Celso Iglesias

Uso y abuso de sustancias psicotrópicas e internet, psicopatología e ideación suicida en adolescentes

Substance and Internet use or abuse, psychopathology and suicidal ideation appear to be related. The aim of this study is to investigate the association between use of psychotropic substances, inadequate Internet use, suicidal ideation and other psychopathological symptoms within the adolescent population. The present study was carried out as part of the Saving and Empowering Young Lives in Europe (SEYLE) project, funded by the European Union. The sample is composed of 1026 adolescents aged between 14 and 16 years from 12 state schools in Asturias (530 men and 496 women). This study adds to the possibility of knowing whether the SEYLE data is confirmed in a relatively isolated and recession hit province of Spain. In the present study the following consumption rates were obtained: a) alcohol 11.89% in males and 7.86% in females; b) tobacco: 4.15% and 5.44 % in males and females respectively; c) other drugs: 6.98% in males and 4.44% in females; d) maladaptive or pathological Internet use: 14.53% and 20.77% in males and females respectively. The variables that predict suicide ideation in the logistic regression model were: previous suicide attempts, depression, maladaptive or pathological Internet use, peer problems and alcohol consumption.

Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings

OBJECTIVE A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11. BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations. This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability. METHOD PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability. RESULTS Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability. CONCLUSION Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.

Biomarcadores sanguíneos diferenciales de las dimensiones psicopatológicas de la esquizofrenia

Symptomatology of schizophrenia is heterogeneous, there is not any pathognomonic symptom. Moreover, the diagnosis is difficult, since it is based on subjective information, instead of markers. The purpose of this study is to provide a review of the current status of blood-based biomarkers of psychopathological dimensions of schizophrenia. Inflammatory, hormonal or metabolic dysfunctions have been identified in patients with schizophrenia and it has attempted to establish biomarkers responsible for these dysfunctions. The identification of these biomarkers could contribute to the diagnosis and treatment of schizophrenia.

It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline

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 12-week smoking cessation programme for patients with SMD in the community under real-world clinical conditions. Eighty-two adult outpatients with schizophrenic/bipolar disorder smoking ≥15 cigarettes/day were assigned by shared decision between doctors and patients to transdermal nicotine patches (TNP) [36(46.2%)] or varenicline [39(50%)]. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes/day=0 and breath carbon monoxide levels≤9ppm) prevalence was 49.3%, without statistically significant differences between medications (TNP 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/required hospitalization. There was no worsening on the psychometric scales. Patients significantly increased weight [TNP 1.1(2.8) vs varenicline 2.5(3.3), p=0.063], without significant changes in vital signs/laboratory results, except significant decreases in alkaline phosphatase and low-density lipoprotein-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.

Psychometric properties of the Spanish version of the Body Weight, Image and Self-Esteem Evaluation Questionnaire in patients with severe mental disorders.

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 < .001) and Visual Analogue Scale for Weight and Body Image (r = 0.47; P < .001). The B-WISE discriminates among patients with mild, moderate, and severe mental disorders according to CGI-S scores (F = 6.52; P < .005). Body mass index categorization significantly influenced total B-WISE scores (F = 3.586, P < .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.

Diagnostic consequences of a new category of anxious depression and a reduced duration requirement for anxiety symptoms in the ICD-11 PHC

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

T17. OXIDATIVE STRESS BIOMARKERS AND NEGATIVE DIMENSION IN THE FIRST TEN YEARS OF SCHIZOPHRENIA: A 1-YEAR FOLLOW-UP STUDY

Abstract 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<0.05) in PANSS-Total [59.4 ± 16.4 - 54.5 ± 16.0 (t=3.362)], PANSS-General [29.7 ± 8.9 - 26.9 ± 7.9 (t=3.362)], Blunted Affect subscale [6.9 ± 5.0 - 5.9 ± 4.7 (t=2.489)], and almost significant (p<0.069) in CAINS-EXP and BNSS total score. No significant changes in BMI, waist circumference, smoking or antipsychotic equivalent doses were detected, but they were also considered in regression analyses. A higher percentage of hemolysis at baseline, with a decrease in equivalent doses of antipsychotics, both significantly predict an improvement in scores of PANSS-N (R2=0.140, F=7.166), BNSS (R2=0.246, F=6.193) and CAINS-EXP (R2=0.186, F=5.259). Discussion Lower concentrations of LPO were related to greater severity of negative symptoms as avolition and blunted affect (inner world). Longitudinal analyses showed that higher % of hemolysis at baseline predict an improvement of negative dimension at 1-year follow-up. From our results, we hypothesize that there is an inverse relationship between oxidative stress and negative dimension in stable patients with schizophrenia during the first ten years of illness.

PO-034 Inhibition of lung carcinoma growth and pulmonary metastasis with dimate as single agent and in combination with cisplatin

Introduction Aberrant cell proliferation in NSCLC causes an aberrant redox state that leads to the production of toxic reactive species and aldehydes. To keep oxidative stress until a threshold, above which oxidative damage can be detrimental to cell viability, cancer cells must actively upregulate multiple antioxidant systems. The aldehyde dehydrogenase (ALDH) gene superfamily encodes enzymes that are critical for certain life processes and detoxification of numerous endogenous and exogenous aldehyde substrates, including pharmaceuticals and environmental pollutants. Material and methods In this study, a meta-analysis was conducted based on multiple microarray data from The Cancer Genome Atlas (TCGA) and gene expression omnibus (GEO) repositories, spanning lung adenocarcinoma and lung squamous cell carcinoma datasets. Twenty-six NSCLC cell lines with different oncogenic driver alterations were used to analyse the molecular and cellular consequences of ALDHs inhibition. Preclinical studies with orthotopic xenografts of NSCLC and lung metastatic breast cancer were performed to evaluate the effect of the inhibition of ALDH class 1 and class3 activity on tumour growth. Results and discussions Here, we found that increased expression of aldehyde dehydrogenase isoenzymes ALDH1A1, ALDH1A3 and ALDH3A1 in human NSCLC tumours has a strong impact on chemotherapy resistance and patient overall survival, correlating with poor prognosis. We showed that inhibition of class 1 and class 3 ALDH activity with the novel irreversible ALDH1/3 inhibitor DIMATE suppresses tumour growth in orthotopic human lung cancer xenograft model and inhibits lung metastasis of human breast cancer in athymic nude mice. Accumulation of HNE-protein adducts and depletion of intracellular GSH are main responsible of DIMATE-induced cell death. Consistently, we found that alteration of tumour redox balance further enhances sensitivity of NSCLC cells to DIMATE. Finally, we demonstrate that the combination of DIMATE with Cisplatin-induced ROS generation in an orthotopic lung cancer model can significantly enhance the cytotoxicity of these two drugs in NSCLC cells with a synergistic promotion of cell death and marginal systemic toxicity in animals. Conclusion Targeting the detoxification machinery of ALDHs constitutes a novel therapeutic avenue for NSCLC. Patients with increased expression of ALDH1 or ALDH3 might greatly benefit from a combination therapy that include drugs interfering with the activity of these enzymes to overcome patient-specific drug resistance.