being aware of the Consensus. The percentage of measurements taken was higher within the psychiatrists who were aware of the Consensus (17.32%) than within those who were not aware of it (10.33%). Conclusions The results of this study show an increase of the physical health control from patients with schizophrenia after the dissemination of the Consensus, which should improve an integral approach of these patients to ensure a similar life expectancy, quality of life and function to the general population.

Introduction: There has considerable debate about the appropriate conceptualization of pathological gambling (PG) and its place in psychiatric nosology. PG has been hypothesized to represent both an Obsessive-Compulsive spectrum disorder (OCD) and a behavioral addiction, that is an addiction without a drug. Conceptualization of pathological gambling is vital to guide research strategies and the development and testing of effective treatments we will review the existing research supporting the non-pharmacologic addiction model and that supporting the obsessive-compulsive spectrum conceptualization. Objetive: To review the conceptualization of PG and the aspects associated with the OCD or a behavioral addiction. Results and Conclusions: Although PG resembles OCD in some domains, the majority of the existing data suggests substantial differences between them. Findings from phenomenology, epidemiology, treatment response, and imaging study appear to support that PG resembles more closely an addiction. Nevertheless, despite the progress over the last decade in understanding addictions, PG, and OCD, existing data are often limited and include methodological concerns that complicate interpretation and comparisons across subject groups.

Introduction: Prior research suggests that racial minority groups in the United States are more vulnerable to develop a gambling disorder than whites. However, no national survey on gambling disorders exists that has focused on ethnic differences.Methods: Analyses of this study were based on the National Epidemiologic Survey on Alcohol and Related Conditions, a large (N=43,093) nationally representative survey of the adult (≥18 years of age) population residing in house-holds during 2001–2002 period. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision diagnoses of pathological gambling, mood, anxiety, drug use, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IVVersion.Results: Prevalence rates of disordered gambling among blacks (2.2%) and Native/Asian Americans (2.3%) were higher than that of whites (1.2%). Demographic characteristics and psychiatric comorbidity differed among Hispanic, black, and white disordered gamblers. However, all racial and ethnic groups evidenced similarities with respect to symptom patterns, time course, and treatment seeking for pathological gambling.Conclusion: The prevalence of disordered gambling, but not its onset or course of symptoms, varies by racial and ethnic group. These varying prevalence rates may reflect, at least in part, cultural differences in gambling and its acceptability and accessibility. These data may inform the need for targeted prevention strategies for high-risk racial and ethnic groups.

A plethora of magnetic resonance imaging studies have shown that ADHD is characterized by multiple functional and structural neural network abnormalities beyond the classical fronto-striatal model, including fronto-parieto-temporal, fronto-cerebellar and even fronto-limbic networks. There is evidence for a maturational delay in brain structure development which likely extends to brain function and structural and functional connectivity, but this needs corroboration by longitudinal imaging studies. Dysfunction of the ventrolateral prefrontal cortex seems to be more pronounced relative to other pediatric disorders and is also the most consistent target of acute psychostimulant medication. Future studies are likely to focus on using neuroimaging for clinical translation such as for individual diagnostic and prognostic classification and as a neurotherapy to reverse brain function abnormalities.

The aim of this study was to examine the demographic, clinical, and treatment correlates of bipolar disorder (BD) in outpatients 65 years or older and to compare patients with BD subtype I (BD-I) versus BD subtype II (BD-II) and patients with early onset (EO; 50 years old) of the illness. Sixty-nine consecutive outpatients with BD were included. Diagnosis was delayed for a mean of 14.1 years, significantly longer in patients with EO (18.6 years) than with LO (3.3 years). Mild to moderate depressive symptoms were detected in 29% of the patients. The patients were receiving a mean of 3 different psychotropic medications. Antidepressants were more frequently prescribed to patients with BD-II than to patients with BD-I (75.80% vs. 48.60%) and to patients with EO (71.7%) than to LO (35.3%). Geriatric BD has similar clinical characteristics with those of younger ages, and these do not seem to greatly differ with subtype or age of onset.

Objectives. To define different subgroups of suicide attempters according to age at onset of suicide attempts. Methods. Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. Results. The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43–50.0). Conclusions. Age at onset of suicide attempts characterizes different subpopulations of suicide attempters, This paper was supported by the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), Fondo de Investigación Sanitaria (FIS) PI060092, Fondo de Investigacion Sanitaria FIS RD06/0011/0016, ETES (PI07/90207), the Conchita Rábago Foundation, the Spanish Ministry of Health, Instituto de Salud Carlos III, and CIBERSAM (Intramural Project, P91B). Dr. Blasco-Fontecilla acknowledges the Spanish Ministry of Health (Rio Hortega CM08/00170), Alicia Koplowitz Foundation, and Conchita Rabago Foundation for funding his postdoctoral stage at CHRU, Montpellier, France

Introduction: Studies on adult bipolar patients have demonstrated a disability associated with the bipolar disorder, even in euthymic patients, but there is a lack of data in the elderly population. Material and method: A cross-sectional, multicentre study on a consecutive sample of ambulatory bipolar patients (DSM-IV-TR criteria), aged 65 years or over. Retrospective and cross-sectional sociodemographic and clinical data were collected, as well as the Clinical Global Impression for Bipolar Modified scale (CGI-BP-M) and the level of disability using the World Health Organisation Disability Assessment Schedule (WHO/DAS). The disability was assessed globally and by areas. The presence of a moderate to maximum disability compared to a mild to no disability was considered a dependent variable. Results: A moderate to maximum global disability was present in 43.6% of the sample. By areas, occupational functioning was the area most frequently affected, and personal care the least affected. The only variables which were associated with disability were the presence of medical comorbidity (P = .01), increased age (P = .005) global clinical severity (P = .0001) and in the depressive pole (P = .03). There was no relationship between clinical subtype, duration of the disease, number of previous episodes, number of hospitalisations, or other clinical variables and the degree of disability. Conclusions: These data underline the need to establish specific therapeutic strategies in the approach to depressive symptoms and medical comorbidity, with the aim of minimising the disability in elderly bipolar patients. Given the lack of current data, new studies are needed with larger samples and control groups. (C) 2010 SEP y SEPB. Published by Elsevier Espana, S.L. All rights reserved.

OBJECTIVE: To investigate the association between substance use disorders (SUDs) and the clinical presentation, risk factors, and correlates of major depressive disorder (MDD) by examining differences among 3 groups: (1) individuals with lifetime MDD and no comorbid SUD (MDD-NSUD); (2) individuals with comorbid MDD and SUD (MDD-SUD); and (3) individuals with substance-induced depressive disorder (SIDD). METHOD: Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: The lifetime prevalence of MDD-NSUD was 7.41%, whereas those of MDD-SUD and SIDD were 5.82% and 0.26%, respectively. Overall, risk factors for MDD were more common among individuals with MDD-SUD and SIDD than among those with MDD-NSUD. Individuals with MDD-SUD and SIDD had similar rates of comorbidity with any psychiatric disorder, but both groups had higher rates than individuals with MDD-NSUD (odds ratio [OR] = 2.3; 95% CI, 1.9-2.7 and OR = 2.5; 95% CI, 1.4-4.4, respectively). Individuals with SIDD were significantly less likely to receive medication than those with MDD-SUD or MDD-NSUD (OR = 0.5; 95% CI, 0.3-0.9 for both groups). CONCLUSIONS: MDD-SUD is associated with high overall vulnerability to additional psychopathology, a higher number of and more severe depressive episodes, and higher rates of suicide attempts in comparison to individuals with MDD-NSUD. SIDD has low prevalence in the general population but is associated with increased clinical severity and low rates of medication treatment. Similar patterns of comorbidity and risk factors in individuals with SIDD and those with MDD-SUD suggest that the 2 conditions may share underlying etiologic factors. Language: en

PurposeTo evaluate the impact of the “Spanish Consensus on Physical Health in Patients with Schizophrenia” on psychiatrists’ evaluations of the physical health of patients with schizophrenia.MethodEpidemiological, non-interventional, national, multicentre study, with two retrospective, cross-sectional data collection stages in which 229 psychiatrists evaluated 1193 clinical records of patients with schizophrenia (ICD-10) seen in January and September of 2007.ResultsMean age of the patients was 39.7 ± 11.6 years, 65.5% were men, diagnosed for schizophrenia 14.0 ± 10.3 years ago. Forty percent of the patients suffer from a concomitant disease, the most prevalent being hypercholesterolemia (46.3%), hypertriglyceridaemia (33.5%) and arterial hypertension (26.0%). The difference in the number of patients who had all the physical measurements taken between the two cross-sectional evaluations was 13.8% (CI: 11.8%, 15.7%). The differences for each parameter were: weight 13.7% (CI: 11.7%, 15.6%), BMI 13.58% (CI: 11.6%, 15.5%), waist circumference 14.0% (CI: 12.0%, 15.39%), lipid profile 2.9% (CI: 1.9%, 3.9%) and glycaemia 2.6% (CI: 1.7%, 3.5%).ConclusionsThese results imply that the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”, and possibly other actions, has made psychiatrists more aware of an integral approach to patients with schizophrenia, promoting increased monitoring of the physical health of these patients.

OBJECTIVE: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population. METHOD: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001-2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). RESULTS: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0-1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR] = 21.8; CI, 6.6-28.5), drug dependence (OR = 7.6; 95% CI, 5.2-10.9), bipolar disorder (OR = 5.6; 95% CI, 4.0-7.9), and pathological gambling (OR = 4.8; 95% CI, 2.4-9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates. CONCLUSIONS: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis of ASPD. Language: en

Objetivo. Revisar los hallazgos de los estudios con resonancia magnetica en el trastorno por deficit de atencion/hiperactividad (TDAH) infantil y adulto. Desarrollo. Dichos estudios han demostrado que el TDAH se caracteriza por la presencia de multiples anomalias de caracter estructural y funcional, primordialmente en los circuitos frontoestriatales, pero tambien en los circuitos frontoparietotemporales, frontocerebelares e, incluso, frontolimbicos. Los datos aportados por los estudios longitudinales de resonancia magnetica estructural demuestran que el TDAH se caracteriza por un retraso en la maduracion estructural del cerebro. Esta conclusion se ve reforzada por los indicios indirectos ofrecidos por los estudios de cortes transversales, que indican la existencia de una inmadurez sustancial tanto en la funcion cerebral como en los patrones de conectividad estructural y funcional, indicios que, sin embargo, estan pendientes de confirmar en estudios longitudinales. La alteracion funcional de la corteza prefrontal ventrolateral parece estar mas afectada en el TDAH que en otros trastornos pediatricos, y existen algunos indicios de anomalias distintivas en los ganglios basales. Un metaanalisis sobre los efectos de los estimulantes en la funcion cerebral demuestra que el mecanismo de accion agudo mas congruente de los farmacos psicoestimulantes consiste en el aumento de la activacion de la corteza prefrontal inferior y los ganglios basales. Los primeros intentos por utilizar los datos de los estudios de neuroimagen para elaborar clasificaciones diagnosticas individuales de los ninos con TDAH a partir de tecnicas de reconocimiento de patrones han cosechado resultados alentadores, pero todavia deben ser replicados por mas centros y aparatos de resonancia magnetica. Conclusiones. Durante los ultimos 20 anos, las tecnicas de neuroimagen han perfilado los biomarcadores del TDAH, pero es necesario que nuevos estudios descubran la utilidad clinica de esa informacion, como el uso de tales tecnicas como instrumento de clasificacion diagnostica y pronostica individualizada o como terapia para revertir las anomalias de la funcion cerebral que han sido confirmadas durante los dos decenios anteriores.