Jerónimo Saiz Ruiz

Criterios de valoración clínicos y de funcionamiento en un estudio de interacción gen-ambiente en primeros episodios psicóticos (PEPs)

The PEPs study is a multicenter, naturalistic, prospective, longitudinal study designed to evaluate clinical, neuropsychological, neuroimaging, biochemical, environmental and pharmacogenetic variables in a sample of nearly 350 first episode of psychosis patients and 250 healthy controls. The PEPs project was conducted in Spain from January 2009 to December 2011. This article describes the rationale for the measurement approach adopted, providing an overview of the selected clinical and functional measures. The main objectives are: a) the thorough clinical and neurocognitive characterization of a sample of first episodes of psychosis, and b) the study of the interactions between the genetic and environmental variables selected to predict clinical and brain structural outcomes, and to determine the relationship of genetic polymorphisms involved in the pharmacokinetics and pharmacodynamics, and the responses and adverse effects of treatment.

Consenso Español de Salud Física del Paciente con Trastorno Bipolar

Resumen Introduccion y objetivos Los pacientes con trastorno bipolar presentan una morbilidad fisica y una mortalidad muy superior a la de la poblacion general. Ademas de una mayor mortalidad por suicidio, tienen tambien una mayor prevalencia de enfermedades fisicas. El objetivo de este consenso, promovido por las Sociedades Espanolas de Psiquiatria y Psiquiatria Biologica, en colaboracion con las sociedades de medicos de asistencia primaria, es establecer recomendaciones practicas sobre los procedimientos de deteccion, prevencion e intervencion en las enfermedades somaticas que coexisten con el trastorno bipolar para mejorar la calidad y esperanza de vida de estos pacientes. Metodo Las Sociedades Espanolas de Psiquiatria y Psiquiatria Biologica eligieron un Comite Cientifico que selecciono a su vez a 32 psiquiatras expertos y 10 medicos expertos en otras especialidades medicas. Se crearon grupos de trabajo para cada especialidad con la finalidad de adaptar las guias aplicadas en la poblacion general a pacientes con trastorno bipolar. Partiendo de una revision sistematica sobre la comorbilidad medica y la mortalidad en el trastorno bipolar se realizaron dos reuniones para acordar el consenso. Resultados En la revision bibliografica se detecto un riesgo aumentado, entre los pacientes con trastorno bipolar, de presentar hipertension arterial, obesidad, tabaquismo, enfermedades pulmonares, migrana e infeccion por virus de la inmunodeficiencia humana (VIH). Tambien se encontro evidencia de un aumento de mortalidad por enfermedades cardiovasculares, respiratorias e infecciones, ademas del suicidio. El grupo de expertos alcanzo el consenso en una serie de medidas basicas para la deteccion de comorbilidad medica aplicables a la monitorizacion de estos pacientes. Las recomendaciones resultantes seran asumidas y divulgadas por las sociedades promotoras. Conclusiones El decalogo generado en el Consenso Espanol de Salud Fisica del Paciente con Trastorno Bipolar recoge los aspectos mas relevantes para la mejora del funcionamiento psicosocial, la calidad y la esperanza de vida en los pacientes con esta patologia.

Protocolo breve de evaluación del suicidio, fiabilidad interexaminadores

INTRODUCTION Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. METHOD In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behavior. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). RESULTS Inter-rater agreement was between poor (<70%) to excelent (90-100%. Inter-rater agreement in Brughas list of threatening experiences ranged from 75.5 and 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in the Becks Suicidal Intent Scale, ranged from 67.5 and 97%; in the Becks Scale for Suicide Ideation, ranged from 63.5 and 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. CONCLUSION The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

Spanish consensus on physical health of patients with bipolar disorder

Background and objective Patients with bipolar disorder have much higher physical morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, these patients also have a higher prevalence of physical disorders. The aim of this consensus, promoted by the Spanish Societies of Psychiatry and Biological Psychiatry in collaboration with the General Practitioners’ Societies, was to establish practical recommendations on procedures for detection, prevention, and intervention in the somatic diseases that coexist with bipolar disorder in order to improve the quality of life and life expectancy of these patients.

Consenso español de salud física del paciente con depresión

Comorbidity between depression and physical illnesses is very common and has a significant impact on the health and management of the patient. With the support of the Sociedades Españolas de Psiquiatría y Psiquiatría Biológica, and Sociedad Española de Médicos de Atención Primaria (SEMERGEN) a consensus was prepared on physical health in patients with depression and is summarized in the present work. The literature review highlighted the high frequency of cardiovascular and endocrine-metabolic disorders in patients with depression such as diabetes and obesity, thus making the primary and secondary prevention recommendations for patients with cardiovascular or metabolic risk applicable to patients with depression. Comorbidity between depression and chronic pain is also frequent, and requires an integrated therapeutic approach. The presence of physical illness in patients with depression may condition, but not preclude, the pharmacological treatment; drug selection should take into account potential side-effect and drug-drug interactions. On the other hand, psychotherapy may contribute to the patients recovery. Overall, coordination between the primary care physician, the psychiatrist and other health professionals involved is essential for the management of patients with depression and concomitant physical illness.

Smoking does not impact social and non-social cognition in patients with first episode psychosis

BACKGROUND Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group. METHODS A sample of 335 patients with FEP and 253 healthy controls was divided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed. RESULTS Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F=13.45; p≤0.001) and working memory domains (F=4.30; p=0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F=19.60; p≤0.001). No significant differences were revealed in the comparison between the patient groups. CONCLUSIONS This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance.