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Multiplex families with a high prevalence of a psychiatric disorder are often examined to identify rare genetic variants with large effect sizes. In the present study, we analysed whether the risk for bipolar disorder (BD) in BD multiplex families is influenced by common genetic variants. Furthermore, we investigated whether this risk is conferred mainly by BD-specific risk variants or by variants also associated with the susceptibility to schizophrenia or major depression. In total, 395 individuals from 33 Andalusian BD multiplex families (166 BD, 78 major depressive disorder, 151 unaffected) as well as 438 subjects from an independent, BD case/control cohort (161 unrelated BD, 277 unrelated controls) were analysed. Polygenic risk scores (PRS) for BD, schizophrenia (SCZ), and major depression were calculated and compared between the cohorts. Both the familial BD cases and unaffected family members had higher PRS for all three psychiatric disorders than the independent controls, with BD and SCZ being significant after correction for multiple testing, suggesting a high baseline risk for several psychiatric disorders in the families. Moreover, familial BD cases showed significantly higher BD PRS than unaffected family members and unrelated BD cases. A plausible hypothesis is that, in multiplex families with a general increase in risk for psychiatric disease, BD development is attributable to a high burden of common variants that confer a specific risk for BD. The present analyses demonstrated that common genetic risk variants for psychiatric disorders are likely to contribute to the high incidence of affective psychiatric disorders in the multiplex families. However, the PRS explained only part of the observed phenotypic variance, and rare variants might have also contributed to disease development.

El suicidio es un importante problema de salud mental a nivel internacional. Más de 800.000 personas se suicidan cada año. La conducta suicida es más frecuente que el suicidio consumado y por cada suicidio consumado, se dan entre 10 y 20 casos de intento suicida (1).Los estudios epidemiológicos que toman en consideración la prevalencia y los factores asociados al riesgo suicida en diferentes poblaciones son escasos, no existiendo estudios previos sobre esta realidad en Andalucía. El objetivo de este estudio es conocer laprevalencia del riesgo suicida y analizar su asociación con variables demográficas, psicosociales y clínicas. Estudio transversal mediante una encuesta domiciliaria sobre una muestra representativa de adultos no institucionalizados de ambos sexos con edades comprendidas entre 18 y 75 años. 4507 sujetos fueron entrevistados utilizando la Entrevista Neuropsiquiátrica Internacional (MINI) (3) para evaluar el riesgo suicida actual. Se utilizaron instrumentos estandarizados para la evaluación de las siguientes variables independientes: demográficas (edad, género, estado civil, situación laboral, nivel educativo, nivel de urbanicidad del lugar de residencia y provincia de residencia), psicosociales (eventos vitales estresantes, experiencias de maltrato físico, psicológico y sexual en la infancia, funcionamiento personal y social, apoyo social y rasgos de personalidad: neuroticismo e impulsividad) y clínicas (historia familiar de problemas psiquiátricos, antecedentes de suicidio en la familia, dependencia a la nicotina y otras drogas y consumo de alcohol). Se realizó un análisis exploratorio de la distribución de los datos, incluyendo frecuencias y medias de todas las variables independientes. Se calculó la prevalencia del riesgo suicida actual (IC; 95%). Para el análisis univariante se utilizó el test chi-cuadrado y la prueba t-student y finalmente se realizó un análisis multivariante de regresión logística de efectos fijos, contralado por provincia. El 6,4% de la muestra de sujetos presentan riesgo de suicidio actual. Los resultados del modelo multivariante indican que las asociaciones estadísticamente significativas con el riesgo suicida actual fueron ser mujer, mayor edad, estar divorciado/separado/viudo/soltero, historia familiar de enfermedad mental, mayor número deeventos vitales estresantes, menos apoyo social, niveles mayores de neuroticismo, consumo elevado de alcohol, y dependencia a nicotina y otras drogas. Nuestros resultados son similares a los encontrados en otros estudios previos (4). Conclusiones Se trata del primer estudio epidemiológico realizado en Andalucía sobre el riesgo de suicidio, ofreciéndonos importantes resultados de interés clínico para la prevención del suicidio. Bibliografía 1. World Health Organisation. Prevention suicide: A global Imperative. 2014. Disponible en: ihttp://www.who.int/mental_health/suicide-prevention/world_report_2014/es/ 2. Hardt J., Bernert S., Matschinger H., Angermeier M.G., VilagutG., Bruffaerts R., et al. Systematic review of risk factors for suicide and suicide attempt among psychiatric J Affective Disorders 2015; 175: 168–174. 3. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Herqueta T, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl.20):22-33. 4. Nock M.K., Borges G, Bromet E.J., Cha C.B., Kessler R.C., Lee S.Suicide and suicidal behavior.Epidemiol Rev. 2008;30:133-54 Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Con los últimos adelantos en la tecnología informática, cada vez resulta más fácil diseñar, alimentar y gestionar grandes bases de datos, estandarizar la entrada y salida de la información, mejorar su accesibilidad, facilitar las tareas administrativas y repetitivas como informes, recetas, circulares,… en definitiva suponen una mejora en la gestión de la información clínica. Efectivamente se está avanzando en el desarrollo informático aplicado al ámbito sanitario, sin embargo, el gran avance tecnológico no se ve acompañado de resultados útiles y aplicables en el ámbito de la atención, la gestión y la investigación sanitaria en general y en el ámbito de la salud mental en particular. El problema de los sistemas de información en salud mental en España reside en las dificultades para crear información relevante, en la falta de homogeneidad en la recogida de la información, el análisis incompleto de los resultados, la tardía explotación y la escasa difusión. Además, en el contexto actual de descentralización administrativa, con la transferencia de las competencias sanitarias a las comunidades autónomas ha aumentado la dispersión en la forma de generar y crear la información, debido al desarrollo desigual de los sistemas de información, en cada comunidad autónoma. Actualmente, no contamos con indicadores mínimos a nivel autonómico, ni a nivel central, que nos permitan comparar la situación de la atención a la salud mental en España. Y, sin buena información será difícil establecer comparaciones en el desempeño de los servicios de salud mental y evaluar los progresos. En conclusión y según el informe de la Sociedad Española de Salud Pública y Administración Sanitaria del año 2010, es necesaria una profunda reforma de los sistemas de información sanitaria, que se encamine hacia la creación de un sistema de información global. Actualmente, existe la necesidad imperiosa de disponer de una única historia de salud electrónica con información básica compartida, con todos los elementos de seguridad y confidencialidad posibles, permitiendo el acceso rápido a la información esencial a cualquier profesional que toma decisiones sobre la salud mental de un paciente, beneficiando igualmente a la investigación médica, a través del acceso a bases de datos que aportan la información imprescindible en la que se fundamenta el progreso científico. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Objectives. Bipolar disorder (BD) is highly heritable, and gene identification will elucidate biological factors and gene-environment interactions. Multiplex families represent a promising resource for identifying rare variants and polygenic effects. However, such families are difficult to recruit. In 1997, >100 multiplex Andalusian BD pedigrees - the largest of which contains >20 affected members- were recruited within an Andalusian-German collaboration study. Since then, the Andalusian psychiatric network and biobank facilities have been expanded in order to facilitate psychiatric research. Therefore in 2013, the Andalusian-German collaborators initiated a follow-up study of this cohort in order to identify new genetic and environmental factors for BD aetiology and clinical course. Methods. In 1997, BD patients at Andalusian psychiatric hospitals who reported a family history of BD were asked to inform their families about the study. All consenting family members (N= 937; BPI/II=265; Recurrent Mayor Depression=149) were assessed using a structured psychiatric interview for life-time best estimate psychiatric diagnosis (SADS) and the family history method, and blood was obtained for DNA genetic analysis. Follow-up involves reassessment of diagnosis, neuropsychological testing (CANTAB), and the collection of biomaterials (RNA, Plasma, IPS, hair cortisol, etc.). Written informed consent is obtained for all study procedures and analyses. Results. For the first three families, follow-up assessments and biomaterial-processing have been completed. Follow-up of the remaining families is ongoing. Conclusion. This cohort represents a unique resource for the investigation of BD aetiology and clinical course, and will be available to international researchers from other sciences. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Background/Objectives Very few studies have examined schizophrenia morbidity in Spain, using multiple sources of information. We performed a 1-year prevalence study of schizophrenia and related disorders in Málaga and the use of services in a population aged 14 years or older living in the mental health catchment area of Carlos Haya hospital (Málaga, Spain). Methods Data were obtained from multiple sources of information mainly clinical databases. We selected more than 4000 persons as “possible cases” and we consult case notes and key informant (general practice and psychiatrists) to confirm schizophrenic diagnoses and place of living. Results A total of 1808 patients, 1169 men and 639 women were included as cases in the study. The one year ICD-10 prevalence rate was 6,8 (6,5-7,1) per 1000 adult population. Almost 80% of cases were in contact with public mental health services. Responsibility for schizophrenic patients is mainly carried by mental health services. Discussion/Conclusion Health planning should be based on local data about prevalence and use of services. Multiple sources of information are essential for accurate estimation of prevalence of schizophrenia disorders. Grants Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Junta de Andalucía (PI/PI338/2008 y CTS-945)

Multiplex families with a high prevalence of a psychiatric disorder are often examined to identify rare genetic variants with large effect sizes. In the present study, we analysed whether the risk for bipolar disorder (BD) in BD multiplex families is influenced by common genetic variants. Furthermore, we investigated whether this risk is conferred mainly by BD-specific risk variants or by variants also associated with the susceptibility to schizophrenia or major depression. In total, 395 individuals from 33 Andalusian BD multiplex families (166 BD, 78 major depressive disorder, 151 unaffected) as well as 438 subjects from an independent, BD case/control cohort (161 unrelated BD, 277 unrelated controls) were analysed. Polygenic risk scores (PRS) for BD, schizophrenia (SCZ), and major depression were calculated and compared between the cohorts. Both the familial BD cases and unaffected family members had higher PRS for all three psychiatric disorders than the independent controls, with BD and SCZ being significant after correction for multiple testing, suggesting a high baseline risk for several psychiatric disorders in the families. Moreover, familial BD cases showed significantly higher BD PRS than unaffected family members and unrelated BD cases. A plausible hypothesis is that, in multiplex families with a general increase in risk for psychiatric disease, BD development is attributable to a high burden of common variants that confer a specific risk for BD. The present analyses demonstrated that common genetic risk variants for psychiatric disorders are likely to contribute to the high incidence of affective psychiatric disorders in the multiplex families. However, the PRS explained only part of the observed phenotypic variance, and rare variants might have also contributed to disease development.