Juan Castaño

Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

OBJECTIVE This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. METHODS A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. RESULTS Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. CONCLUSIONS Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.

Enfermedades somáticas en pacientes con trastornos de ansiedad

Fundamento y objetivo: Diversos estudios han indicado una mayor prevalencia de enfermedades somaticas en pacientes con trastornos de ansiedad, entre los que especialmente destacan la cardiopatia, la neumopatia, las enfermedades digestivas y la cefalea. El objetivo del presente estudio es investigar la comorbilidad entre trastornos de ansiedad y enfermedades somaticas en una muestra de pacientes con trastornos de ansiedad atendidos en atencion primaria y pacientes con otras enfermedades psiquiatricas, pero sin ansiedad. Pacientes y metodo: Es un estudio retrospectivo de casos y controles en el que los pacientes fueron apareados por edad y sexo. En el grupo con trastornos de ansiedad se incluyo a 130 pacientes diagnosticados de trastorno de panico con/sin agorafobia y agorafobia sin crisis de panico segun criterios de la cuarta edicion del Manual de Clasificacion de los Trastornos Mentales (DSM-IV). Se los comparo con 2 grupos control, un grupo de 150 pacientes atendidos en atencion primaria sin diagnostico de enfermedad psiquiatrica y otro grupo de 130 pacientes atendidos en servicios de psiquiatria sin diagnostico de trastorno de ansiedad. Resultados: Los pacientes con trastornos de ansiedad presentaron mayor riesgo para algunas enfermedades somaticas que otros pacientes sin trastornos de ansiedad. Tras el analisis de regresion logistica multivariante, las variables que se mantuvieron significativas fueron la cefalea (4,2 veces mas riesgo), la cardiopatia (3,9), las enfermedades osteomusculares (3,8) y las enfermedades digestivas (2). Conclusiones: Los pacientes con trastornos de ansiedad presentan significativamente mayor comorbilidad con algunas enfermedades somaticas. Mecanismos fisiopatologicos o causas geneticas comunes podrian explicar esta asociacion.

Joint Hypermobility, Anxiety, and Psychosomatics — The New Neuroconnective Phenotype

In this chapter, after summarizing the concept and diagnosis of the Joint Hypermo‐ bility (Hyperlaxity), we review case control studies in two directions: Anxiety in Joint Hypermobility and Joint Hypermobility in Anxiety disorders, studies in non‐ clinical samples, review papers, and one incidence study. Collected evidence tends to confirm the strength of the association described two and a half decades ago. Common mechanisms involved include genetics, autonomic nervous system dys‐ functions, and interoceptive and exteroceptive processes. Considering clinical and nonclinical data, pathophysiological mechanisms, and present nosological status, we suggest a new Neuroconnective phenotype in which together around a common core Anxiety-Collagen hyperlaxity, it includes five dimensions: behavioral, psycho‐ pathology, somatic symptoms, somatosensory symptoms, and somatic illnesses. So‐ matic illnesses include irritable bowel, dysfunctional esophagus, multiple chemical sensitivity, dizziness or unsteadiness (central vestibular pattern), chronic fatigue, fi‐ bromyalgia, glossodynia, vulvodynia, hypothyroidism, asthma, migraine, temporo‐ mandibular dysfunction, and intolerances or food and drug hypersensitivity. It is envisaged that new descriptions of anxiety disorders and also of some psychoso‐ matic conditions will emerge and different nosological approaches will be required.

Use of benzodiazpines in the treatment of major depressive disorder in an outpatient mental health center

Results There is use of BZD in a 76% of the sample, with a predominancy of the female gender (72.4% vs 27.6%), a global average age of 56.55 ± 12.4 years. In relation to personal psychiatric background it can be observed in 47.4% the absence of these, followed by 39.5% in which there is presence of previous depressive episodes. There is a predominancy in the absence of toxic abuse (97.4%) and the absence of previous hospitalisations (81%) It can be observed the following distribution by frequencies in the use of BZD: diazepam (25%), dipotassic clorazepate (23,7%), clonazepam (14.5%) and alprazolam (10.5%). The average dose was 10.2 mg/d for diazepam, 22.9 mg/d for dipotasic clorazepate, 2.7 mg/d for clonazepam and 1 mg/d for alprazolam. Conclusions The use of BZD in the DMM is large in our sample but the potential benefits of adding a BZD to an antidepressant must be balanced judiciously against possible harms including development of dependence and accident proneness, on the one hand, and against continued suffering following no response and drop out, on the other.

Use of antipsychotics in the treatment of major depressive disorder in an outpatient mental health center

Results Antipsychotics are used in 27% of the patients, with a predominancy in the female gender (77.8%), a global average age of 57.9 ± 12.6 years. There is a predominancy of absence of psychiatric background (55.6%) and the absence of previous hospitalisations (66.7%). In 96.3% of the sample there was no toxic abuse. It is observed the following distribution in the use of antipsychotics: quetiapine and olanzapine (29.6% each one), risperidone (26%), paliperidone (3%). Average dose was 5.7 mg/d for olanzapine, 2.3 mg/d for risperidone, 84.5 mg/d for quetiapine and 6 mg/d for paliperidone. Conclusions It is observed an important frequency in the use of antipsychotic treatment for MDD, in relation with the fact that there is growing evidence for the efficacy of atypical antipsychotics for adjunctive treatment of depressive symptoms of MDD. There is scientific evidence that supports the use of the two antipsychotics predominantly used in our sample (olanzapine and quetiapine) [2], but more studies are needed to establish its place in management.

Use of mood stabilizer drugs in the treatment of major depressive dissorder in an outpatient mental health center

BackgroundMajor depressive disorder (MDD) is a common and dis-abling psychiatric condition. Antidepressants are cur-rently the mainstay of treatment for depression;however, almost two thirds of patients will fail toachieve remission with initial treatment, as a result, arange of augmentation and combination strategies havebeen used [1].Materials and methodsMajor depressive disorder (MDD) is a common and dis-abling psychiatric condition. Antidepressants are cur-rently the mainstay of treatment for depression;however, almost two thirds of patients will fail toachieve remission with initial treatment, as a result, arange of augmentation and combination strategies havebeen used [1].ResultsMood stabilizers are used in 14% of the sample with apredominancy in the female gender (85.7%), a globalaverage age 50.6 ± 12.2 years. Regarding personal psy-chiatric background, there’s an absence of these in thefirst place (64.3%), followed by the presence of previousdepressive episodes (21.4%) and dysthymic disorder(7.1%). In none of these cases there was toxic abuse.There is a predominancy in the absence of previouspsychiatric hospitalisations (64.3%).The frequencies of use of mood stabilizers was: topira-mate in the first place (50%) followed by lithium, carba-mazepine and pregabaline (14.28% each of them), in thelast place lamotrigine (7.1%). The average dose was900 mg/d for carbamazepine, 600 mg/d for lithium,300 mg/d for pregabaline,128.5 mg/d for topiramateand 100 mg/d for lamotrigine.ConclusionsIn our sample the frequency of use of lithium is similarto the registered for the several antiepiletics (lithium,carbamazepine and pregabaline: 14.28% each one). How-ever, lithium addition is recommended as a first choicefor depressed patients who do not respond to therapywith conventional antidepressants [2].

Use of methylphenidate in the treatment of major depressive disorder in an outpatient mental health center

Background According to the American Psychiatric Association practice guidelines, if a patient with Major Depressive Disorder (MDD) has not responded or achieved only a partial response after 4-8 weeks of therapy, a dose change, switch to a new drug, or augmentation therapy is recommended [1]. Combined use of standard antidepressants with dopaminergic agents and psychostimulants can lead to accelerate and enhance response if administered early in the course of treatment [2].