Javier Goti

Prevalence and factors related to substance use among adolescents with eating disorders.

Objective: Very few studies have assessed substance use in clinical samples of adolescents with eating disorders (ED). This paper reports the prevalence of regular or risky substance use (RRSU) and substance use disorder (SUD) in adolescents with ED. Methods: The Teen-Addiction Severity Index (T-ASI), the Youth Self-Report (YSR) scale and substance use questionnaires were administered to 95 adolescent patients aged 12–17 years who fulfilled the DSM-IV-TR diagnostic criteria for anorexia nervosa, bulimia nervosa and ED not otherwise specified. All patients were consecutively attended at an Eating Disorders Unit. Results: 14.7% presented SUD related to tobacco, 3.2% to cannabis, 1.1% to alcohol, and 1.1% to other substances. Patients with RRSU-SUD of any substance except tobacco were 34.7%. Patients with RRSU-SUD failed more subjects, repeated more school years and had higher scores on T-ASI scales of problems at school, family function and social relationships, and on YSR scales of delinquent behavior and externalizing problems. Conclusions: Substance use problems in ED adolescents are frequent and formal screening of them as well as a specific therapeutic approach are necessary.

-141C Ins/Del polymorphism of the dopamine D2 receptor gene is associated with schizophrenia in a Spanish population.

Objective In this study we examined the relationship between dopamine D2 receptor (DRD2) polymorphisms (TaqIA, TaqIB, -141C Ins/Del) and dopamine D3 receptor (DRD3) Ser9Gly polymorphism and the risk of schizophrenia in a Spanish population. Methods Two hundred and forty-three schizophrenia patients and 291 healthy controls from the general population participated in a case–control study. Results No significant differences were observed in the allele or genotype frequencies of TaqIA, TaqIB or Ser9Gly polymorphisms between the schizophrenia patients and the healthy controls. The frequency of the -141C Del allele was significantly lower in the former group (odds ratio=0.4, P=0.01). The -141C Del allele, which produces lower expression of DRD2, may protect against dopaminergic hyperactivity in schizophrenia. Conclusion This study is one of the few studies of Caucasian participants that supports the results obtained in the original Japanese study, in which the -141C Ins/Del polymorphism was first described. Furthermore, our findings reinforce the hypothesis that excess dopaminergic activity leads to schizophrenia.

Patterns of substance use in adolescents attending a mental health department

This study aimed to describe patterns of substance use in adolescents initiating mental health treatment and analyse factors associated with a high-risk pattern of substance use differentially by gender. Two hundred and thirty-seven 12- to 17-year-old new patients in an urban public mental health service were prospectively recruited and evaluated using semi-structured interviews and standardized questionnaires to obtain socio-demographic, psychopathological, family, school and substance use data. The most prevalent primary diagnoses among males were attention deficit disorder and conduct disorder, while among females they were eating disorders, affective and conduct disorders. Substance use disorder was diagnosed as follows: cannabis in 10.1% of the sample, alcohol in 3.4% and other drugs in 0.4%. A pattern of substance use with high risk of developing problems (at least regular use of alcohol or occasional use of cannabis or other illegal drugs) was found in 48.9% of the sample. After adjusting for age in the multivariate logistic regression, this pattern of risky use of drugs was found to be associated with Youth Self-Report scales of thought problems, delinquent and aggressive behaviour, in both genders. Altered family structure, having had to repeat a school grade and Youth Self-Report attention problems were only significantly associated with risky drug consumption in females. The high prevalence of risky and problematic substance use in adolescents entering mental health treatment warrants early systematic screening and specific preventive and therapeutic interventions, addressing mental health psychoeducation and motivation to avoid drugs, as well as differential associated risk factors for males and females.

Plasma homovanillic acid differences in clinical subgroups of first episode schizophrenic patients.

This study evaluates the relationship between plasma homovanillic acid (pHVA) levels, which have been used to study the role of central dopamine in schizophrenia, and the positive/negative syndrome in first episode schizophrenic patients before and after antipsychotic treatment. Forty neuroleptic-naive first episode schizophrenic patients were monitored at baseline and on days 7, 14 and 28. Clinical status was evaluated with the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Brief Psychotic Rating Scale. Plasma HVA levels were also measured. Patients were divided into predominantly positive or negative syndrome groups by subtracting SAPS from SANS scores, at baseline. A healthy control group was also enrolled. Schizophrenic patients as a group had significantly higher pHVA levels than controls at baseline (20.50+/-11.85 vs. 13.04+/-7.22 ng/ml). Moreover, 12 predominantly negative syndrome patients had similar mean baseline pHVA levels (21.30+/-12.36 ng/ml) to those of 28 predominantly positive syndrome patients (19.40+/-11.33 ng/ml). During follow-up, there was a different evolution of pHVA levels in the predominantly positive syndrome group than in the predominantly negative syndrome group, with a significantly greater global reduction of pHVA levels in the former. Although both groups showed clinical improvement following 4 weeks of treatment with risperidone, pHVA levels at endpoint were lower (13.29+/-5.91 ng/ml) than at baseline in patients in the predominantly positive syndrome group, while among those in the predominantly negative syndrome group there was no difference in pHVA levels before and after treatment (21.02+/-13.06 ng/ml). The different pHVA level profiles observed in predominantly positive and negative syndrome first episode patients after 4 weeks of treatment with risperidone suggest that each syndrome may have a different underlying neurobiology.

Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls

Substance use is a risk behavior that tends to increase during adolescence, a time when part of the personality is still in development. Traditionally, personality psychopathology has been measured in terms of categories, although dimensional models have demonstrated better consistency. This study aimed to analyze differences in personality profiles between adolescents with substance use disorders (SUD n = 74) and matched community controls (MCC n = 74) using the Personality Psychopathology Five (PSY-5) dimensional model. Additionally, we compared age at first drug use, level of drug use and internalizing and externalizing symptoms between the groups. In this study, the PSY-5 model has proved to be useful for differentiating specific personality disturbances in adolescents with SUD and community adolescents. The Disconstraint scale was particularly useful for discriminating adolescents with substance use problems and the Delinquent Attitudes facet offered the best differentiation.

Debería considerarse la obesidad un factor limitante para el tratamiento con clozapina

OBJECTIVE Clozapine is the first choice in drug-resistant schizophrenia but also causes important weight changes. This might discourage clinicians concerned about the risk of developing health problems. To assess this issue we measured change in body mass index (cBMI) induced by clozapine at 18 and 56 weeks. METHODS Baseline body weight and height were measured and weight weekly thereafter during the first 18 weeks of treatment. After that, measurements were made monthly. Steady clozapine dose, clozapine and norclozapine blood concentrations, concomitant medication, gender and age were recorded. RESULTS At 18 weeks (n=76) mean cBMI was 1.83 kg/m(2). Baseline BMI was inversely correlated with cBMI. At 56 weeks (n=57) cBMI was 2.67 kg/m(2) and was inversely correlated with basal BMI. Multiple regression analysis replicated the results. When split with BMI categories, obese patients had lesser risk for further weight gain. CONCLUSIONS Obesity should not discourage clinicians from starting clozapine in drug-resistant patients.