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The degree of satisfaction of patients and their relatives with electroconvulsive therapy (ECT) is considered an important treatment goal; however there is no scale in Spanish to quantify it. The aim of the study was to translate and adapt into Spanish the#8220;Patient Satisfaction Survey#8221; (PSS) for its use in patients and their relatives.

The MATRICS Consensus Cognitive Battery (MCCB) was administered to 293 schizophrenia outpatients and 210 community residents in Spain. Our first objective was to identify the age- and gender-corrected MCCB cognitive profile of patients with schizophrenia. The profile of schizophrenia patients showed deficits when compared to controls across the seven MCCB domains. Reasoning and Problem Solving and Social Cognition were the least impaired, while Visual Learning and Verbal Learning showed the greatest deficits. Our second objective was to study the effects on cognitive functioning of age and gender, in addition to diagnosis. Diagnosis was found to have the greatest effect on cognition (Cohen's d>0.8 for all MCCB domains); age and gender also had effects on cognitive functioning, although to a lesser degree (with age usually having slightly larger effects than gender). The effects of age were apparent in all domains (with better performance in younger subjects), except for Social Cognition. Gender had effects on Attention/Vigilance, Working Memory, Reasoning and Problem Solving (better performance in males), and Social Cognition (better performance in females). No interaction effects were found between diagnosis and age, or between diagnosis and gender. This lack of interactions suggests that age and gender effects are not different in patients and controls.

Resumen Introduccion La terapia electroconvulsiva de continuacion/mantenimiento ha demostrado su eficacia en la prevencion de recaidas tanto en cuadros afectivos como psicoticos. Sin embargo, existen pocos estudios sobre variables de gestion clinica, costes asociados y calidad percibida. Material y metodos Se presenta una serie de 8 casos incluidos en el Programa de terapia electroconvulsiva de Continuacion/Mantenimiento del Servicio de Psiquiatria del Hospital Universitario 12 de Octubre durante los primeros 18 meses de su funcionamiento. Para cada paciente se compararon variables clinicas (Escala de Impresion Clinica Global-Mejoria Global, dias de ingreso, visitas a Urgencias, ingresos urgentes) antes y despues de su inclusion en el programa, asi como costes asociados y calidad percibida. Resultados Tras su inclusion en el programa, el 50,0% de los pacientes refirio encontrarse «mucho mejor», y el 37,5% «moderadamente mejor» en la Escala de Impresion Clinica Global-Mejoria Global. Ademas, una vez incluidos en el programa de terapia electroconvulsiva de continuacion/mantenimiento, los pacientes tuvieron un total de 349 dias de ingreso, 3 visitas a Urgencias y 2 ingresos urgentes, frente a los 690 dias de ingreso (p = 0,012), 26 visitas a Urgencias (p = 0,011) y 22 ingresos urgentes (p = 0,010) en el mismo periodo, antes de su inclusion en el programa. Los costes directos asociados por estancia/dia tras su inclusion en el programa se redujeron al 50,6% del coste previo, y los costes asociados a visitas a Urgencias disminuyeron al 11,5% del coste previo. Respecto a la calidad percibida, un 87,5% de los pacientes evaluaron la atencion y tratamiento recibido como «muy satisfactorio», y un 12,5% como «satisfactorio». Conclusiones El programa de terapia electroconvulsiva de continuacion/mantenimiento estudiado ha demostrado utilidad clinica, repercusion economica favorable, asi como una elevada calidad percibida.

It has been suggested that data on positive and negative psychotic symptoms in patients with schizophrenia as assessed using different scales may be combined. For the first time, we assessed correlations between the positive syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-P) and the Scale for the Assessment of Positive Symptoms (SAPS), and between the negative syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-N) and the Scale for the Assessment of Negative Symptoms (SANS) in patients with bipolar disorder. We also aimed to confirm these correlations in patients with schizophrenia. This cross-sectional study was conducted with a group of 94 patients (40 diagnosed with bipolar disorder, 54 with schizophrenia). Assessments were carried out using the PANSS, SAPS and SANS. Large significant correlations were found between the PANSS-P and SAPS, and between the PANSS-N and SANS, in both the bipolar disorder group and the schizophrenia group. These results confirm previous findings regarding correlations between these scales in schizophrenia, and support the hypothesis that similar correlations exist in bipolar disorder. Therefore, our data support the potential usefulness in collaborative research of combining results from different scales for the assessment of psychotic symptoms in patients with bipolar disorder.

Objective To examine emotion processing in euthymic bipolar patients (EBP) compared to healthy controls. In addition, to determine whether or not there is an association between emotion processing and psychosocial functioning. Material and methods A sample of 60 EBP and 60 healthy controls matched for age, gender, education level, and premorbid intelligence were studied. All subjects were assessed using the MATRICS Consensus Cognitive Battery (MCCB) and two additional executive function measures: the Trail Making Test-Part B and the Stroop Test. Emotion processing was examined using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Psychosocial functioning was assessed using the Functional Assessment Short Test (FAST). Results Euthymic bipolar patients obtained lower scores than controls in all MSCEIT measures except for the using emotions branch. Likewise, EBP obtained a worse performance than healthy controls in all neurocognitive domains. Correlation between MSCEIT strategic area measures and FAST total score was found (r = −0.311; P < 0.016). Regression analysis showed that residual depressive symptomatology explains a 9.1% of the variance in functional outcome. MSCEIT strategic area score explained an additional 8.6%. Neurocognition did not increase the percentage of the variance explained by emotion processing. Conclusions Euthymic bipolar patients exhibit deficits in emotion processing. Emotion processing is associated with social functioning in these patients.

Background: A 12-week, double-blind, parallel, multi-center randomized controlled trial in 316 adult patients with major depressive disorder (MDD) was conducted to evaluate the effectiveness of pharmacogenetic (PGx) testing for drug therapy guidance. Methods: Patients with a CGI-S = 4 and requiring antidepressant medication de novo or changes in their medication regime were recruited at 18 Spanish public hospitals, genotyped with a commercial PGx panel (Neuropharmagen®), and randomized to PGx-guided treatment (n = 155) or treatment as usual (TAU, control group, n = 161), using a computer-generated random list that locked or unlocked psychiatrist access to the results of the PGx panel depending on group allocation. The primary endpoint was the proportion of patients achieving a sustained response (Patient Global Impression of Improvement, PGI-I = 2) within the 12-week follow-up. Patients and interviewers collecting the PGI-I ratings were blinded to group allocation. Between-group differences were evaluated using ?2-test or t-test, as per data type. Results: Two hundred eighty patients were available for analysis at the end of the 12-week follow-up (PGx n = 136, TAU n = 144). A difference in sustained response within the study period (primary outcome) was not observed (38.5% vs 34.4%, p = 0.4735; OR = 1.19 [95%CI 0.74-1.92]), but the PGx-guided treatment group had a higher responder rate compared to TAU at 12 weeks (47.8% vs 36.1%, p = 0.0476; OR = 1.62 [95%CI 1.00-2.61]), and this difference increased after removing subjects in the PGx-guided group when clinicians explicitly reported not to follow the test recommendations (51.3% vs 36.1%, p = 0.0135; OR = 1.86 [95%CI 1.13-3.05]). Effects were more consistent in patients with 1-3 failed drug trials. In subjects reporting side effects burden at baseline, odds of achieving a better tolerability (Frequency, Intensity and Burden of Side Effects Rating Burden subscore =2) were higher in the PGx-guided group than in controls at 6 weeks and maintained at 12 weeks (68.5% vs 51.4%, p = 0.0260; OR = 2.06 [95%CI 1.09-3.89]). Conclusions: PGx-guided treatment resulted in significant improvement of MDD patient's response at 12 weeks, dependent on the number of previously failed medication trials, but not on sustained response during the study period. Burden of side effects was also significantly reduced. © 2017 The Author(s).

Objectives Cognitive dysfunction in bipolar disorder has been well-established in cross-sectional studies; however, there are few data regarding the longitudinal course of cognitive performance in bipolar disorder. The aim of this study was to examine the course of cognitive function in a sample of euthymic patients with bipolar disorder during a five-year follow-up period. Methods Eighty euthymic outpatients with a DSM-IV diagnosis of bipolar disorder and 40 healthy control comparison subjects were neuropsychologically assessed at baseline (T1) and then at follow-up of five years (T2). A neurocognitive battery including the main cognitive domains of speed of processing, working memory, attention, verbal memory, visual memory, and executive function was used to evaluate cognitive performance. Results Repeated-measures multivariate analyses showed that progression of cognitive dysfunction in patients was not different to that of control subjects in any of the six cognitive domains examined. Only a measure from the verbal memory domain, delayed free recall, worsened more in patients with bipolar disorder. Additionally, it was found that clinical course during the follow-up period did not influence the course of cognitive dysfunction. Conclusions Cognitive dysfunction that is characteristic of bipolar disorder is persistent and stable over time. Only dysfunction in verbal recall was found to show a progressive course that cannot be explained by clinical or treatment variables.

Cognitive function in schizophrenia has been associated with different sociodemographic and clinical variables. Substance use disorder (SUD) history has also been associated with cognition in schizophrenia; however, contradictory results have been found regarding its influence on cognitive function. Our aim was to study the relationship between executive function and a) age, b) duration of illness, c) number of psychotic episodes, d) positive symptoms, and e) negative symptoms, in a sample of schizophrenic patients, and secondly to study whether these relationships persisted after stratification of the sample according to the presence or absence of SUD history. A final sample of 203 schizophrenic patients were evaluated for psychotic symptoms using the PANSS, and assessed using a neuropsychological battery to calculate a composite executive function score. Linear regression analyses were performed, with this executive score as the dependent variable, and age, duration of illness, number of psychotic episodes, positive PANSS score and negative PANSS score as independent variables. For the total sample, the regression model showed three variables to be significant predictors of the executive score: age (p=0.004), number of episodes (p=0.027), and PANSS negative score (p=0.003). However, once the sample was stratified, the regression model showed age (p=0.011) and number of episodes (p=0.011) to be predictor variables for the executive score in the group of schizophrenic patients with SUD history, while age (p=0.028) and PANSS negative score (p=0.006) were predictors in the group of schizophrenic patients without such history. These findings highlight the importance of considering SUD history in studies of cognitive function in schizophrenia.

Patients with schizophrenia exhibit impairments in prepulse inhibition (PPI) of the startle response. Available data suggest that atypical antipsychotics may be more effective than typical antipsychotics in improving PPI deficits in schizophrenia. However, previous studies have used between-subjects rather than longitudinal within-subjects designs to demonstrate superiority of particular atypical antipsychotics over typical antipsychotics in improving PPI in patients with schizophrenia. This longitudinal within-subjects test-retest study was designed to evaluate changes in PPI and clinical symptoms in patients with schizophrenia after switching from the conventional antipsychotic zuclopenthixol to long-acting injectable risperidone. PPI was measured in 45 chronic male patients with schizophrenia treated with zuclophentixol depot (session T1), and 12 weeks after switching to long-acting injectable risperidone (session T2). Thirty-six healthy control subjects were also evaluated. Patients with schizophrenia showed a significant improvement in PPI after changing to long-acting risperidone. Improvement of PPI deficits between T1 and T2 assessments correlated significantly with improvements in PANSS general psychopathology subscale scores. Our findings indicate that long-acting risperidone improves PPI deficits in subjects with chronic schizophrenia. These results also suggest that the PPI-restoring effect of risperidone may be related to improvement in symptoms other than positive and negative symptoms.

Previous studies have generally found a relationship between negative and cognitive symptoms in schizophrenia. The present study investigated the relationship between the 5 PANSS factors of a recent consensus model developed by NIMH researchers, and cognitive performance as assessed with the MATRICS Consensus Cognitive Battery (MCCB) in 80 patients with schizophrenia using correlation and regression analyses. The PANSS Cognitive factor showed a small to moderate significant association with MCCB Speed of processing, Working memory, Verbal learning, the Neurocognitive composite score, and the Overall composite score. Notably, however, no relationship was found between the PANSS Negative factor and any of the MCCB scores. The Positive, Excited and Depressed factors also did not show associations with the MCCB. These results highlight the need for refined assessment instruments and support the relative independence of cognition from other domains of psychopathology, including negative symptoms, in patients with schizophrenia.

Introduction: Previous studies have associated a decreased striatal D2 dopamine receptor (DRD2) binding with impaired performance in cognitive tasks. In vivo studies have found a lower DRD2 binding associated with the CC genotype of the C957T single nucleotide polymorphism (SNP) of the DRD2 gene. Objective: The aim of this study was to investigate the relationship between executive functions and the C957T DRD2 SNP. We hypothesized that the CC genotype would be associated with a poorer executive functioning. Methods: Our sample consisted of 83 healthy volunteers (28 males and 55 females; mean age 25.2, SD 1.7 years). To assess executive functions, the Wisconsin Card Sorting Test was used, considering the variables perseverative errors, perseverative responses, and number of categories achieved. The genotype distribution was 13 CC, 41 CT, and29 TT, satisfying Hardy-Weinberg equilibrium. Results: Carriers of the CC genotype, compared with carriers of the CT/TT genotypes, achieved significantly fewer categories (5.00 vs. 5.81; p = 0.004), made a greater number of perseverative errors (13.46 vs. 8.39; p = 0.018), and had a greater number of perseverative responses (14.92 vs. 8.94; p = 0.014). Conclusions: Our results support the hypothesis that the C957T DRD2 SNP may influence cognitive performance through its repercussions on central dopaminergic function.

Background and Objectives: A relationship has been found between cognition and functioning in patients with schizophrenia. Our objective was to study the relationship between the cognitive domains assessed by the MATRICS Consensus Cognitive Battery (MCCB), and functioning as evaluated using the functioning subscale of the Global Assessment of Functioning scale (GAF-f). Methods: A sample of 83 clinically stable outpatients diagnosed with schizophrenia according to DSM-IV criteria were assessed using the MCCB and the GAF-f. Pearson correlations and stepwise linear regression analyses were performed. Results: Correlation analysis between the GAF-f and the cognitive domains of the MCCB showed a significant relationship between functioning and all of the cognitive domains. Regression yielded a statistically significant model (F2,74 = 20.4, p < 0.001) in which functioning was related to Speed of processing (standardized β = 0.369, p = 0.001) and to Social cognition (standardized β = 0.325, p = 0.003). Together, these two variables explained 33.8% of the variance of functioning. Conclusions: Both speed of processing and social cognition have an important association with functioning in patients with schizophrenia.

Introduction Continuation/maintenance electroconvulsive therapy has been shown to be effective for prevention of relapse in affective and psychotic disorders. However, there are a limited number of studies that investigate clinical management, associated costs, and perceived quality variables. Material and methods A series of 8 cases included during the first 18 months of the continuation/maintenance electroconvulsive therapy programme of the Psychiatry Department at 12 de Octubre University Hospital is presented. Clinical variables (clinical global impression-improvement scale, length of hospitalisation, number of emergency department visits, number of urgent admissions) before and after inclusion in the continuation/maintenance electroconvulsive therapy programme were compared for each patient, as well as associated costs and perceived quality. Results After inclusion in the programme, 50.0% of the patients reported feeling “much better” and 37.5% “moderately better” in the clinical global impression-improvement scale. In addition, after inclusion in the continuation/maintenance electroconvulsive therapy programme, patients were hospitalized for a total of 349 days, visited the Emergency Department on 3 occasions, and had 2 urgent admissions, compared to 690 days of hospitalisation ( p = 0.012), 26 Emergency Department visits ( p = 0.011) and 22 urgent admissions ( p = 0.010) during the same period before inclusion in the programme. Associated direct costs per day of admission were reduced to 50.6% of the previous costs, and costs associated with emergency department visits were reduced to 11.5% of the previous costs. As regards perceived quality, 87.5% of the patients assessed the care and treatment received as being “very satisfactory”, and 12.5% as “satisfactory”. Conclusions This continuation/maintenance electroconvulsive therapy programme has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality.

Los déficit neurocognitivos en la esquizofrenia han sido descritos desde las primeras descripciones del trastorno. Su influencia en la funcionalidad y en la calidad de vida ha sido puesta de manifiesto en múltiples estudios. La iniciativa Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) del National Institute of Mental Health (NIMH) de Estados Unidos fue puesta en marcha para impulsar el desarrollo de una batería cognitiva de consenso que pudiera ser empleada en ensayos clínicos de fármacos para mejorar la neurocognición en la esquizofrenia. Aunque en el momento de consensuar los diferentes dominios cognitivos que deberían ser incluidos en dicha batería, la denominada cognición social no cumplía con los requisitos para ser incluida, se decidió finalmente incluir este dominio dada la importante relación con la funcionalidad que presentaba. Estudios posteriores han demostrado el acierto de incluir dicho dominio cognitivo, dada la relevancia que la cognición social ha demostrado en relación a la funcionalidad y calidad de vida de los pacientes con esquizofrenia; bien como variable per se, o bien como variable mediadora entre la neurocognición y la funcionalidad., Psilogos, v. 11, n. 1 (2013)

Los déficit neurocognitivos en la esquizofrenia han sido descritos desde las primeras descripciones del trastorno. Su influencia en la funcionalidad y en la calidad de vida ha sido puesta de manifiesto en múltiples estudios. La iniciativa Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) del National Institute of Mental Health (NIMH) de Estados Unidos fue puesta en marcha para impulsar el desarrollo de una batería cognitiva de consenso que pudiera ser empleada en ensayos clínicos de fármacos para mejorar la neurocognición en la esquizofrenia. Aunque en el momento de consensuar los diferentes dominios cognitivos que deberían ser incluidos en dicha batería, la denominada cognición social no cumplía con los requisitos para ser incluida, se decidió finalmente incluir este dominio dada la importante relación con la funcionalidad que presentaba. Estudios posteriores han demostrado el acierto de incluir dicho dominio cognitivo, dada la relevancia que la cognición social ha demostrado en relación a la funcionalidad y calidad de vida de los pacientes con esquizofrenia; bien como variable per se, o bien como variable mediadora entre la neurocognición y la funcionalidad.

Los pacientes con dependencia alcoholica de larga evolucion frecuentemente presentan sintomas depresivos durante las primeras semanas tras la desintoxicacion. Aunque se ha descrito que en la mayoria de los casos esta clinica depresiva suele mejorar espontaneamente tras 4-6 semanas de abstinencia, frecuentemente requieren tratamiento antidepresivo. En ocasiones, incluso a pesar de haberse instaurado un tratamiento antidepresivo convencional, persiste parte de los sintomas depresivos. Estos sintomas depresivos persistentes, desde un punto de vista neurobiologico, podrian tener relacion con la disfuncion hipodopaminergica descrita tras cesar el consumo enolico. Presentamos el caso de un varon de 49 anos, con dependencia alcoholica de larga evolucion, que presentaba sintomas depresivos resistentes al tratamiento antidepresivo convencional tras haber superado el periodo inicial de desintoxicacion. El paciente mostro una mejoria de los sintomas depresivos persistentes despues de anadir amisulprida, a dosis de 100 mg/dia, a su tratamiento antidepresivo.

Sexual dysfunction is a frequent side effect associated with antipsychotic treatment. It is known to be caused by the hyperprolactinemia that results from the D2 receptor blockade that is characteristic of antipsychotic drugs. The D2 partial dopaminergic agonism of aripiprazole could explain why its use does not usually cause this side effect, and may even revert it when added to another antipsychotic.We present the cases of two patients treated with D2 dopaminergic antagonists for a first episode of psychosis, who complained of amenorrhea and erectile dysfunction during follow-up. After the addition of aripiprazole to their previous antipsychotic treatment, these side effects reverted without a negative impact on treatment adherence or therapeutic efficacy.Pharmacological treatments with the potential of reverting sexual dysfunction secondary to antipsychotic treatment can improve compliance and quality of life of our patients, especially in those who are younger and are being treated for a first psychotic episode. In the cases reported here, the use of aripiprazole as an adjunctive treatment resulted in the disappearance of the undesirable effects without affecting the efficacy already achieved with the previous antipsychotic treatment.

Cognitive deficits constitute a core symptom in schizophrenia, are difficult to treat, and have special relevance regarding prognosis and functional outcome. The search for pharmacological strategies for improving cognition in schizophrenic patients has been hindered by the lack of a consensus regarding instruments for cognitive assessment. The 'Measurement and Treatment Research to Improve Cognition in Schizophrenia' (MATRICS) initiative of the U.S. National Institute of Mental Health (NIMH) set the development of a consensus cognitive battery as one of its objectives. In a first phase, the seven cognitive domains which have been shown to be impaired in schizophrenia and that were to be assessed were identified: Speed of processing, Attention/Vigilance, Working memory, Verbal learning, Visual learning, Reasoning and problem solving, and Social cognition. In a second phase, the MATRICS Consensus Cognitive Battery (MCCB) was developed. This is a cognitive assessment battery composed of ten instruments, which assess the seven domains in a little over one hour. The MCCB has been standardized in U.S. population, and the Spanish standardization has been recently published.

Different exploratory and confirmatory factorial analyses of the Positive and Negative Syndrome Scale (PANSS) have found a number of factors other than the original positive, negative, and general psychopathology. Based on a review of previous studies and using confirmatory factor analyses (CFA), Wallwork et al. (Schizophr Res 2012; 137: 246–250) have recently proposed a consensus five-factor structure of the PANSS. This solution includes a cognitive factor which could be a useful measure of cognition in schizophrenia. Our objectives were 1) to study the psychometric properties (factorial structure and reliability) of this consensus five-factor model of the PANSS, and 2) to study the relationship between executive performance assessed using the Wisconsin Card Sorting Test (WCST) and the proposed PANSS consensus cognitive factor (composed by items P2-N5-G11). This cross-sectional study included a final sample of 201 Spanish outpatients diagnosed with schizophrenia. For our first objective, CFA was performed and Cronbach's alphas of the five factors were calculated; for the second objective, sequential linear regression analyses were used. The results of the CFA showed acceptable fit indices (NNFI = 0.94, CFI = 0.95, RMSEA = 0.08). Cronbach's alphas of the five factors were adequate. Regression analyses showed that this five-factor model of the PANSS explained more of the WCST variance than the classical three-factor model. Moreover, higher cognitive factor scores were associated with worse WCST performance. These results supporting its factorial structure and reliability provide robustness to this consensus PANSS five-factor model, and indicate some usefulness of the cognitive factor in the clinical assessment of schizophrenic patients.

Background: Negative symptoms and cognitive dysfunction are of crucial functional and prognostic importance in schizophrenia. However, the nature of the relationship between them and the factors that may influence it have not been well established. Aims: To investigate whether the relationship between negative symptoms and executive function changes according to the duration of illness in schizophrenia. Methods: The Positive and Negative Syndrome Scale was used to assess psychopathology and the Wisconsin Card Sorting Test (WCST) to evaluate executive function in a sample of 200 schizophrenic patients who were classified in 3 groups according to their duration of illness: up to 5 years (short duration group), 6-20 years (intermediate duration group) and over 20 years of illness (long duration group). Results: Medium-sized correlations were found between negative symptoms and WCST performance as assessed by the number of completed categories in all 3 groups. However, differences were found according to the duration of schizophrenia. For patients in the short duration group, negative symptoms correlated with WCST nonperseverative errors, but for those in the long duration group the correlation was with perseverative errors. Conclusion: We found a differential relationship between negative and cognitive symptoms in different stages of schizophrenia. Illness duration should be considered when studying the relationship between negative symptoms and cognition.

Functional neuroimaging studies carried out on healthy volunteers while performing different n-back tasks have shown a common pattern of bilateral frontoparietal activation, especially of the dorsolateral prefrontal cortex (DLPFC). Our objective was to use functional magnetic resonance imaging (fMRI) to compare the pattern of brain activation while performing two similar n-back tasks which differed in their presentation modality. Thirteen healthy volunteers completed a verbal 2-back task presenting auditory stimuli, and a similar 2-back task presenting visual stimuli. A conjunction analysis showed bilateral activation of frontoparietal areas including the DLPFC. The left DLPFC and the superior temporal gyrus showed a greater activation in the auditory than in the visual condition, whereas posterior brain regions and the anterior cingulate showed a greater activation during the visual than during the auditory task. Thus, brain areas involved in the visual and auditory versions of the n-back task showed an important overlap between them, reflecting the supramodal characteristics of working memory. However, the differences found between the two modalities should be considered in order to select the most appropriate task for future clinical studies. © 2009 Elsevier B.V. All rights reserved.

Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment.

La comorbilidad entre un trastorno por uso de sustancias (TUS) y otros trastornos psiquiátricos es conocida como patología dual. Tiene gran relevancia por su repercusión clínica y coste asistencial. Apenas existen estudios en nuestro medio sobre prevalencia de patología dual en pacientes ingresados en unidades de hospitalización psiquiátrica de hospitales generales (UHPHG). Los objetivos de este trabajo fueron determinar la presencia de patología dual en los pacientes ingresados consecutivamente durante un año en una Unidad de hospitalización Psiquiátrica (Hospital Universitario 12 de Octubre, Madrid, España), comparar variables sociodemográficas y clínicas entre el grupo de patología dual (grupo PD) y el grupo de trastorno mental sin TUS concurrente (grupo TM), y estudiar el tipo de sustancias consumidas. Se trata de un estudio retrospectivo, basado en la revisión de las historias clínicas de los 257 pacientes ingresados en dicha UHPHG durante un año. Los resultados mostraron que el 24,9% de los pacientes ingresados presentó un TUS (excluyendo dependencia a nicotina) concurrente a otro trastorno psiquiátrico. De manera significativa los pacientes del grupo PD fueron predominantemente varones y más jóvenes. Además, tenían menor edad en el primer ingreso psiquiátrico y al inicio de recibir atención psiquiátrica, y presentaban más diagnósticos de esquizofrenia o psicosis esquizofreniforme que el grupo TM, este último caracterizado por mayor frecuencia de diagnósticos afectivos. Las sustancias más frecuentemente consumidas en el grupo PD fueron alcohol (78,1%), cannabis (62,5%) y cocaína (51,6%). La elevada prevalencia de la patología dual y su repercusión asistencial hacen aconsejable disponer de programas terapéuticos especializados para su tratamiento. Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment.

Previous studies have associated a decreased striatal D2 dopamine receptor (DRD2) binding with impaired performance in cognitive tasks. In vivo studies have found a lower DRD2 binding associated with the CC genotype of the C957T single nucleotide polymorphism (SNP) of the DRD2 gene.The aim of this study was to investigate the relationship between executive functions and the C957T DRD2 SNP. We hypothesized that the CC genotype would be associated with a poorer executive functioning.Our sample consisted of 83 healthy volunteers (28 males and 55 females; mean age 25.2, SD 1.7 years). To assess executive functions, the Wisconsin Card Sorting Test was used, considering the variables perseverative errors, perseverative responses, and number of categories achieved. The genotype distribution was 13 CC, 41 CT, and 29 TT, satisfying Hardy-Weinberg equilibrium.Carriers of the CC genotype, compared with carriers of the CT/TT genotypes, achieved significantly fewer categories (5.00 vs. 5.81; p = 0.004), made a greater number of perseverative errors (13.46 vs. 8.39; p = 0.018), and had a greater number of perseverative responses (14.92 vs. 8.94; p = 0.014).Our results support the hypothesis that the C957T DRD2 SNP may influence cognitive performance through its repercussions on central dopaminergic function.

El principal mecanismo de acción de la cocaína es la inhibición de la recaptación de dopamina y noradrenalina, produciendo un aumento de estos neurotransmisores en la sinapsis. El consumo agudo de cocaína produce una serie de cambios bastante conocidos en el sistema cerebral de recompensa. Sin embargo, el consumo crónico, produce, además, otra serie de cambios a nivel molecular que llevan al sujeto desde una situación de consumo puntual, a una situación de dependencia. Se han propuesto diferentes teorías explicativas de este fenómeno como la sensibilización del incentivo, o la homeostasis y alostasis neuroquímica, planteamientos basados en el condicionamiento clásico y operante. Por otra parte, se ha señalado la intervención de diferentes moléculas y vías de segundos mensajeros, que producen, en última instancia, una serie de cambios neuronales mantenidos a muy largo plazo, probablemente permanentes, que se podrían relacionar con la vulnerabilidad a las recaídas, propia de la adicción a cocaína, incluso años después de abandonar el consumo.