Search

Resumen Los sintomas cognitivos son uno de los criterios diagnosticos de la depresion y, sin embargo, no existe en la actualidad un metodo gold standard para su deteccion y evaluacion. En el presente articulo se revisan los metodos de evaluacion existentes en la actualidad, desde la historia clinica a la evaluacion mediante instrumentos de evaluacion psicometrica. Dentro de los instrumentos de evaluacion psicometrica se diferencian 3 tipos de medidas: a) valoradas por el clinico (CROM, clinician rated outcome measures); b) valoradas por el paciente (PROM, patient reported outcome measures), y c) mixtas, valoradas por el clinico y por el paciente (CROM + PROM). La tendencia en la actualidad es utilizar medidas de evaluacion que combinen ambos tipos de informacion: objetiva, proporcionada por el clinico basandose en la observacion de la ejecucion de determinadas tareas del paciente, y subjetiva, basada en las dificultades autopercibidas por el paciente.

Resumen Objetivo Examinar las propiedades psicometricas de la version en espanol de la escala C-SSRS (Sp-CSSRS). Metodo Estudio de validacion naturalista, transversal y multicentrico. Muestra: 467 pacientes psiquiatricos ambulatorios (242 con tentativa de suicidio previa). Instrumentos: C-SSRS; Escala de Hamilton para la Depresion (HDRS); Escala de Intencionalidad Suicida de Beck; Escala de Gravedad Medica de la Tentativa (MDS). Resultados Validez del constructo: el coeficiente de Pearson entre la subescala de gravedad (C-Grave) y la de intensidad (C-Int) de la Sp-C-SSRS fue 0,44 (p Conclusion La Sp-C-SSRS es un instrumento fiable y valido para evaluar la ideacion y la conducta suicidas en la practica clinica y en contextos de investigacion.

This study investigated whether the risk of presenting antipsychotic (AP)-induced extrapyramidal symptoms (EPS) could be related to single-nucleotide polymorphisms (SNPs) in a naturalistic cohort of first episode psychosis (FEP) patients. Two hundred and two SNPs in 31 candidate genes (involved in dopamine, serotonin and glutamate pathways) were analyzed in the present study. One hundred and thirteen FEP patients (43 presenting EPS and 70 non-presenting EPS) treated with high-potency AP (amisulpride, paliperidone, risperidone and ziprasidone) were included in the analysis. The statistical analysis was adjusted by age, gender, AP dosage, AP combinations and concomitant treatments as covariates. Four SNPs in different genes (DRD2, SLC18A2, HTR2A and GRIK3) contributed significantly to the risk of EPS after correction for multiple testing (P

Objective Our aim was to analyse sociodemographic and clinical differences between non-suicidal (NS) bipolar patients (BP), BP reporting only suicidal ideation (SI) and BP suicide attempters according to Columbia–Suicide Severity Rating Scale (C-SRSS) criteria. Secondarily, we also investigated whether the C-SRSS Intensity Scale was associated with emergence of suicidal behaviour (SB). Method A total of 215 euthymic bipolar out-patients were recruited. Semistructured interviews including the C-SRSS were used to assess sociodemographic and clinical data. Patients were grouped according to C-SRSS criteria: patients who scored ≤1 on the Severity Scale were classified as NS. The remaining patients were grouped into two groups: ‘patients with history of SI’ and ‘patients with history of SI and SB’ according to whether they did or did not have a past actual suicide attempt respectively. Results Patients from the three groups differed in illness onset, diagnosis, number of episodes and admissions, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile. Conclusion Our results suggest that increased impulsivity, higher rates of psychiatric admissions and a reported poor controllability of SI significantly increased the risk for suicidal acts among patients presenting SI.

BackgroundFew randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder.AimsTo examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline.MethodThis was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668).ResultsThere was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group (F = 3.071, d.f. = 2, P = 0.049).ConclusionsImprovement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.

The present manuscript is based on the recommendations of a panel of health care professionals, including several experts in primary health care, psychiatry and addictions. The participants are recognized specialists in the treatment of alcohol use disorder. The panel met in Barcelona on 2015 April 22 with the aims of evaluating the current management of alcohol use disorder in primary health care and developing a strategy to address this problem, basing on the evidence and the recommendations of the scientific societies and national and international organizations.

The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Programme (FP7), Grant agreement number HEALTH-F2-2009-223091, Kasahara-Kiritani, M., Hadlaczky, G., Westerlund, M., Carli, V., Wasserman, C., Apter, A., Balazs, J., Bobes, J., Brunner, R., McMahon, E.M., Cosman, D., Farkas, L., Haring, C., Kaess, M., Kahn, J.-P., Keeley, H., Nemes, B., Bitenc, U.M., Postuvan, V., Saiz, P., Sisask, M., Värnik, A., Sarchiapone, M., Hoven, C.W., Wasserman, D.

Government of the Principality of Asturias [PCTI 2018-2022 IDI/2018/235]; ERDF funding from the Principality of Asturias Health Research Institute (ISPA); Center for Biomedical Research in Mental Health Network (CIBERSAM); Spanish Ministry of the Economy, Industry and Competitiveness

It has recently been suggested that alterations of the layers of the retina could be a biomarker of specific mental disorders since they originate in the same embryonic layer as the brain and both are interconnected through the optic nerve. The purpose of this article is to offer a systematic review of the literature and a thematic synthesis on the current state of the alterations of the retina layers identified by optical coherence tomography in patients with schizophrenia, bipolar disorder and major depression. For this purpose, we performed a bibliographic search, a systematic review of the studies and a thematic synthesis of the reported findings. Patients with schizophrenia have more abnormal findings followed by patients with bipolar disorder, with very few findings in depression. The nerve fiber layer is the retinal layer with more abnormal findings both in schizophrenia and in bipolar disorder, while no study in major depression found alterations in it. Of the clinical parameters, the duration of the illness correlates significantly and inversely with the thickness of the different layers in all disorders. When interpreting these data, it is necessary to take into account the limitations and differences of the studies, especially the mean length of the disorders. Given that this was very different among the 3 disorders (more than doubled in the case of schizophrenia respect to major depression), the differences in the results found could be due more to the effect of the length of illness than to the disorder itself. In summary, optical coherence tomography findings are promising, since they could provide biomarkers of neurodegeneration and/or neuroprogression of both schizophrenia and bipolar disorder.

Elucidating schizotypal traits is important if we are to understand the various manifestations of psychosis spectrum liability and to reliably identify individuals at high risk for psychosis. The present study examined the network structures of (1) 9 schizotypal personality domains and (2) 74 individual schizotypal items, and (3) explored whether networks differed across gender and culture (North America vs China). The study was conducted in a sample of 27001 participants from 12 countries and 21 sites (M age = 22.12; SD = 6.28; 37.5% males). The Schizotypal Personality Questionnaire (SPQ) was used to assess 74 self-report items aggregated in 9 domains. We used network models to estimate conditional dependence relations among variables. In the domain-level network, schizotypal traits were strongly interconnected. Predictability (explained variance of each node) ranged from 31% (odd/magical beliefs) to 55% (constricted affect), with a mean of 43.7%. In the item-level network, variables showed relations both within and across domains, although within-domain associations were generally stronger. The average predictability of SPQ items was 27.8%. The network structures of men and women were similar (r = .74), node centrality was similar across networks (r = .90), as was connectivity (195.59 and 199.70, respectively). North American and Chinese participants networks showed lower similarity in terms of structure (r = 0.44), node centrality (r = 0.56), and connectivity (180.35 and 153.97, respectively). In sum, the present article points to the value of conceptualizing schizotypal personality as a complex system of interacting cognitive, emotional, and affective characteristics.

The SEYLE project was funded by the European Union Seventh Framework Program (FP7; HEALTH-F2–2009-223091; PI, Professor D. Wasserman MD PhD, NASP)., Gambadauro, P., Carli, V., Wasserman, C., Hadlaczky, G., Sarchiapone, M., Apter, A., Balazs, J., Bobes, J., Brunner, R., Cosman, D., Haring, C., Hoven, C.W., Iosue, M., Kaess, M., Kahn, J.P., McMahon, E., Postuvan, V., Värnik, A., Wasserman, D.

OBJECTIVES To identify the psychopathological, cognitive, functional, physical health and inflammatory markers that differentiate between early-stage schizophrenia (ESSCH) and late-stage schizophrenia (LSSCH). METHODS Cross-sectional, naturalistic study of 104 patients with SCH. The sample was divided in two groups: 35 ESSCH (≤7 years' duration of illness) and 69 LSSCH (>10 years' duration of illness). STATISTICAL ANALYSIS chi-square test and Student's t-test and ANCOVA (or Quade test) controlling for age, sex, BMI and number of cigarettes/day. Finally, a binomial logistic regression was made. RESULTS ESSCH show greater negative symptom severity (t = 2.465, p = 0.015), lower levels of IκBα (F = 7.644, p = 0.007), were more frequently classified as normal weight (40% vs 18.8%, p = 0.032) compared with LSSCH. The binomial logistic regression model included age (B = 0.127, p = 0.001) and IκBα (B = 0.025, p = 0.002) and accounted for 38.9% of the variance (model df =7, chi-square =41.841, p

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer’s perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation. Trial registration number DRKS00000214.

Background:The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs.Methods:Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life.Results:For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight.Conclusions:These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.

Alcohol use/abuse is a health problem in adolescents. The last Survey on use of drugs in Secondary Schoolers carried out in Spain (ESTUDES 2014-2015), reveals that 76.8% of adolescents aged 14 to 18 years consumed alcohol in the previous year and 68.2% in the last month. The aim of this study is to determine the medium-term factors associated with alcohol consumption in a sample of Spanish adolescents. The present study was carried out as a part of the Saving and Empowering Young Lives project in Europe (SEYLE) project. The final sample was composed of 708 students, assessed at two times [basal (T0) and one year later (T1)] [males: 51.98%, basal mean age (SD)=4.43 (0.67)]. Univariate and multivariate regression analyses were performed in order to investigate relationships between possible predictive variables found at time T0 and alcohol consumption at time T1. At basal time (T0) the prevalence of alcohol abuse was 25.56%, whereas the prevalence one year later was 49.72% (T1). Variables that significantly predict alcohol abuse within a year are: previous alcohol abuse at T0 (plt;0.001), previous abuse of drugs (p=0.011), parents attending their sporting events (p=0.005), peer problems (p=0.019), and lack of prosocial behaviour (p=0.043). In the light of our results, it can be concluded that, in adolescents, externalizing disorders seem to be determining factors of medium-term alcohol consumption.El uso/abuso de alcohol es un problema de salud en los adolescentes. La última Encuesta sobre uso de drogas en Enseñanzas Secundarias realizada en España (ESTUDES 2014-2015), pone de manifiesto que 76,8% de los adolescentes entre 14 y 18 años consumieron alcohol en el último año y 68,2% en el último mes. El principal objetivo es determinar los factores que se asocian con el consumo de alcohol a medio plazo en una muestra de adolescentes españoles. El estudio forma parte del proyecto Saving and Empowering Young Lives in Europe (SEYLE). La muestra final estuvo compuesta por 708 estudiantes, evaluados en dos momentos temporales [basal (T0) y al año (T1)] [varones: 51,98%, edad media basal (DE)=4,43 (0,67)]. Se realizaron análisis de regresión univariante y multivariante, con el fin de investigar las relaciones entre posibles variables predictoras descritas en el momento temporal T0 y el consumo de alcohol en el momento T1.En el momento basal (T0) la prevalencia de abuso de alcohol fue del 25,56%, mientras que la prevalencia al año fue del 49,72% (T1). Las variables que predicen de forma significativa el abuso de alcohol al cabo de un año son: abuso previo del alcohol en el momento T0 (plt; 0,001), abuso previo de drogas (p=0,011), padres que asisten a sus competiciones deportivas (p=0,005), problemas de relación con compañeros (p=0,019) y ausencia de comportamiento prosocial (p=0,043). A la vista de nuestros resultados se puede concluir que, en adolescentes, los trastornos externalizantes parecen ser factores determinantes de consumo de alcohol a medio plazo.

La utilizacion de nuevas intervenciones sanitarias con un innovador perfil de eficacia y seguridad, pero con mayor impacto presupuestario respecto a tratamientos utilizados anteriormente, se asocia con un aumento de los gastos sanitarios. Por tanto, en la toma de decisiones aparece la necesidad de utilizar criterios adicionales a los tradicionales de evidencia clinica, entre los que destaca la evaluacion de la eficiencia, que establece la relacion entre los costes y los resultados en salud de las nuevas opciones terapeuticas. En este sentido, los Sistemas Sanitarios basados en el Valor tienen como objetivo fundamental conseguir los mejores resultados en salud para los pacientes, a un coste aceptable y sostenible para estos sistemas. De ello, se deriva que resulte fundamental medir y comparar los resultados en salud de las estrategias utilizadas en una determinada patologia (Porter, 2010; McMahon, 2012). Sin embargo, hay otros criterios adicionales en la toma de decisiones, como son la relevancia social, prevalencia e incidencia de las enfermedades, el grado de innovacion, la efectividad comparada, las necesidades medicas no cubiertas, las decisiones individuales o preferencias de los pacientes, la satisfaccion con el tratamiento, el numero de pacientes afectados, el empoderamiento de los pacientes y los principios de equidad. Es decir, en muchos casos, considerando el importante numero de aspectos a valorar, hay amplias diferencias de criterio en el abordaje de una enfermedad entre los profesionales sanitarios que la tratan, los decisores o gestores politicos que aportan recursos para ese tratamiento y los pacientes que la padecen. Con el objetivo de facilitar la toma de decisiones, se estan incorporando recientemente los analisis de decision multicriterio (ADMC). Estos analisis suponen una novedad en el abordaje de la toma de decisiones en entornos complejos, ya que permiten sistematizar y simplificar de forma transparente la decision en diferentes etapas, estableciendo y estimando las preferencias de los decisores e influenciadores (medicos, farmaceuticos, personal de enfermeria, psicologos, gestores y pacientes) de una manera explicita (Thokala, 2016; Marsh, 2016). Es sabido que los trastornos por consumo de opiaceos (TCO) representan un problema de salud publica, desde la perspectiva asistencial y social (Torrens 2017, Pedrero-Perez 2017, Barrio 2017, Martinez-Luna 2018). En Europa, se ha estimado que los consumidores de opiaceos tienen una probabilidad de al menos 5-10 veces mayor de mortalidad que el resto de poblacion de la misma edad y genero (Observatorio Europeo de las Drogas y las Toxicomanias, 2017). Asimismo, en Estados Unidos, se ha detectado un aumento de las muertes asociadas a las sobredosis de heroina y opiaceos de laboratorio legales e ilegales (Holly, 2017). Por todo ello, para aportar informacion que nos ayude a dimensionar los TCO y facilitar la toma de decisiones sobre su tratamiento, actualmente se esta desarrollando un analisis de decision multicriterio patrocinado por Indivior Espana. El objetivo de este proyecto es establecer, mediante la metodologia del ADMC, cuales serian los resultados en salud de mayor relevancia y cual seria su peso en la evaluacion de los programas de tratamiento de sustitucion de opiaceos en pacientes con TCO. En este proyecto, con una participacion de un Panel de 20 Expertos en el manejo de las adicciones, se han establecido 3 fases, en base a las recomendaciones internacionales de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR) (Thokala, 2016; Marsh, 2016) (Figura 1): i) una primera fase de definicion de las medidas de resultados en salud que se deberian considerar en la evaluacion de los pacientes con TCO; ii) una segunda fase de cribado y ponderacion donde se estima el peso de cada uno de estos criterios en la toma de decisiones; basado en la metodologia de Experimentos de Elecciones Discretas ( Discrete Choice Experiments , DCE) y iii) una fase final consistente en un proceso deliberativo, para valorar a nivel global cada uno de los criterios considerados en las fases anteriores. En una primera reunion con el Panel de Expertos, los criterios considerados para valorar los resultados en salud en los pacientes con TCO en Espana han sido: consumo de sustancias (opiaceos, alcohol, tabaco, estimulantes y cannabis; segun criterios DSM-5), otros trastornos mentales (trastorno afectivo ansioso, psicosis y riesgo de suicidio, trastorno por deficit de atencion e hiperactividad, trastorno limite de personalidad, trastornos de personalidad antisocial, trastorno por juego y otras alteraciones del control de los impulsos; segun criterios DSM-5), nivel de discapacidad (mediante el cuestionario WHODAS II), adherencia, enfermedades medicas (comorbilidades medicas, conductas de riesgo, enfermedades infecciosas y de transmision sexual), aspectos psicosociales (conducta hostil y/o violenta, presencia de problemas laborales), discapacidad funcional (calidad de vida -a traves del cuestionario SF-36-, satisfaccion con el tratamiento y con el servicio –segun Escala de Verona de Satisfaccion con el Servicio-, funcionalidad social -mediante Escala de Apoyo Social de Duke-UNC). Ademas, el Panel de Expertos considero que habia determinados factores relacionados con el perfil de los pacientes que podian influir en la valoracion de dichos criterios: segmento de edad (menores de 18 anos, de 18 a 24 anos, de 25 a 34 anos, de 35 a 44 anos y mayores de 45), recaidas (si o no), periodo de tiempo con adiccion (menor de un ano, de 1 a 2 anos y mayor de 2 anos), numero de tratamientos previos recibidos (ninguno, uno, dos, tres o mas), tipo de tratamientos previos recibidos (antagonistas opiaceos, agonistas opiaceos y tratamiento libre de farmacos), localizacion donde se recibieron los tratamientos previos (regimen ambulatorio, centro de dia y unidad de deshabituacion residencial), antecedentes delictivos (encausado judicialmente por delitos relacionados con el consumo de sustancias y no encausado). El numero de ADMC a nivel internacional es escaso y se ha centrado en patologias concretas, como enfermedades raras o VIH/SIDA (Paulden, 2015; Radaelly, 2014; Sussex, 2013; Youngkon, 2012). Sin embargo, ya se han realizado este tipo de analisis para la evaluacion de medicamentos huerfanos en Cataluna (Gilabert-Perramon, 2017). Ademas, en la actualidad existe experiencia de la aplicacion de los ADMC en el campo de las adicciones, en Reino Unido, con el objetivo de ponderar el dano derivado del consumo de drogas en el usuario y otros individuos. Ademas, los ADMC podrian ser una herramienta que facilitase la implantacion de nuevas formas de financiacion como el pago por resultados. En este sentido, ya se han producido iniciativas promovidas por el Gobierno de Reino Unido, el cual realizo una propuesta para medir los resultados en el tratamiento de las adicciones y establecer como los acuerdos de pago por resultados podrian utilizarse para sufragar los servicios de tratamiento de adicciones (UK Goverment Policy Paper. Payment by Results). Por todo ello, los ADMC pueden convertirse en una metodologia que favorezca la toma de decisiones y la gestion socio-sanitaria de los recursos existentes, incorporando informacion sobre resultados en salud, evidencia farmacoeconomica y criterios eticos, incorporando en la seleccion de intervenciones sanitarias a todos los agentes decisores, desde una perspectiva multidisciplinar, en patologias como los TCO.

To identify barriers to complete recovery in patients suffering from major depressive disorder.A total of 461 psychiatrists participated in a cross-sectional, non-randomised, qualitative and multi-centre study based on a survey. The study questionnaire included 42 ítems related to management, prevalence, patient profile, impact of residual symptoms, barriers to full recovery, and strategies to increase complete recovery.Complete recovery was defined by 86% of participants as complete remission of symptoms plus functional recovery. A total of 83.4% of participants considered that sick leave usually lasted more than 4 months. Seventy-five percent stated that residual symptoms were the main reason for prolongation of sick leave, and 62% that between 26%-50% of patients complained of residual symptoms. Poor compliance with treatment was the most important barrier to complete recovery, followed by a lack of patient cooperation, late beginning of treatment, partial response to antidepressants, and low doses of antidepressant medication. In the case of partial response, 71.8% of participants chose to increase the dose of current treatment, and in the case of lack of response, 72.7% would switch to another antidepressant, and 22.8% would use the combination of two antidepressants, in which case 85.2% would choose agents with complementary mechanisms of action. Forty-nine percent of participants would recommend standard cognitive-behavioural psychotherapy for patients without complete response.Some 50% of patients did not achieve complete remission, frequently related to persistence of residual symptoms. Achievement of complete recovery should be an essential objective.

Aims: Smoking cessation in subjects with a severe mental illness (SMI) is a challenging but attainable goal. Furthermore, the identification of variables involved in the quitting process is a highly relevant factor in clinical practice. This study aimed to analyze the influence of smokers’ motivation in smoking reduction and cessation and select the most suitable way of measuring motivation. Methods: This is a secondary analysis of a 9-month, multicenter trial examining a Multicomponent Smoking Cessation Program in 82 adult outpatients with SMI. At the end of the preparation stage, the smokers’ motivational level was evaluated with the University of Rhode Island Change Assessment Scale. This allowed us to rate subjects using a continuous measure (“Readiness to Change,” RTC) and group them in “Stages of Change” (SOC). Regression analyses were carried out to identify predictors of the efficacy outcomes: a reduction in at least 50% of the cigarettes smoked per day (CPD), a reduction in the expired carbon monoxide (CO), and complete abstinence from smoking. Results: We studied differences in measurements of motivational levels independently (RTC and SOC) for patients who had a reduction in at least 50% of the CPD and for patients who achieved complete abstinence from smoking. However, these differences did not reach statistical significance during the follow-up study with a logistic mixed-effects model. In a linear mixed-effects model, the reduction of expired CO was significantly associated with RTC, at the end of the active treatment phase and during follow-up (β: –1.51; SD 0.82; p < 0.01). Conclusion: The motivation level achieved in the preparation phase predicted the reduction of expired CO over a given period when calculated by a continuous measure (RTC).

Background: Hyperprolactinemia is a common side-effect of antipsychotics (APs), which may trigger serious secondary problems and compromise the adherence to treatment which is crucial for prognosis, especially in patients presenting with a first-episode of psychosis (FEP). Aims: We evaluated, in some cases for the first time, the effect of polymorphisms in multiple candidate genes on serum prolactin (PRL) levels in an AP-treated FEP cohort recruited in the multicenter PEPs study (Phenotype − genotype and environmental interaction; Application of a predictive model in first psychotic episodes). Methods: PRL concentration was measured in serum from 222 patients. A total of 167 polymorphisms were selected in 23 genes. Genetic association analysis was performed in the whole sample and also in homogenous subgroups of patients treated with APs with a high (N = 101) or low risk (N = 95) of increasing PRL release, which showed significant differences in their PRL levels. Results: After Bonferroni correction, polymorphisms in NTRK2, DRD2 and ACE genes were associated with PRL concentration. Conclusion: Our results give more support to the impact of DRD2, but also of other genes related to dopamine availability such as ACE. Moreover, this study provides the first evidence for the involvement of NTRK2, which suggests that pathways other than the ones related to dopamine or serotonin may participate in the AP-related PRL levels.

Background A new diagnosis of anxious depression (AD), characterized by both depressive and anxious symptoms at case level, has been proposed for the classification of mental disorders for primary care for ICD-11 (ICD-11 PHC). The ICD-11 PHC proposes a duration requirement for anxiety symptoms of 2 weeks, in line with the requirement for depressive symptoms. This study examined diagnostic assignment under ICD-11 PHC as compared to the previous classification, the ICD-10 PHC, and the relationship of anxiety duration to disability and suicidal ideation. Methods Primary care physicians in five countries referred patients based on either perceived psychological distress or distressing somatic symptoms to a research assistant who administered a computer-guided diagnostic interview. Complete data were obtained for 2279 participants. Results Under ICD-11 PHC 47.7% participants received a diagnosis of AD and had greater disability than other diagnostic groups. Under ICD-10 PHC, in addition to meeting requirements for depressive episode, most of these patients met requirements for either generalized anxiety disorder (41.5%) or mixed anxiety and depressive disorder (45.4%). One third of individuals diagnosed with AD had anxiety durations between 2 weeks and 3 months and presented as much disability and suicidal ideation as individuals with longer anxiety durations. Limitations The study was not designed to establish prevalence of these conditions. Conclusion The proposed ICD-11 PHC encourages early identification and management of significant anxiety symptoms in primary care, particularly when these co-occur with depression. This study provides support for the clinical relevance of these symptoms and the importance of early identification.

Objective: The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. Methods: Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. Results: The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. Conclusions: Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.

El Proyecto SEYLE está apoyado por la Unión Europea a través del Séptimo Programa Marco (FP7), mediante acuerdo de subvención número HEALTH-F2.2009-223091. Los autores desean agradecer a todos los investigadores y personal que participa en el Programa SEYLE, Bousoño, M., Al-Halabí, S., Burón, P., Garrido, M., Díaz-Mesa, E.M., Galván, G., García-Álvarez, L., Velasco, Á., Wasserman, C., Carli, V., Hoven, C., Sarchiapone, M., Wasserman, D., Bousoño, M., García-Portilla, M.P., Iglesias, C., Sáiz, P.A., Bobes, J.

Clinical staging is a diagnostic tool used in other medical specialties, which has resulted from the combination of a categorical and dimensional approach. In the last 2decades, the usefulness of its application in the field of psychiatry has been suggested, mainly as a tool for diagnostic help, and therapeutic and prognostic orientation. In this paper we review the clinical staging models that have been proposed to date for bipolar disorder, depression and schizophrenia. A literature search was performed in PubMed and Medline databases. A total of 15 studies were selected according to inclusion and exclusion criteria. Models were grouped according to the type of disorder for which staging was proposed (bipolar disorder: 4, depression: 5, schizophrenia: 6), and their characteristics were described. As a conclusion, we identify the need to empirically validate these models to demonstrate that staging is a useful tool for clinical practice.

The EIRE (Estudio de Investigacion de Resultados en Esquizofrenia — Outcomes Research Study in Schizophrenia) study was initiated in order to assess the frequency of adverse reactions [extrapyramidal symptoms (EPS), hyperprolactinaemia, sexual dysfunction and weight gain] caused by atypical antipsychotics and haloperidol in patients with schizophrenia during routine treatment in clinical practice. This paper presents the results of the assessment of extrapyramidal adverse reactions. Outpatients diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of mental disorders, 4th edition (DSM-IV), criteria and receiving a single antipsychotic (risperidone, olanzapine, quetiapine or haloperidol) for at least 4 weeks were consecutively recruited. In this cross-sectional and non-interventional study data were collected in a single visit; this included demographic and clinical characteristics, current antipsychotic and concomitant treatment, and data on several adverse effects listed in a modified version of the UKU (Udvalg for Kliniske Undersogelser — Committee on Clinical Investigations) scale. For paired comparisons of the frequency of adverse reactions between treatments the Chi-squared (χ2) test was used. For estimation of the risk of a given adverse reaction with a given treatment a logistic regression method was used. 636 evaluable patients (of 669 recruited) were assessed. The frequency of EPS with haloperidol (78.3% of the cases) was higher than with risperidone (55.1%), quetiapine (39.5%) and olanzapine (35.8%) [χ2: p < 0.05], and the difference between risperidone and olanzapine was also statistically significant (χ2: p < 0.05). Very similar results were obtained in the individualised analysis of the items as regards the occurrence of akathisia, which was also more frequent in the haloperidol (36.8%) and risperidone (19.7%) groups than in the olanzapine (11.4%) and quetiapine (2.6%) groups (χ2: p < 0.05). Olanzapine, quetiapine and risperidone also showed a lower risk of EPS than haloperidol when adjusting by dose. Our results suggest that the atypical antipsychotics studied are less likely to induce extrapyramidal adverse reactions compared with haloperidol in stabilised patients, although these reactions are still common.

Background We investigated whether negative symptoms, such as poor motivation or anhedonia, were associated with higher body mass index (BMI) in stable patients with schizophrenia chronically treated with antipsychotic medication. Methods 62 olanzapine- or clozapine-treated patients with illness duration of at least four years were selected from an international multicenter study on the characterization of negative symptoms. All participants completed the Brief Negative Symptom Scale (BNSS) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between BMI and negative symptoms (BNSS) were explored, as well as multiple regression analyses. We further explored the association of two principal component factors of the BNSS and BMI. Subsidiary analyses re-modeled the above using the negative symptoms subscale of the PANSS and the EMSLEY factor for negative symptoms for convergent validity. Results Lower negative symptoms (BNSS score) were associated with higher BMI ( r = − 0.31; p = 0.015). A multiple regression analysis showed that negative symptoms (BNSS score) and age were significant predictors of BMI ( p = 0.037). This was mostly driven by the motivation/pleasure factor of the BNSS. Within this second factor, BMI was negatively associated with anhedonia ( r = − 0.254; p = 0.046) and asociality ( r = − 0.253; p = 0.048), but not avolition ( r = − 0.169; p = 0.188). EMSLEY score was positively associated with BNSS ( r = 0.873, p r = − 0.308; p = 0.015). The association between PANSS and BMI did not reach significance ( r = − 224, p = 0.080). Conclusions We conclude that lower negative symptoms were associated with higher BMI (assessed using both the BNSS and EMSLEY) in chronic stable schizophrenia patients, mostly due to lower anhedonia and asociality levels.

BackgroundCognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.MethodsTwo hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].ResultsImpairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.ConclusionsClinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.

BackgroundImmune-inflammatory processes have been implicated in schizophrenia (SCH), but their specificity is not clear.Main aimTo identify potential differential intra-/intercellular biochemical pathways controlling immune-inflammatory response and their oxidative-nitrosative impact on SCH patients, compared with bipolar disorder (BD) patients and healthy controls (HC).MethodsCross-sectional, naturalistic study of a cohort of SCH patients (n=123) and their controls [BD (n=102) and HC (n=80)].Statistical analysisANCOVA (or Quade test) controlling for age and gender when comparing the three groups, and controlling for age, gender, length of illness, cigarettes per day, and body mass index (BMI) when comparing SCH and BD.ResultsPro-inflammatory biomarkers: Expression of COX-1 was statistically higher in SCH and BD than HC (PPP=0.001; PP=0.003; PP=0.005); and CPR showed a gradient among the three groups. Anti-inflammatory biomarkers: BD patients had lower PPARγ and higher 15d-PGJ2 levels than SCH (P=0.005; P=0.008) and HC (P=0.001; P=0.001). Differences between SCH and BD: previous markers of SCH (NFκB and PGE2) and BD (PPARγ and 15d-PGJ2) remained statistically significant and, interestingly, iNOS and COX-2 (pro-inflammatory biomarkers) levels were statistically higher in SCH than BD (P=0.019; P=0.040).ConclusionsThis study suggests a specific immune-inflammatory biomarker pattern for established SCH (NFκB, PGE2, iNOS, and COX-2) that differentiates it from BD and HC. In future, their pharmacological modulation may constitute a promising therapeutic target.

Background: We aimed to investigate the state of cardiovascular risk/protection factors in early psychosis patients. Methods: A total 119 subjects were recruited during the first year after their first episode of psychosis. Eighty-five of these subjects were followed during the next 6 months. Cardiovascular risk/protection factors were measured in plasma and co-variated by sociodemographic/clinical characteristics. Multiple linear regression models detected the change of each biological marker from baseline to follow-up in relation to clinical scales, antipsychotic medication, and pro-/antiinflammatory mediators. Results: Glycosylated hemoglobin is a state biomarker in first episode of psychosis follow-up patients and inversely correlated to the Global Assessment of Functioning scale. We found opposite alterations in the levels of VCAM-1 and E-selectin in first episode of psychosis baseline conditions compared with control that were absent in the first episode of psychosis follow-up group. Adiponectin levels decreased in a continuum in both pathological time points studied. E-Selectin plasma levels were inversely related to total antipsychotic equivalents and adiponectin levels inversely co-related to the Global Assessment of Functioning scale. Finally, adiponectin levels were directly related to antiinflammatory nuclear receptor PPARy expression in first episode of psychosis baseline conditions and to proinflammatory nuclear factor nuclear factor kB activity in follow-up conditions, respectively. Conclusions: Our results support the need for integrating cardiovascular healthcare very early after the first episode of psychosis.

Resumen Introduccion Los sintomas negativos prevalecen en la esquizofrenia y estan asociados con un peor resultado. La validacion de nuevos instrumentos psicometricos podria contribuir a una mejor evaluacion de los sintomas negativos y a un avance en su tratamiento. La escala de evaluacion de los sintomas negativos-16 (Negative Symptom Assessment-16 [NSA-16]) ha demostrado adecuadas propiedades psicometricas, pero existe la necesidad de validarla en otros idiomas diferentes del ingles. Este estudio tiene como objetivo examinar las propiedades psicometricas de la version espanola de la NSA-16 (Sp-NSA-16). Material y metodo Estudio observacional, transversal de validacion en una muestra de 123 pacientes con diagnostico de esquizofrenia en tratamiento ambulatorio. Evaluacion: NSA-16, PANSS, HDRS, ICG-ESQ y PSP. Resultados Los resultados muestran unas adecuadas propiedades psicometricas, alta consistencia interna (alfa de Cronbach = 0,86), validez convergente (escala negativa de la PANSS, factor negativo de Marder de la PANSS y escala de los sintomas negativos de la ICG: valores r entre 0,81 y 0,94) y validez divergente (escala positiva de la PANSS y HDRS: valores r entre 0,10 y 0,34). Ademas, la NSA-16 tambien muestra validez discriminante (curva ROC = 0,97; IC 95% = 0,94 a 1,00; 94,3% de sensibilidad y 83,3% de especificidad). Conclusiones La Sp-NSA-16 es fiable y valida para medir los sintomas negativos en pacientes con esquizofrenia. Proveemos a los clinicos espanoles con una nueva herramienta para la practica clinica e investigacion. Sin embargo, es necesario proporcionar mas informacion sobre su fiabilidad interevaluadores.

BackgroundA study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.MethodPrimary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.ResultsA total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].ConclusionsThese data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.

Physical disorders and anxiety are frequently comorbid. This study investigates the characteristics of physical disorders, self-rated heath, subjective well-being and anxiety in adolescents. Data were drawn from the Saving and Empowering Young Lives in Europe cohort study. From 11 countries 11,230 adolescents, aged 14&ndash, 16 years were included. Zung Self-Rating Anxiety Scale (SAS), WHO-5 Well-Being Index and five questions prepared for this study to evaluate physical illnesses and self-rated heath were administered. Anxiety levels were significantly higher in adolescents who reported having physical disability (p &lt, 0.001, Cohen&rsquo, s d = 0.40), suffering from chronic illnesses (p &lt, s d = 0.40), impairments associated to health conditions (p &lt, s d = 0.61), or reported poor to very poor self-rated health (p &lt, s d = 1.11). Mediational analyses revealed no direct effect of having a chronic illness/physical disability on subjective well-being, but the indirect effects through higher levels of anxiety were significant. Functional impairment related to health conditions was both directly and indirectly (through higher levels of anxiety) associated with lower well-being. The co-occurrence of anxiety and physical disorders may confer a greater level of disability and lower levels of subjective well-being. Clinicians have to screen anxiety, even in a subthreshold level in patients with choric physical illness or with medically unexplained physical symptoms.

Background: Patients with schizophrenia often present sleep complaints which have been related to poor patient quality of life. Physiologic sleep, compatible with work routines is necessary, and may translate into better social functioning, engagement in rehabilitation strategies, and satisfaction with life. Methods: In this cross-sectional, non-interventional study, 811 adult outpatients with a diagnosis of schizophrenia were divided into two groups according to the presence (or absence) of sleep disturbances, and assessed using measures of symptom severity, quality and patterns of sleep (Pittsburgh Sleep Quality Index - PSQI), personal and social functioning, and satisfaction with life. Results: Patients with sleep disturbances were significantly more symptomatic, and revealed worse quality of sleep on all componentes of the PSQI (p

Lithium is considered the first-line treatment in bipolar disorder, although response could range from an excellent response to a complete lack of response. Response to lithium is a complex phenotype in which different factors, part of them genetics, are involved. In this sense, the aim of this study was to investigate the potential association of genetic variability at genes related to phosphoinositide, glycogen synthetase kinase-3 (GSK3), hypothalamic-pituitary-adrenal, and glutamatergic pathways with lithium response. A sample of 131 bipolar patients (99 type I, 32 type II) were grouped and compared according to their level of response: excellent responders (ER), partial responders (PR), and nonresponders (NR). Genotype and allele distributions of the rs669838 (IMPA2), rs909270 (INNP1), rs11921360 (GSK3B), and rs28522620 (GRIK2) polymorphisms significantly differed between ER, PR, and NR. When we compared the ER versus PR+NR, the logistic regression showed significant association for rs669838-C (IMPA2; P = 0.021), rs909270-G (INPP1; P = 0.009), and rs11921360-A (GSK3B; P = 0.004) with lithium nonresponse. Haplotype analysis showed significant association for the haplotypes rs3791809-rs4853694-rs909270 (INPP1) and rs1732170-rs11921360-rs334558 (GSK3B) and lithium response. Our study is in line with previous studies reporting association between genetic variability at these genes and lithium response, pointing to an effect of IMPA2, INPP1, and GSK3B genes to lithium response in bipolar disorder patients. Further studies with larger samples are warranted to assess the strength of the reported associations.

Resumen En el presente capitulo se realiza una revision de la literatura medica sobre el estado actual del aumento de peso y el sindrome metabolico en los pacientes con trastorno bipolar. Los datos para nuestro pais indican que la prevalencia de obesidad en estos pacientes es superior a la de la poblacion general, tanto en poblacion adulta como infantojuvenil, mientras que la prevalencia de sindrome metabolico en adultos es inferior. La presencia de obesidad y el sindrome metabolico son factores de riesgo para el desarrollo de enfermedades cardiovasculares, osteoartrosis, alteraciones menstruales, esterilidad, ciertos tipos de cancer y alteraciones psicologicas. Asimismo, se asocian con peor calidad de vida y mayor coste sanitario. La aparicion de estas complicaciones endocrinometabolicas esta determinada por distintos factores, desde geneticos y sociodemograficos hasta el estilo de vida, pasando por factores clinicos y psicofarmacologicos. Respecto al tratamiento antipsicotico, los datos coinciden en senalar 3 grupos de farmacos en funcion de su impacto sobre el peso y el sindrome metabolico. Los farmacos que se asocian con menor riesgo para ambas complicaciones son el aripiprazol, la asenapina, el haloperidol, la lurasidona, la perfenazina y la ziprasidona, mientras que los que se relacionan con mayor riesgo son la clorpromazina, la clozapina y la olanzapina. Finalmente, se describen las recomendaciones para la monitorizacion y el manejo de estas complicaciones en los pacientes con trastorno bipolar.

Background The extent to which socio-demographic, clinical, and premorbid adjustment variables contribute to cognitive deficits in first-episode schizophrenia spectrum disorders remains to be ascertained. Aims To examine the pattern and magnitude of cognitive impairment in first-episode psychosis patients, the profile of impairment across psychosis subtypes and the associations with premorbid adjustment. Methods 226 first-episode psychosis patients and 225 healthy controls were assessed in the PEPsCog study, as part of the PEPs study. Results Patients showed slight to moderate cognitive impairment, verbal memory being the domain most impaired compared to controls. Broad affective spectrum patients had better premorbid IQ and outperformed the schizophrenia and other psychosis groups in executive function, and had better global cognitive function than the schizophrenia group. Adolescent premorbid adjustment together with age, gender, parental socio-economic status, and mean daily antipsychotic doses were the factors that best explained patients' cognitive performance. General and adolescent premorbid adjustment, age and parental socio-economic status were the best predictors of cognitive performance in controls. Conclusions Poorer premorbid adjustment together with socio-demographic factors and higher daily antipsychotic doses were related to a generalized cognitive impairment and to a lower premorbid intellectual reserve, suggesting that neurodevelopmental impairment was present before illness onset.

In this paper, we reviewed the available instruments for assessing the negative syndrome of schizophrenia, describing their strengths and weaknesses. Current instruments were classified into two categories according to their content validity and assessment approach as first- or second-generation instruments. The BPRS, SANS, the SENS and the PANSS belong to the first generation, while the BNSS, the CAINS and the MAP-SR belong to the second generation. The NSA can be considered a transitional instrument between the two. First-generation instruments have more content validity problems than second-generation instruments do, as they do not accurately reflect the currently accepted negative syndrome (they do not include all negative symptoms and signs or they include symptoms from other dimensions). They also have more problems relative to the use of behavioural referents instead of internal experiences of deficits when assessing symptoms, which may lead to measuring functioning instead of negative symptoms. Further research needs to be done in this area in order to ensure the evaluation of primary negative symptoms and internal experiences involved in negative symptoms rather than external behaviours.

Objectives. To systematically review the evidence about the switching of antipsychotics in SZA in acute and maintenance treatment. Methods. A systematic review following the PRISMA statement identifying studies specifi cally conducted on, or including, SZA patients. Results. One analysis considered uniquely a SZA population, 13 more studies including an adequate SZA subsample were considered. Most of the studies were aimed at switching antipsychotic treatments to improve tolerability issues. Despite the absolute lack of trials specifi cally conducted on SZA populations, we found limited evidence on the use of aripiprazole, lurasidone, and, to a lesser extent, risperidone and ziprasidone as possible agents to substitute previous treatments whereas effi cacy or, more frequently, tolerability issues arise. Evidence supports also the switch to risperidone long-acting injectable when the adherence to oral treatment may be a concern. Conclusions. Antipsychotic switching in SZA is a neglected topic that would need better profi ling. Clinicians should keep in mind the receptor binding characteristics of drugs in order to optimize transitions. Evidence supports the switch to aripiprazole and lurasidone, less strongly to risperidone and ziprasidone. The switch to risperidone long-acting injectable is supported, especially in patients with limited treatment adherence to oral therapy.

Introduction The age at onset of bipolar disorder (BD) has significant implications for severity, duration of affective episodes, response to treatment, and psychiatric comorbidities. It has been suggested that early-onset BD (EO-BD) could represent a clinically distinct subtype with probable genetic risk factors different from those of late-onset BD (LO-BD). To date, several genes have been associated with BD risk but few studies have investigated the genetic differences between EO-BD and LO-BD. The aim of this study was to evaluate if variants of the gene coding for myo-inositol monophosphatase (IMPA2) are linked to age at onset of BD. Method 235 bipolar patients were recruited and assessed. The final sample consisting of 192 euthymic individuals, was compared according to the age at onset. Polymorphisms were genotyped in the IMPA2 gene (rs669838, rs1020294, rs1250171, and rs630110). Early-onset was defined by the appearance of a first affective episode before the age of 18. Results The analyses showed that in the genotype distribution rs1020294 (p = .01) and rs1250171 (p = .01) were associated with the age at onset. The significant effect remained only in the rs1020294 SNP in which G carriers were more likely to debut later compared to patients presenting the AA genotype (p = .002; OR = 9.57, CI95%[2.37–38.64]). The results also showed that EO-BD tended to experience more alcohol misuse (p = .003; OR = .197, CI95%[.07–.58]) compared to LO-BD. Conclusions Our results provide evidence for genetic differences between EO-BD and LO-BD at the IMPA2 gene as well as clinical differences between subgroups with therapeutic implications.

Background Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group. Methods A sample of 335 patients with FEP and 253 healthy controls was divided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed. Results Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F = 13.45; p ≤0.001) and working memory domains (F = 4.30; p = 0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F = 19.60; p ≤0.001). No significant differences were revealed in the comparison between the patient groups. Conclusions This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance.

Summary Background Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. Methods We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. Findings We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24–0·85; p=0·014) and suicidal ideation (0·5, 0·27–0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. Interpretation In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. Funding The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

Patients with a first episode of psychosis (FEP) display a broad range of metabolic risk factors related to the development of diverse medical comorbidities. Initial stages of these disorders are essential in understanding the increased vulnerability of developing cardiometabolic disturbances, associated with a reduced life expectancy. This study aimed to evaluate the metabolic profile of a cohort of patients with a FEP and its evolution during a two year follow-up, as well as the factors that influence the changes in their metabolic status. 16 participating centers from the PEPs Project recruited 335 subjects with a FEP and 253 matched healthy controls, aged 9–35 years. We investigated a set of anthropometric measures, vital signs and laboratory data obtained from each participant over two years in a prospective, naturalistic study. From the beginning of the study the FEP group showed differences in the metabolic profile compared to the control group, together with a progressive worsening in the major part of the analyzed variables during the follow-up period, with higher rates of obesity and metabolic syndrome. Certain risk factors were related to determinate clinical variables such as male gender, the presence of affective symptoms or an early onset or to treatment variables such as the use of antipsychotic polypharmacy, antidepressants or mood stabilizers. Our results highlight the extremely high risk of patients at early phases of schizophrenia and other psychotic disorders of developing cardiovascular comorbidity and the fast worsening of the metabolic profile during the first two years.

Substance and Internet use or abuse, psychopathology and suicidal ideation appear to be related. The aim of this study is to investigate the association between use of psychotropic substances, inadequate Internet use, suicidal ideation and other psychopathological symptoms within the adolescent population. The present study was carried out as part of the Saving and Empowering Young Lives in Europe (SEYLE) project, funded by the European Union. The sample is composed of 1026 adolescents aged between 14 and 16 years from 12 state schools in Asturias (530 men and 496 women). This study adds to the possibility of knowing whether the SEYLE data is confirmed in a relatively isolated and recession hit province of Spain. In the present study the following consumption rates were obtained: a) alcohol 11.89% in males and 7.86% in females; b) tobacco: 4.15% and 5.44 % in males and females respectively; c) other drugs: 6.98% in males and 4.44% in females; d) maladaptive or pathological Internet use: 14.53% and 20.77% in males and females respectively. The variables that predict suicide ideation in the logistic regression model were: previous suicide attempts, depression, maladaptive or pathological Internet use, peer problems and alcohol consumption.El uso o abuso de sustancias o internet, la psicopatología y la ideación suicida parecen estar relacionadas. El objetivo del presente estudio es investigar la asociación en población adolescente entre consumo de sustancias potencialmente adictivas, uso inadecuado de internet, psicopatología e ideación suicida. El estudio forma parte del proyecto europeo Saving and Empowering Young Lives in Europe (SEYLE). La muestra está compuesta por 1026 adolescentes con edades comprendidas entre 14 y 16 años procedentes de 12 centros escolares públicos del Principado de Asturias (530 varones y 496 mujeres). El presente trabajo aporta la posibilidad de conocer si los datos generales del proyecto SEYLE varían en una zona relativamente aislada y socioeconómicamente en recesión. Las tasas obtenidas de consumo de las distintas sustancias y de uso de internet fueron: a) alcohol: 11,89% en varones y 7,86% en mujeres; b) tabaco: 4,15% y 5,44% en varones y mujeres respectivamente; c) otras drogas: 6,98% en varones y un 4,44% en mujeres; d) uso de internet desadaptativo o patológico: 14,53% y 20,77% en varones y mujeres respectivamente. Se ha observado que las variables con capacidad predictiva sobre las conductas suicidas fueron: tentativas suicidas previas, síntomas depresivos, uso desadaptativo o patológico de internet, problemas con los compañeros y consumo de alcohol.