J. Bobes

Quality of life and disability in patients with obsessive-compulsive disorder

UNLABELLED The aim of this study is to describe the situation of Spanish obsessive-compulsive disorder (OCD) patients and compare it to that of the general population and other patient groups. METHODS Thirty-six OCD patients on maintenance treatment were evaluated using the Y-BOCS, SF-36, and DAS-S. Their SF-36 scores were compared to Spanish norms and to those obtained from U.S. OCD patients, schizophrenic outpatients, depressed outpatients, heroin dependents, patients on hemodialysis, and kidney transplant recipients. RESULTS Sixty-one percent of the patients had severe or extremely severe symptoms. Their quality of life was worse when compared with the Spanish norms in all SF-36 areas, but especially with respect to mental health. In contrast to U.S. OCD patients, social functioning is more impaired in the Spanish OCD patients. OCD patients reported the same quality of life as schizophrenics in the areas of mental health, but better in the areas of physical health. Compared with heroin dependents and depressed patients, their quality of life was worse. On mental health scales, OCD patients scored worse than somatic patients. CONCLUSIONS OCD in the Spanish population was shown to be associated with worse quality of life than for any other patient group (including physical groups), except schizophrenics.

Quality of life measures in schizophrenia

The recognition of the importance of evaluating the quality of life of patients with schizophrenia highlighted the importance of developing appropriate instruments. In this paper we review the available quality of life instruments focusing on their conceptual framework, structure, administration and psychometric properties. First, we address the generic instruments that have been validated for schizophrenic populations, namely the World Health Organization Quality of Life Assessment (WHOQOL), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF-36) and the EuroQoL-5 Dimensions (EQ-5D). Then, we focus on instruments that have been specifically developed for patients with schizophrenia and other or severe mentally illness such as the Quality of Life Scale (QLS), the Quality of Life Interview (QoLI), the Lancashire Quality of Life Profile (LQoLP), the Sevilla Quality of Life Questionnaire (SQLQ), the Personal Evaluation of Transitions in Treatment (PETIT), and the Quality of Life Questionnaire in Schizophrenia (S-QoL).

EPA guidance on tobacco dependence and strategies for smoking cessation in people with mental illness.

Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.

The role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety-related traits

Arias B, Aguilera M, Moya J, Sáiz PA, Villa H, Ibáñez MI, García‐Portillo MP, Bobes J, Ortet G, Fañanás L. The role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety‐related traits.

Quality of life in schizophrenia: Long-term follow-up in 362 chronic Spanish schizophrenic outpatients undergoing risperidone maintenance treatment.

Our aim was to determine the effect of risperidone monotherapy treatment on disability and on the quality of life of 318 schizophrenic outpatients who had been previously treated with other neuroleptics. Patients were assessed at baseline 2, 4 and 8 months using the BPRS, CGI, WHO/DDS and SF-36. BPRS scores showed a significant decrease at month 2, both in the total score and in each of the three clusters, negative, positive and depression/anxiety. WHO/DDS scores significantly decreased both in the overall score (from 51.8 to 37.4, P < 0.0001) and in the four dimensions. SF-36 scale scores and summary measures showed a significant improvement after 8 months of risperidone treatment. Risperidone long-term treatment (8 months) has a positive effect on clinical and on psychosocial outcomes. Females, paranoids patients and patients without history of use-abuse of substances showed greater improvements in quality of life.

Use of MDMA and other illicit drugs by young adult males in northern Spain: A five-year study

Aim: To measure the prevalence of 3,4-methylenedioxymethamphetamine (MDMA) and other drug use in young males entering compulsory military service in Asturias (northern Spain) and to define trends in MDMA use in this group during the period from 1995 to 1999. We also sought to determine whether MDMA users have distinct personality features or higher levels of sensation seeking. Methods: 3,634 conscripts [mean age (SD) = 20.19 years (2.52)] who entered military service during the period between 1995 and 1999 were evaluated using the World Health Organization (WHO) questionnaire for drug consumption, the Eysenck Personality Questionnaire-A (EPQ-A), and the Zuckerman Sensation Seeking Scale. Results and Conclusions: The prevalence of lifetime, previous year and previous month MDMA use among military recruits between 1995 and 1999 was 10.9, 7.8 and 4.5%, ranking fifth among illicit drugs ever used. Once individuals used MDMA for the first time, they were likely to use it again, with 71% of individuals who had ever used MDMA reporting that they had used it during the past year (ranking second only to hallucinogens), and 41% reporting having used it in the last month. Compared to recruits who had never used MDMA (but who may have used other illicit drugs), MDMA users had a more extensive drug abuse history. Recruits who had used MDMA during the year prior to study had significantly higher scores on the Neuroticism and Psychoticism Subscales of the EPQ-A, and reported higher levels of sensation seeking.

Impact of substance use on the physical health of patients with bipolar disorder

Garcia‐Portilla MP, Saiz PA, Benabarre A, Florez G, Bascaran MT, Díaz EM, Bousoño M, Bobes J. Impact of substance use on the physical health of patients with bipolar disorder.

Genetic variability at IMPA2, INPP1 and GSK3β increases the risk of suicidal behavior in bipolar patients

Bipolar patients (BP) are at high risk of suicide. Causal factors underlying suicidal behavior are still unclear. However, it has been shown that lithium has antisuicidal properties. Genes involved in its putative mechanism of action such as the phosphoinositol and the Wnt/β-catenine pathways could be considered candidates for suicidal behavior (SB). Our aim was to investigate the association of the IMPA1 and 2, INPP1, GSK3α and β genes with suicidal behavior in BP. 199 BP were recruited. Polymorphisms at the IMPA1 (rs915, rs1058401 and rs2268432) and IMPA2 (rs66938, rs1020294, rs1250171 and rs630110), INPP1 (rs3791809, rs4853694 and 909270), GSK3α (rs3745233) and GSK3β (rs334558, rs1732170 and rs11921360) genes were genotyped. All patients were grouped and compared according to the presence or not of history of SB (defined as the presence of at least one previous suicidal attempt). Single SNP analyses showed that suicide attempters had higher frequencies of AA genotype of the rs669838-IMPA2 and GG genotype of the rs4853694-INPP1gene compared to non-attempters. Results also revealed that T-allele carriers of the rs1732170-GSK3β gene and A-allele carriers of the rs11921360-GSK3β gene had a higher risk for attempting suicide. Haplotype analysis showed that attempters had lower frequencies of A:A haplotype (rs4853694:rs909270) at the INPP1 gene. Higher frequencies of the C:A haplotype and lower frequencies of the A:C haplotype at the GSK-3β gene (rs1732170:rs11921360) were also found to be associated to SB in BP. Therefore, our results suggest that genetic variability at IMPA2, INPP1 and GSK3β genes is associated with the emergence of SB in BP.

2-COM: an instrument to facilitate patient-professional communication in routine clinical practice.

Objective:  A simple patient‐completed self‐report instrument may facilitate patient–professional carer communication.

How can we promote smoking cessation in people with schizophrenia in practice? A clinical overview

High rates of smoking and nicotine dependence are associated with increased physical comorbidity and premature death in people with schizophrenia. We conducted a clinical overview to establish how smoking cessation should be promoted in practice.