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To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.

Increased Internet accessibility has been accompanied by an increased awareness of pathological Internet use (PIU). The aim of the study was to investigate a potential increase of PIU among European adolescents.Comparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU.The comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratio = 1.69, p.001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility.Our findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.

The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), Grant Agreement No. The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), Grant Agreement No. HEALTH-F2-2009-223091., Durkee, T., Carli, V., Floderus, B., Wasserman, C., Sarchiapone, M., Apter, A., Balazs, J.A., Bobes, J., Brunner, R., Corcoran, P., Cosman, D., Haring, C., Hoven, C.W., Kaess, M., Kahn, J.-P., Nemes, B., Postuvan, V., Saiz, P.A., Värnik, P., Wasserman, D.

This chapter is focused on opioid dependence treatment and is framed in a holistic perspective. Specifically, there are three main approaches to pharmacological treatment of opioid dependence: opioid detoxification, agonist maintenance, and antagonist maintenance. There is a great amount of evidence supporting the efficacy of methadone and buprenorphine or the combination of buprenorphine–naloxone for the treatment of opioid withdrawal and their clinical utility as pharmacotherapy in long-term maintenance programs. Secondary or adjunctive medications such as heroin, naltrexone, and alpha-2-adrenergics are also reviewed. The need for further research and to overcome nonscientifically based barriers that prevent from developing and improving treatment resources, and the importance of managing comorbidity with other substances as well as other psychiatric illnesses, is briefly discussed.

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

Objective: Clinicians need brief and valid instruments to monitor the psychosocial impact of weight gain in persons with psychiatric disorders. We examined the psychometric properties of the Spanish version of the Body Weight, Image and Self-Esteem Evaluation (B-WISE) questionnaire in patients with severe mental disorders. Method: The data come from a naturalistic, cross-sectional, validation study conducted at 6 centres in Spain. A total of 211 outpatients with severe mental disorders, 118 with schizophrenia and 93 with bipolar disorder, were evaluated using the B-WISE, the Visual Analogue Scale for Weight and Body Image, and the Clinical Global Impression–Severity (CGI-S). The body mass index was also obtained. Results: The principal component analysis confirms 3 components explaining 50.93% of the variance. The Cronbach α values for B-WISE scales ranged between .55 and .73. Significant Pearson correlations were found between B-WISE total score and CGI-S (r = −0.25; P b .001) and Visual Analogue Scale for Weight and Body Image (r = 0.47; P b .001). The B-WISE discriminates among patients with mild, moderate, and severe mental disorders according to CGI-S scores (F = 6.52; P b .005). Body mass index categorization significantly influenced total B-WISE scores (F = 3.586, P b .050). The B-WISE score corresponding to the 5th and 10th percentiles was 22. Conclusions: We were able to demonstrate that the Spanish version of the B-WISE is a valid instrument for assessing psychosocial impact of weight gain in patients with severe mental disorders in daily clinical practice.

The 1986 General Health Act and the so-called 'psychiatric reform' were key issues in the development of the mental healthcare system (MHCS) in Spain. The World Health Organization Declaration and Action Plan on Mental Health in 2005 gave it a revitalizing impetus and resulted in the first National Health System (NHS) Mental Health Strategy in 2006. A literature search was performed using MEDLINE, Spanish journals, reference lists, national databases, and European and Spanish official documents to describe the current state of the MHCS in Spain. The main results were: (1) existence of great variability among the autonomous communities with respect to mental health resources and provision of care; (2) lack of national epidemiological information on mental disorders with the exception of substance use disorders and suicide, which comprise powerful longitudinal national data, (3) training in psychiatry is well established, although there is no specialism of child and adolescent psychiatry, and (4) a dramatic increase in scientific productivity in the last decade among research groups, in part due to the creation of the Spanish Mental Health Network, the Centro de Investigación Biomédica en Red en el Área de Salud Mental (CIBERSAM). Quantifiable and reliable indicators are needed to provide efficient monitoring and analysis of epidemiological events and subsequently to understand the status of the Spanish MHCS.

PurposeTo evaluate the effectiveness and tolerability of pregabalin in the management of the discontinuation of benzodiazepines in long-term users.Subjects and methodsWe performed a 12-week, prospective, uncontrolled, non-interventional, and observational study in patients aged 18 years old or above, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression Scale, and the Sheehan Disability Scale. A urine drug screen for benzodiazepines was performed at baseline and every 4 weeks thereafter. The primary effectiveness variable was success rate, defined as achievement of benzodiazepine-free status at week 12 according to the urine drug screen.Results and discussionThe mean dose at week 12 was 315 (±166) mg/day. The success rate of the benzodiazepine taper in the primary efficacy population (n = 282) was 52% (95% confidence interval [CI], 46–58). Success rates for women and men were 58% (95% CI, 49–67) and 46% (95% CI, 38–55), respectively. The success rates did not differ according to either the benzodiazepine of abuse or the presence of other substance use disorders. Significant and clinically relevant improvements were observed in withdrawal and anxiety symptoms, as well as in patients’ functioning. At week 12, tolerability was rated as good or excellent by 90% and 83% of the clinicians and patients, respectively.ConclusionOur results suggest that pregabalin is an efficacious and well-tolerated adjunctive treatment for benzodiazepine withdrawal.

Background: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a person's ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors.Methods: Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments. Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability.Results: The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms.Conclusions: Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.

This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk–benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.

Resumen Introduccion El suicidio es un problema importante de salud publica que constituye una de las principales causas de anos de vida perdidos por enfermedad y la tercera causa de mortalidad en adultos jovenes. El objetivo de este proyecto iniciado por la Sociedad Espanola de Psiquiatria y la Sociedad Espanola de Psiquiatria Biologica fue preparar un documento que, a partir de la evidencia disponible y la opinion de los expertos, realizara unas recomendaciones sobre la prevencion y el manejo del comportamiento suicida. Material y metodos En este trabajo se resume la revision de la evidencia disponible sobre la magnitud e impacto epidemiologico de la conducta suicida, los factores de riesgo y factores protectores, los instrumentos de evaluacion del riesgo de conducta suicida, los protocolos preventivos existentes a nivel internacional y local, las intervenciones preventivo-educativas a nivel de los profesionales de la salud, y las posibles intervenciones sobre poblaciones de riesgo. Resultados De esta revision un amplio grupo de psiquiatras expertos sintetizo y consensuo un conjunto de recomendaciones sobre el impacto, la prevencion y el manejo de la conducta suicida. Conclusion Las recomendaciones sobre la prevencion y el manejo del comportamiento suicida fueron resumidas en las diez conclusiones que se presentan en este trabajo.

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.

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a smoking cessation programme designed for the treatment of patients with SMD in the community under real-world clinical conditions. A total of 82 patients were enrolled. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes per day =0 and breath CO levels ≤9 ppm) prevalence was 49.3%, with no statistically significant differences between medications (transdermal nicotine patches 50.0% vs. varenicline 48.6%, chi-square =0.015, P = 1.000). Long-term efficacy: At weeks, 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and tolerability: No patients made suicide attempts or required hospitalization. There was no worsening of the scores on the psychometric scales. In both groups, patients significantly increased weight, without significant changes in vital signs or laboratory results, with the exception of significant decreases in ALP y LDL-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (P < 0.0005), patients under TNP experienced skin reactions more frequently (P = 0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.Disclosure of interestThis work was partly supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (FIS PI10/01758) and Fondos Europeos de Desarrollo Regional (FEDER). The Health Services of the Principado de Asturias, Spain, donated part of the medication used in this study.

Mental disorders are one of the leading causes of disability globally. Inherited genetic variation in pharmacokinetic (PK) and pharmacodynamic (PD) genes may contribute to the observed interindividual differences in clinical efficacy and tolerability of psychopharmaceuticals. Therefore, strategies for improving effectiveness of pharmacological treatments translating pharmacogenomic information from bench to clinic have been recently attempted. However, effectiveness of available psychiatric pharmacogenomic tools in ameliorating clinical symptoms has not been analyzed in populations of suitable size by means of adequately powered multicentric randomized clinical trials. The Neuropharmagen personalized medicine platform integrates pharmacogenomic data from the analysis of PK and PD genes to provide actionable recommendations for psychoactive drugs, including genotype-specific dose adjustments and the risk of specific adverse effects based on FDA-approved drug labelling, Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines, and meta-analyses of clinical studies. Moreover, within the Neuropharmagen platform, pharmacogenomic recommendations can be complemented combined with alerts on drug-drug, drug-clinical condition and drug-environmental factor interactions. Notably, the later can be updated by the doctor whenever there are changes in the condition of the patient or the pharmacological treatment. Clinical efficacy of the Neuropharmagen test has been evaluated in two multicentric clinical studies totaling 462 patients analyzed for the primary outcome at study endpoint. A retrospective study evaluating patients with different psychiatric diagnoses and at least 1 treatment failure found that patients whose treatment followed the pharmacogenetic (PGx) test recommendations had odds of improvement about 4 times higher than patients whose treatment did not (adjusted OR = 3.86, 95%CI 1.36–10.95; p = 0.011). Recently, we have completed a prospective randomized clinical trial conducted in 316 patients with major depressive disorder with a wide range of depression severities and number of treatment failures. In this talk, I will describe the main results of both studies, with a major focus in those obtained in the multicentric randomized clinical trial. Overall, the combined results of studies conducted with Neuropharmagen show that PGx-guided treatment constitutes a significant tool to improve clinical response and medication tolerability, especially in subjects with moderate to severe depression and in those with previous failed drug trials.

The objective of this study was to compare coronary heart disease (CHD) risk and metabolic syndrome (MS) prevalence in patients with deficit (DS) and non-deficit schizophrenia treated with antipsychotics. A total of 1452 antipsychotic-treated outpatients meeting criteria for schizophrenia, schizophreniform or schizoaffective disorder were included in this cross-sectional multicentre study. CHD risk was assessed by SCORE (10-year cardiovascular death) risk score, and metabolic syndrome was assessed according to NCEP-ATP III criteria. A total of 1452 patients (863 men, 60.9%), 40.7±12.2years (mean±SD) were included. DS was found in 404 patients (35.1%). Patients with DS were older, more frequently male and obese, more likely to be receiving sickness benefits, and had longer illness duration and fewer previous hospitalisations. Furthermore, DS patients had higher negative PANSS scores (56.3% vs. 40.6% of patients with PANSS-N>21). High/very high risk of fatal CHD according to SCORE function (≥3%) was significantly higher in DS [11.8% (95% CI: 8.8-15.5) vs. 6.0% (95% CI: 4.4-8.1), (p

Arias B, Aguilera M, Moya J, Saiz PA, Villa H, Ibanez MI, Garcia-Portillo MP, Bobes J, Ortet G, Fananas L. The role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety-related traits. Objective: The aims of this study were to test the individual association of the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor gene (BDNF) and the GABAAα6 receptor subunit gene (GABRA6) with anxiety-related traits and to explore putative gene–gene interactions in a Spanish healthy sample. Method: A sample of 937 individuals from the general population completed the Temperament and Character Inventory questionnaire to explore Harm Avoidance (HA) dimension; a subsample of 553 individuals also filled in the Big Five Questionnaire to explore the Neuroticism dimension. The whole sample was genotyped for the 5-HTTLPR polymorphism (SLC6A4 gene), the Val66Met polymorphism (BDNF gene) and the T1521C polymorphism (GABRA6 gene). Results: Homozygous individuals for the T allele of the T1512C polymorphism presented slightly higher scores for HA than C allele carriers (F = 2.96, P = 0.019). In addition, there was a significant gene–gene interaction on HA between the 5-HTTLPR and Val66Met polymorphisms (F = 3.4, P = 0.009). Conclusion: GABRA6 emerges as a candidate gene involved in the variability of HA. The effect of a significant gene–gene interaction between the SLC6A4 and BDNF genes on HA could explain part of the genetic basis underlying anxiety-related traits.

The main purpose of this study was to explore the dimensionality of the borderline personality disorder in nonclinical young adults by means of the Borderline Personality Questionnaire (BPQ; Poreh et al., 2006). We also studied the phenotypic expression of the borderline personality traits as a function of participants’ gender and age, and the relationship between BPQ subscales and measures of depressive symptoms, anxiety, stress, hallucinatory predisposition, and paranoid ideation. The sample comprised 809 young adults, 562 (69.5%) were women, with a mean age of 20.2 years (SD = 2.9). The results indicate that the BPQ self-report has adequate psychometric properties. The levels of internal consistency for the BPQ subscales ranged between .78 and .93. Analysis of the internal structure of the BPQ subscales yielded a onedimensional solution. In contrast, second-order principal components analysis at the item level yielded a five-dimensional solution. Likewise, statistically significant differences in the mean scores of the borderline personality traits as a function of participants’ gender and age were found. The BPQ subscales correlated significantly with measures of depression, anxiety, stress, paranoid ideation, and hallucinatory predis position. These results help to improve our understanding of the dimen sional structure of the borderline personality in the general population. Future research should continue to identify participants who are at risk for the development of borderline personality disorder and facilitating the development of early detection and prevention programs.

Resumen El cambio de antipsicoticos es un hecho frecuente en la practica clinica y esta sujeto a potenciales complicaciones clinicamente relevantes. Un grupo de expertos seleccionados por la Sociedad Espanola de Psiquiatria y la Sociedad Espanola de Psiquiatria Biologica ha revisado y discutido las pruebas provenientes de los ensayos clinicos y otros articulos relevantes para llegar a unas recomendaciones de consenso sobre el cambio de antipsicoticos. En este articulo se revisa toda la informacion que ha dado lugar a esas recomendaciones y que incluye: indicaciones y contraindicaciones del cambio de antipsicoticos, aspectos farmacologicos, estrategias de cambio, el cambio por motivos de eficacia, el cambio por motivos de tolerabilidad (incluyendo los sintomas extrapiramidales y la discinesia tardia, el aumento de peso, los trastornos metabolicos, la hiperprolactinemia, la disfuncion sexual, la sedacion persistente y la prolongacion del QT), el cambio por problemas de cumplimiento y el cambio de antipsicoticos en el trastorno bipolar.

Sexual dysfunction in patients with severe mental disorders is often underestimated or overlooked by psychiatrists. A brief and valid self-report instrument for assessing sexual functioning may well contribute to changing this situation.To validate the Short Form of the Changes in Sexual Functioning Questionnaire (CSFQ-14) in Spanish patients with severe mental disorders.Naturalistic, cross-sectional, multicenter, validation study. Eighty-nine patients with schizophrenia and 82 with bipolar disorder were evaluated using the CSFQ-14, the Visual Analogue Scale for Sexual Functioning Satisfaction (VAS-SFS), and the Clinical Global Impression-Severity scales for mental disorders (CGI-S) and for Sexual Dysfunction (CGI-SSD).The 14-item Changes in Sexual Functioning Questionnaire.Internal reliability (Cronbach's alpha) = 0.90. Construct validity = 3 principal components, of which the first, arousal-orgasm, explained 46.4% of the total variance. Convergent validity: Pearson correlation coefficients between CSFQ-14 and VAS-SFS = 0.33 (P0.01) and between CSFQ-14 and CGI-SDS = -0.71 (P0.01). Discriminant validity: The CSFQ-14 was able to discriminate among patients with no, mild, moderate, and severe sexual dysfunction according to CGI-SDS scores, both in males (P0.001) and females (P 0.001). In males, the area under the curve (AUC) was 0.833 and a cutoff point of 49 provided a sensitivity of 92.9% and a specificity of 59.5%. In females, the AUC was 0.834 and a cutoff point of 43 provided a sensitivity of 91.9% and a specificity of 62.5%.The Spanish version of the CSFQ-14 is a reliable and valid instrument for assessing sexual functioning in patients with severe mental disorders. As a brief, self-rated instrument, the CSFQ-14 scale seems to be appropriate for use in everyday clinical practice as a means of identifying and monitoring changes in sexual functioning.

Resumen La concepcion de la esquizofrenia como una enfermedad incapacitante e indefectiblemente progresiva esta en proceso de revision gracias a las evidencias acumuladas en estudios de seguimiento a largo plazo. Los avances en el tratamiento, por otro lado, permiten mejorias funcionales contrastadas en algunos pacientes. Todo ello esta provocando un aumento de las expectativas terapeuticas, orientadas hacia la recuperacion funcional. Aunque la formulacion de unos criterios de remision consensuados y validos ha sido un paso importante en la definicion de los objetivos del tratamiento y en la conceptualizacion de la recuperacion, los conceptos de remision y recuperacion aun se utilizan poco en el contexto de la practica clinica habitual. En el presente articulo se incluye una revision breve de estos conceptos, y se presentan los resultados de dos estudios observacionales europeos que aportan datos empiricos que permiten conocer cual es la situacion real de los pacientes ambulatorios con esquizofrenia en terminos de remision sintomatica y, adicionalmente, avanzar en la conceptualizacion de la recuperacion, lo que contribuye al desarrollo de unos criterios de definicion clinicos y de investigacion. Segun estos resultados, la remision de sintomas es un objetivo terapeutico realista en un numero significativo de pacientes y presenta una estabilidad considerable en el tiempo; por su parte, las definiciones de recuperacion deben incluir aspectos funcionales y subjetivos. En conclusion, la remision es un concepto viable y clinicamente valido, y que favorece notablemente la mejoria funcional; mientras, el concepto de recuperacion aun esta en proceso de definicion.

The traditional view of schizophrenia as a disabling and irremediably progressive disease is being reconsidered because of the evidences arising from long-term follow-up studies. On the other hand, recent advances of therapies have yielded significant functional improvements for some patients. Together, these facts are serving to raise treatment prospects, placing the focus on functional recovery. Although the availability of a valid set of consensus remission criteria has been an important step toward the definition of therapeutic objectives and the conceptualization of recovery, remission and recovery still are rare concepts in the setting of routine clinical practice. The present article includes a brief review of these concepts, and presents the results from two observational European studies that provide empirical data about the actual situation of ambulatory patients with schizophrenia in terms of symptomatic remission, and that help in advancing the conceptualization of recovery, contributing to the development of clinical and research definitional criteria. Such results indicate that remission of symptoms constitutes a realistic therapeutic goal in a number of patients, with a considerable temporal stability; on the other hand, recovery definitions should include functional and subjective dimensions. In conclusion, remission is a tenable and clinically valid concept, with a significant contribution to functional improvement. Meanwhile, the recovery construct still requires substantial development. (C) 2010 SEP y SEPB. Published by Elsevier Espana, S.L. All rights reserved.

The main long-term therapeutic goals of schizophrenia should go beyond the symptoms and include the improvement of patients' psychosocial functioning and quality of life. The aim of this study was to validate the Personal and Social Performance (PSP) scale in Spanish outpatients with schizophrenia.Naturalistic, 6-month follow-up, multicentre study. 244 patients and 76 controls were evaluated using the PSP, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Clinical Global Impression - Severity (CGI-S) and Change (CGI-C) scales.Internal reliability=0.87. Test-retest reliability=0.98. Construct validity=1 component that explained 73.2% of the variance. Convergent validity: Pearson correlation coefficient between PSP and SOFAS=0.95 (p0.0001), between PSP and CGI-S=-0.88 (p0.0001). Discriminant validity: the PSP discriminates between patients and controls [50.3 versus 91.9, p0.0001] and among patients with mild, moderate, and severe schizophrenia according to CGI-S scores [73 versus 56.6 versus 37.5, p0.0001]. Area under the curve=0.986. A cut-off point of 79 on the PSP scale provided good sensitivity (94.3%) and specificity (96.1%) for identifying patients and controls according to their level of functioning. At month 6 significant improvements (p0.0001) were seen in PSP, SOFAS, and CGI-C scores. The PSP was sensitive to improvement; a score of very much improved in the CGI-C corresponds to a improvement of 34 points in the PSP.The Spanish PSP is a reliable, valid and sensitive instrument for measuring functioning in outpatients with schizophrenia. As a brief, clinician-rated instrument, the PSP scale seems to be appropriate for use in everyday clinical practice as a mean of identifying and monitoring changes in patient's functioning.

Resumen Introduccion Uno de los objetivos terapeuticos principales a largo plazo en la esquizofrenia incluye la mejoria en el funcionamiento psicosocial y la calidad de vida del paciente. El objetivo de este estudio fue validar la version espanola de la escala de Funcionamiento Personal y Social (PSP, del ingles Personal and Social Performance) en pacientes ambulatorios con esquizofrenia. Material y metodos Estudio naturalistico, de 6 meses de seguimiento, multicentrico, en el que se evaluo a 244 pacientes ambulatorios y 76 controles con la PSP, la Escala de Evaluacion del Funcionamiento Social y Ocupacional (SOFAS, del ingles Social and Occupational Functioning Assessment Scale) y la Escala de Evaluacion de Gravedad de la Enfermedad (ICG-G, en sus siglas en ingles)/Impresion Clinica Global del Cambio (ICG-C). Resultados La consistencia interna fue de 0,87, la fiabilidad test-retest, de 0,98, y la validez de constructo, 1, componente que explicaba el 73,2% de la varianza. Validez convergente: coeficiente de correlacion entre las puntuaciones PSP y SOFAS = 0,95 (p Conclusion La version espanola de la PSP es un instrumento fiable, valido y sensible para medir el funcionamiento de los pacientes ambulatorios con esquizofrenia. Dada su brevedad, es un instrumento apropiado para ser utilizado en la practica clinica cotidiana para cuantificar y controlar el funcionamiento de los pacientes.

Background: A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone was conducted, with assessments at enrollment and after 3 and 6 months of treatment. 182 alcohol-dependent patients who had been drinking heavily during the past month were included. Methods:Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. Results: At the 6-month evaluation, patients taking topiramate had significantly lower scores on the OCDS (all subscales), the EuropASI (medical, alcohol, family/social, and psychiatric) and the WHO/DAS (employment/social). More patients taking topiramate remained in the abstinence group and the moderate drinking without problems group. Conclusions: Topiramate at a mean dose of 200 mg/day was better than naltrexone at a mean dose of 50 mg/day at reducing alcohol intake and cravings throughout the study.

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.

The main objective of the present study was to examine measurement invariance of the Reynolds Depression Adolescent Scale (RADS) (Reynolds, 1987) across gender and age in a representative sample of nonclinical adolescents. The sample was composed of 1,659 participants, 801 males (48.3%), with a mean age of 15.9 years (SD = 1.2). Confirmatory factor analysis supported Reynolds' (2002) four-factor model, consisting of the Anhedonia, Somatic Complaints, Negative Self-Evaluation, and Dysphoric Mood dimensions. In addition, the results support the measurement invariance of the RADS across gender and age. When latent means were compared as a function of gender and age, statistically significant differences were found. Females obtained higher scores than males in Somatic Complaints, Negative Self-Evaluation, and Dysphoric Mood. On the other hand, males obtained higher scores in Anhedonia. As a function of age, the 17–19 year olds obtained higher scores than the 14–16 year olds in Dysphoric Mood. The results sugg...

The Temperament and Character Inventory (TCI) assesses four dimensions of temperament – novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (P) – and three character dimensions – self-directedness (SD), cooperation (C), and self-transcendence (ST). Previous research has shown that these personality traits may be affected by several factors. This study explored the influence of sociodemographic factors on personality in a healthy Spanish sample. The Spanish version of the TCI was administered to 404 adults aged 20–60 years screened for personal mental disorder using the Mini-International Neuropsychiatric Interview. There were gender differences in HA [ t = 2.47, p = 0.014], RD [ t = 2.91, p = 0.002], and C [ t = 3.06, p = 0.050], with women scoring higher on each measure. Multivariate models showed that NS decreased with increasing age for men, HA increased with age and RD decreased with increasing age for both genders, and SD increased with age for women. C varied significantly according to age in women (younger women scored higher). After adjustment for age, demographic variables (i.e., residence, socio-economic group, education, employment, civil and parental status) were significantly associated with all dimensions (except ST) in women and with HA, RD, SD, C, and ST in men. The scores obtained appear to reflect macrosocial characteristics of Western culture.

Background Several studies have documented changes in oxidative parameters and antioxidant enzymes in patients with schizophrenia (1, 2). However, their relation to negative symptoms and the longitudinal clinical course is still unclear. The objectives of the present study are to: 1) analyze the association between oxidative stress biomarkers and negative dimension; 2) identify if these biomarkers could predict clinical outcomes in stable patients with schizophrenia at 1-year follow-up. Methods A 1-year follow-up study of 57 stable outpatients with schizophrenia (≤10 years of illness) (mean age=31.5 ± 6.5; 63.2% males). Assessment PANSS, Clinical Assessment Interview of Negative Symptoms (CAINS) -Motivation/Pleasure (MAP) & Expression (EXP) domains-, Brief Negative Symptom Scale (BNSS). Oxidative stress biomarkers: homocysteine, hemolysis test (% hemolysis), lipid peroxidation subproducts (LPO), catalase activity in erythrocytes (CAT). Pearson correlations were performed to determine associations between biomarkers and clinical scores at baseline, and they were included in stepwise multiple linear regression analyses, considering potential confounding factors. The clinical course for each psychopathological domain was determined using the formula: [follow-up-baseline scores]. Positive values were interpreted as worsening, while negative improvement. Pearson correlation and multiple linear regression analyses were performed to determine if baseline levels of oxidative stress parameters were predictors of clinical changes at follow-up. Results 1) Baseline associations: Final regression models identified that LPO level was a significant predictor of lower scores in PANSS-N, BNSS total, Avolition and Blunted Affect subscale of BNSS and CAINS-EXP (β= -0.408; -0.290, -0.254, -0.296, -0.247, respectively). 2) Longitudinal course: At 1-year follow-up, patients only improved significantly (p

Background Negative, cognitive and depressive symptoms, as well as physical comorbidities, have a great impact on the real-world functioning in patients with schizophrenia (SZ) (1, 2, 3). However, not all the studies have employed accurate psychometric instruments to assess these symptoms, nor have all these factors been studied simultaneously. The aim of the current study is to analyze the determinants of functionality in SZ measured by the Personal and Social Performance (PSP) scale, and considering not exclusively psychopathological and cognitive variables, but also aspects related to physical health and inflammation. Methods Sample: 73 outpatients with SZ, duration of illness ≤10 years, under stable maintenance treatment [mean age (31.7 ± 6.5), males (61.6%)]. Clinical variables: PANSS, CGI-Severity, Clinical Assessment Interview of Negative Symptoms (CAINS) -Motivation/Pleasure (MAP) & Expression (EXP) domains-, Brief Negative Symptom Scale (BNSS), Calgary Depression Scale (CDS), MATRICS Consensus Cognitive Battery (MCCB), PSP. Biological variables: Glucose, cholesterol, LDL, HDL, triglycerides, TSH, prolactin, insulin, uric acid, alkaline phosphatase (APh), C-reactive protein (CRP), TNF-α, interleukin(IL)-6, IL-2, IL-1β, IL-1RA, homocysteine, HT (% hemolysis), lipid peroxidation (LPO), catalase. Pearson correlations were performed to select variables significantly related to PSP scores which were later included in stepwise multiple linear regression analyses. Age, sex, education, smoking, alcohol use, BMI, antipsychotic equivalent doses and other confounding factors were considered. Results Final model for PSP total score (R2=0.778, F=45.564, p

Objective To investigate the association between dopaminergic polymorphisms [ DRD2 −141C Ins/Del, DRD3 Ser9Gly, and SLC6A3 VNTR] and schizophrenia. Methods Two hundred and eighty-eight outpatients with schizophrenia (DSM-IV criteria) [mean age (SD) = 36.4 (12.4), 60.1% males] and 421 unrelated healthy controls [mean age (SD) = 40.6 (11.3), 51.3% males] from a homogeneous Spanish Caucasian population were genotyped using standard methods. Results There was a significant difference in genotype distribution for the DRD2 −141C Ins/Del polymorphism [( χ 2 (2) = 12.35, corrected p = 0.012]. The − 141C Del allele was more common in patients than in controls [0.19 vs. 0.13; χ 2 (1) = 9.14, corrected p = 0.018, OR (95% CI) = 1.57 (1.17–2.10)]. Genotype and allele distributions for DRD3 Ser9Gly and SLC6A3 VNTR polymorphisms were similar in both groups. However, there was tentative evidence of an interaction effect between DRD3 Ser9Gly and SLC6A3 VNTR [Wald = 9.56 (4), p = 0.049]. Compared to the SLC6A3 10/10 genotype category, the risk of schizophrenia was halved among those with 9/10 [OR = 0.51 (95% CI = 0.30–0.89), p = 0.017]. This protective effect was only present in combination with DRD3 Ser/Ser genotype because of the significant interaction between 9/10 and both Ser/Gly [OR = 2.45 (95% CI = 1.16–5.17), p = 0.019] and Gly/Gly [OR = 3.80 (95% CI = 1.24–11.63), p = 0.019]. Conclusions This study provides evidence that a genetic variant in the DRD2 gene and possible interaction between DRD3 and SLC6A3 genes are associated with schizophrenia. These findings warrant examination in replication studies.

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.

Increasing clinical evidence indicates that bipolardisorder is associated with reduced life expec-tancy and worse physical health compared to thegeneral population (1). The mortality rate as aresult of suicide is double that of the generalpopulation and the rate is 10 times higher whenother factors are taken into account, such asthe increased risk of weight gain, metabolicsyndrome (MetS) and cardiovascular disease(2–7). In addition, substance use constitutes asignificant health problem in patients with bipo-lar disorder, given its high prevalence and theconsequences it entails. The reported lifetimeprevalence rates vary between 48% and 56%(8, 9) and the current prevalence is about 11%(9), figures that place it second only to antisocialpersonality disorder in the ranking of psychiatricdisorders (10).Garcia-Portilla MP, Saiz PA, Benabarre A, Florez G, Bascaran MT,Di´az EM, Bouson˜o M, Bobes J. Impact of substance use on thephysical health of patients with bipolar disorder.Objective: To describe the impact of tobacco, alcohol and cannabis onmetabolic profile and cardiovascular risk in bipolar patients.Method: Naturalistic, cross-sectional, multicenter Spanish study.Current use of tobacco, alcohol and cannabis was determined based onpatient self-reports. Metabolic syndrome was defined using theNational Health and Nutrition Examination Survey 1999–2000 and theAmerican Heart Association⁄National Heart, Lung and BloodInstitute criteria, and cardiovascular risk using the Framingham andthe Systematic Coronary Risk Evaluation functions.Results: Mean age was 46.6 years, 49% were male. Substance use:51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reportedconsuming any substance were significantly younger and a higherproportion was male. After controlling for confounding factors,tobacco was a risk factor for coronary heart disease (CHD)(unstandardized linear regression coefficient 3.47, 95% confidenceinterval 1.85–5.10).Conclusion: Substance use, mainly tobacco, was common in bipolarpatients. Tobacco use negatively impacted CHD risk.

Resumen Introduccion El 30-80% de los pacientes con trastorno mental grave manifiestan dificultades del sueno. Su impacto es especialmente significativo en ellos por lo que su evaluacion y su manejo resultan obligados. El objetivo fue examinar la fiabilidad y validez del Cuestionario Oviedo de Sueno (COS) en pacientes con trastorno mental grave. Material y metodos Estudio observacional, prospectivo (3 meses), multicentrico. Participaron 259 sujetos (184 con trastorno mental grave y 75 como controles). Evaluacion: COS, items del sueno de las Escalas de Bech-Rafaelsen para Depresion (MES, item 3) y para Mania (MAS, item 5), escalas de Impresion Clinica Global de Gravedad del Trastorno Mental (ICG-GTM) y del Trastorno del Sueno (ICG-GTS). Resultados a) Estructura factorial: dos factores que explican el 57,65% de la variancia; el factor 1, insomnio, explica el 44,65% y el 2, hipersomnio, el 13%; b) consistencia interna: COS total = 0,90, escala insomnio = 0,91, escala hipersomnio = 0,88; c) fiabilidad test-retest, 0,87; d) validadez convergente: coeficiente de correlacion de Pearson con item 3 MES = 0,632, con item 5 MAS = 0,619, y con ICG-GTS = 0,630 (p Conclusiones El COS es un instrumento de medida del ritmo sueno-vigilia valido y fiable en los pacientes con trastorno mental grave.

Background To date, little is known about cardiovascular risk (CVR) in terms of coronary heart disease (CHD) and cardiovascular mortality risk (CMR) in patients with bipolar disorder. This study provides data on the overall risk of any fatal or non-fatal coronary heart disease (CHD) and on the cardiovascular mortality risk (CMR) within 10 years in these patients. Methods Naturalistic, cross-sectional, multicenter study conducted in Spain. Patients were evaluated for cardiovascular risk using the Framinghan function (CHD) and the Systematic COronary Risk Evaluation (SCORE) function (CMR). Results The mean age was 46.6 years and 49% were male. Forty-six percent were in remission. Ten-year CHD risk was 7.6% (males 10.2% versus females 4.7%, p p 0.161). Fifty-one percent smoked and 34% was obese. Metabolic syndrome was present in 22.4% of the sample (35.6% according to AHA and NHLBI criteria). Cardiovascular risk significantly increases with age, body mass index and presence of metabolic syndrome. Limitations The cross-sectional design of the study. Conclusions Cardiovascular risk is high in patients with bipolar disorder. It is associated with age, body mass index and metabolic syndrome. Psychiatrists should be aware of this issue and carefully monitor these patients for cardiovascular risk factors, including cigarette smoking, as part of the standard of care when treating them.

Background Twin studies suggest that genetic factors account for 40–60% of the variance in alcohol dependence. It has been stated that different drug dependencies may have unique genetic influences. Alterations in serotonin availability and function can affect drinking behaviour. This study aimed to investigate whether three serotonergic polymorphisms (HTR2A A-1438G (rs6311), and SCL6A4 5-HTTLPR and STin2 VNTR) were associated with alcohol dependence, and, whether the serotonergic polymorphisms played a similar role in conferring vulnerability in alcohol and heroin dependence. Methods 165 alcohol dependent patients, 113 heroin dependent patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. Results Genotypic frequencies of the A-1438G, 5-HTTLPR, and STin2 VNTR polymorphisms did not differ significantly across the three groups. None of the three polymorphisms contributed to distinguishing alcoholic patients from healthy controls. There was an excess of −1438G and 5-HTTLPR L carriers in alcoholic patients in comparison to the heroin dependent group (OR (95% CI) = 1.98 (1.13–3.45) and 1.92 (1.07–3.44), respectively). The A-1438G and 5-HTTLPR polymorphisms also interacted in distinguishing alcohol from heroin dependent patients (Wald (df) = 10.21 (4), p = 0.037). The association of −1438A/G with alcohol dependence was especially pronounced in the presence of 5-HTTLPR S/S, less evident with 5-HTTLPR L/S and not present with 5-HTTLPR L/L. SCL6A4 polymorphism haplotypes were similarly distributed in all three groups. Conclusions Our data do not support a role of serotonergic polymorphisms in alcohol dependence but suggest a differential genetic background to alcohol and heroin dependence.

Resumen Objetivos Investigar la relacion entre tres polimorfismos serotoninergicos (A-1438G [rs6311] del gen HTR2A, STin2 VNTR y 5-HTTLPR del gen SLC6A4) y la gravedad de la sintomatologia de panico y depresion en pacientes ambulatorios con un diagnostico de trastorno de panico (TP). Metodos Se evaluo a un total de 92 pacientes ambulatorios con TP (criterios diagnosticos del DSM-IV) no emparentados, de una poblacion espanola caucasica homogenea (media de edad ± desviacion estandar de 35,9 ± 12,4 anos; 28 [30,4%] varones) con el empleo de las escalas Panic and Agoraphobia Scale (PAS) y Hamilton Depression Rating Scale (HDRS), y se determino su genotipo con metodos estandar. Resultados La edad de inicio del TP variaba segun el genotipo STin2 VNTR (F = 3,21; p = 0,045). En promedio, el inicio del TP se produjo antes en los pacientes con el genotipo 10/10 que en los que presentaban el genotipo 12/12 (25,1 frente a 33,3; p = 0,043). No se observo relacion alguna entre los genotipos A-1438G, 5-HTTLPR y STin2 VNTR y las puntuaciones totales de las escalas PAS o HDRS. La variacion en las puntuaciones de la subescala de Ansiedad de la HDRS en funcion del genotipo A-1438G alcanzaba casi la significacion estadistica (F = 3,03; p = 0,053). Las comparaciones post hoc de datos emparejados pusieron de manifiesto un grado de ansiedad mayor en los portadores del genotipo A/G que en los portadores del A/A (4,1 frente a 2,9; p = 0,043). Por ultimo, la variacion de las puntuaciones de la subescala de Preocupacion por la Salud de la PAS, en funcion del genotipo 5-HTTLPR, se aproximaba a la significacion estadistica (F = 2,56; p = 0,083). Las comparaciones post hoc para datos emparejados mostraron unas puntuaciones mas altas en los portadores del genotipo L/S que en los portadores del L/L (2,4 frente a 1,4; p = 0,078). Conclusiones Nuestros datos respaldan la participacion del sistema serotoninergico, y en especial del gen HTR2A, en la gravedad del TP.

To investigate the association between three serotonergic polymorphisms (A-1438G [rs6311] of the HTR2A gene, STin2 VNTR and 5-HTTLPR of the SLC6A4 gene) and the severity of panic and depression symptomatology among mental health outpatients with diagnosis of panic disorder (PD).92 unrelated PD outpatients (DSM-IV criteria) from a homogeneous Spanish Caucasian population (mean age±SD, 35.9±12.4 years; 28 [30.4%] males) were assessed using the Panic and Agoraphobia Scale (PAS), and the Hamilton Depression Rating Scale (HDRS), and genotyped using standard methods.Age of onset of PD varied by STin2 VNTR genotype (F=3.21; p=0.045). On average, onset of PD occurred earlier for those with the 10/10 than for those with the 12/12 genotype (25.1 νs 33.3; p=0.043). No relationship was found between A-1438G, 5-HTTLPR, and STin2 VNTR genotypes and PAS or HDRS total scores. Variation in scores on the HDRS Anxiety subscale by A-1438G genotype almost reached statistical significance (F=3.03; p=0.053). Post hoc pairwise comparisons showed higher anxiety levels among A/G than among A/A carriers (4.1 νs 2.9; p=0.043). Finally, variation in scores on the Preoccupied with Health subscale of the PAS by 5-HTTLPR genotype approached statistical significance (F=2.56; p=0.083). Post hoc pairwise comparisons showed higher scores among L/S than among L/L carriers (2.4 νs 1.4; p=0.078).Our data provide support of an involvement of the serotonin system, particularly, the HTR2A gene in the severity of PD.

To compare clinical, laboratory, lifestyle, and sociodemographic parameters and cardiac risk in antipsychotic-treated patients with and without metabolic syndrome (MS).A multicenter cross-sectional study in which 117 psychiatrists recruited antipsychotic-treated outpatients meeting DSM-IV criteria for schizophrenia, schizophreniform or schizoaffective disorder. MS was diagnosed when 3 or more of the following criteria were met: waist circumference102 cm (men)/88 cm (women); serum triglyceridesor = 150 mg/dl; HDL cholesterol40 mg/dl (men)/50 mg/dl (women); blood pressureor = 130/85 mmHg; fasting blood glucoseor = 110 mg/dl. The 10-year cardiovascular (CV) risk was assessed by the Systematic COronary Risk Evaluation (SCORE) function (CV mortality) and the Framingham function (any-CV-event).1452 evaluable patients (863 men, 60.9%), aged 40.7+/-12.2 years and with a mean duration of illness of 15.5+/-10.8 years (mean+/-SD), were included. MS was present in 24.6% [23.6% (men), 27.2% (women); p=0.130]. Overall 10-year risks were 0.9+/-1.9 (SCORE) and 7.2+/-7.6 (Framingham). Coronary heart disease (CHD) 10-year risk was higher in MS patients: 6.6% vs 2.8% showed high/very-high CV mortality risk (SCOREor = 3%), and 44.2% vs 12.9% high/very-high CV event risk (Framinghamor = 10%) (p0.001). MS patients also had more psychopathology (PANSS) and greater severity (CGI).MS is highly prevalent in antipsychotic-treated patients and is associated with increased cardiovascular risk and psychopathology.

To investigate the association between four functional polymorphisms in interleukin-1 (IL-1) [IL-1 alpha -889 C/T, IL-1 beta +3953 C/T, IL-1RA (86 bp)n] and tumor necrosis factor alpha (TNFalpha) (-308A/G) genes and suicide attempts. Distribution of the aforesaid polymorphisms was analyzed in 193 suicide attempters compared with 420 unrelated healthy controls from Asturias (Northern Spain). Genotypes were determined using standard methods. No significant differences were found in genotype or in allelic distribution of IL-1 alpha, IL-1 beta, IL-1RA, or TNFalpha gene polymorphisms. No relationship was found between genotypes and the impulsivity of the suicide attempt. Estimated IL-1 haplotype frequencies were similar in both groups (likelihood ratio test=13.26, df=14, P=0.506). Our data do not suggest that genetically determined changes in the IL-1 or TNFalpha genes confer increased susceptibility to suicidal behavior. Language: en

Aims: The aim of this study was to investigate the potential association between functional polymorphisms of dopaminergic [dopamine receptor D2 (DRD2), dopamine receptor D3 (DRD3) and dopamine transporter (SLC6A3)] and serotonergic [serotonin 2A receptor (HTR2A) and serotonin transporter (SLC6A4)] genes and treatment outcome in alcohol-dependent patients. Methods: A total of 90 Spanish Caucasian alcohol-dependent outpatients (ICD-10 criteria) were enrolled in the study. The association between genotypes and drinking outcomes was measured over 6 months of treatment. Biomarkers of alcohol consumption, as well as alcohol consumption and its consequences, craving, disability and quality of life, were assessed. Based on those measures, we created a composite secondary measure to globally assess treatment outcome in alcoholism. Results: No association was found between DRD2, DRD3, SLC6A3 or HTR2A gene variants and treatment outcome. However, SLC6A4 STin2 12/12 carriers showed poor 6-month time point treatment outcome [32.8% in the good outcome group versus 64.0% in the poor outcome group, χ2 ( df ) = 7.20 (1), corrected P = 0.042, OR (95% CI) = 0.27 (0.10–0.72)]. Nevertheless, independent analysis of each treatment group reveals that the excess of 12/12 carriers in the poor outcome group was only found in the naltrexone-treated group [24.1% versus 64.7% χ2 ( df ) = 7.41 (1), corrected P = 0.042, OR (95% CI) = 0.17 (0.05–0.64)]. In the whole sample, the L-10 repeats haplotype (5-HTTLPR-STin2 VNTR) is associated with good outcome (LRT = 3.88, df = 1, P = 0.049). Conclusions: Our findings suggest that functional polymorphism of the SLC6A4 gene may have an influence on treatment outcome in alcohol-dependent patients.

Background To date, research examining the relationship between serotonergic genes and obsessive–compulsive disorder (OCD) has yielded conflicting results. The purpose of this study is to investigate the association between four serotonergic polymorphisms (STin2 VNTR and 5-HTTLPR of the SLC6A4 gene, and A-1438G (rs6311) and T102C (rs6313) of the HTR2A gene) and OCD. Methods 99 OCD patients, 456 non-OCD psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. Results All groups showed Hardy–Weinberg equilibrium for the analyzed genetic variability. A-1438G and T102C polymorphisms were in complete linkage disequilibrium. OCD patients showed an excess of STin2.12 carriers (12/12, 12/10, and 12/9 genotypes) compared with healthy controls ( χ 2 (1) = 7.21, corrected p = 0.021; OR = 3.38, 95% CI = 1.32–8.62) and non-OCD psychiatric patients ( χ 2 (1) = 6.70, corrected p = 0.030; OR = 3.24, 95% CI = 1.27–8.26). However, no differences were found between non-OCD patients and healthy controls ( χ 2 (1) = 0.05, corrected p > 1; OR = 1.04, 95% CI = 0.72–1.51). No significant differences were found with respect to A-1438G and 5-HTTLPR polymorphisms. Conclusions Our data provide supporting evidence of an association between the STin2 VNTR polymorphism of the SLC6A4 gene and OCD.

ResumenObjetivo.El progreso de las opciones terapéuticas para la esquizofrenia ha reavivado las expectativas a largo plazo de investigadores, médicos y pacientes. Actualmente, en las definiciones de resultado terapéutico se incluyen la remisión mantenida de los síntomas y el funcionamiento adecuado en un marco conceptual, siendo la recuperación del paciente el propósito final. Nuestro objetivo fue conocer la prevalencia y los rasgos clínicos de los pacientes con esquizofrenia que consiguen estos resultados.Métodos.Se hizo un estudio multicéntrico y transversal en más de 100 centros de salud mental de España. Para evaluar los resultados se usaron los criterios publicados recientemente sobre la remisión sintomática basados en acuerdos operativos generales y en la escala de Evaluación Global del Funcionamiento. También se evaluaron otros aspectos clínicos, como los síntomas depresivos, la cognición social, el ajuste premórbido y las actitudes de los pacientes frente a la medicación.Resultados.Se analizaron los datos de 1.010 pacientes. De estos, 452 (44,8%) estaban en remisión clínica, pero sólo 103 (10,2%) tenían un funcionamiento social y/o profesional adecuado. Los factores que predicen ambos resultados son mejor ajuste premórbido (cociente de probabilidad, CP = 1,56) y mejor función cognitiva social (CP = 1,14). Otros factores, como la aceptación del tratamiento, la psicoterapia actual o pasada y la edad del paciente, no se asociaron a la funcionalidad, sino sólo a la remisión clínica. El abuso actual de sustancias y la rehabilitación anterior se asociaron a una probabilidad menor de remisión sintomática.Conclusión.Aunque la remisión de los síntomas en pacientes con esquizofrenia es un objetivo realista y accesible, deberían realizarse esfuerzos en el futuro para conseguir un funcionamiento prolongado adecuado en estos pacientes.

To analyze the concordance between standard and modified NCEP-ATP-III criteria for identification of metabolic syndrome (MS) in outpatients with schizophrenia.We used the sample from a cross-sectional study carried out to ascertain the prevalence of MS in schizophrenia. Kappa agreement and the symmetry Kendall's tau-b coefficients were calculated in a post-hoc analysis, a long with McNemar test and logistic regression models.The study enrolled 1,452 consecutive outpatients. MS was found in 24.6% (95%CI: 22.4%-26.8%) using the standard criteria and in 25.5% (23.2%-27.7%) using the modified criteria. Agreement was high; kappa 0.81 (p0.0001) and tau-b 0.81 (p0.0001), with a McNemar value of 0.2325. Kappa coefficients varied between 1.0 and 0.76 in subgroups according to sex, age-group, severity of disease, and duration of therapy.MS in outpatients with schizophrenia may be assessed by either the standard or the modified NCEP ATP III criteria without losing reliability.

Objective: To investigate the association between four polymorphisms of the 5-HT2A receptor and 5-HT transporter genes and heroin dependence. Methods: 113 heroin- dependent patients (DSM-IV criteria) and 420 unrelated healthy controls from Asturias (Northern Spain) were genotyped using standard methods. Results: There was an apparent difference in the distribution of genotypes for A-1438G polymorphisms (p = 0.024, not significant after Bonferroni correction). The 5-HT2A -1438A allele was significantly more common in patients than controls [0.55 and 0.45, respectively; corrected p = 0.042, OR = 1.51 (95% CI = 1.13–2.03)]. An interaction was observed between A-1438G of 5-HT2A and 5-HTT polymorphisms. The association between the -1438AA vs. AG/GG genotypes and heroin dependence was enhanced in the presence of 12-repeat 5-HTT VNTR and short 5-HTTLPR alleles [24.8% in heroin-dependent patients vs. 12.6% in controls; corrected p = 0.045, OR = 2.28 (95% CI = 1.36–3.82)]. Conclusions: Our findings support a contribution of the 5-HT2A gene to susceptibility to heroin dependence, as well as a possible synergistic effect of 5-HT2A and 5-HTT genes on susceptibility to heroin dependence.

Attempted suicide may be a different phenomenon in adolescents than in adults. To our knowledge, direct comparisons between these two populations are very scarce. The aim of this study is to analyze the differences between adolescents and adults in methods of attempted suicide, accompanying certainty of death, and intentionality. All cases admitted to one adult (n=173) and one adolescent (n=104) inpatient unit who attempted suicide in the period from January 2003 through October 2005 were included in a prospective, common, national register, with data on methods, circumstances, and intentionality. The methodology followed that of the WHO/Euro Multicenter Study on Parasuicide. A stratified analysis was performed using the Mantel-Haenszel procedure in order to control for the effects of gender and diagnosis. Adolescents used significantly more over-the-counter medicines. Adults were significantly more certain of the possible fatal outcome of their attempt and had a significantly more severe intention when harming themselves. Individuals appear to use the methods that are available to them to attempt suicide. Adolescents may display more impulsive and less lethal directed behavior than adults or, alternatively, they are more frequently admitted for less severe attempts.

Background The Hamilton depression rating scale (HAMD) has been criticised for its multidimensionality, sensitivity to change, and discriminative power to define remission. To overcome these limitations several short scales have been devised but they have had limited use. We compared the performance of five HAMD short scales and their parental 17-item HAMD on sensitivity to change and discriminative power. Methods A local multicenter study was conducted with depressed outpatients (n = 113). Depression severity was appraised at baseline and at 6 weeks since inception with the HAMD-17 and the clinical global impression scale (CGI). Sensitivity to change was calculated by a within-group standardised effect size (dw). Discriminative power (against a clinical remission criterion [CGI = 1]) was assessed by receiver operating characteristic (ROC) analysis and the areas under the ROC curves (AUC). Results There were no differences among the five short scales on sensitivity to change (HAMD-17 dw: 1.6, 95% CI: 1.3–2.0; subscales range: 1.5–1.7), and discriminative power (HAMD-17 AUC: 0.93, 95% CI: 0.86–0.99; subscales range: 0.86–0.99). Appropriate cutoff points to define remission with short scales are suggested. Limitations The non-independence of the scales may have overestimated their performance. Nevertheless their comparisons seem fair as we do not expect a differential bias among them. Conclusions The short scales showed similar performance when compared with the parental HAMD. Since some were devised as unidimensional depression severity measures, and others to be sensitive to change, their use could circumvent previous criticisms raised to the canonical HAMD.