PMH2 Treatment Outcomes for Patients with Treatment Resistant Depression in European Standard Clinical Practice

Differential serum acute-phase biomarker profile in schizophrenia and bipolar disorder

There is a growing interest in inflammation and immune dysfunction in severe psychiatric disorders such as schizophrenia and bipolar disorder. This dysfunction seems to consist in abnormal blood levels of cytokines and acute-phase proteins, with increased levels of C-reactive protein (CRP), fibrinogen, homocysteine and erythrocyte sedimentation rate (ESR). Higher levels can be found in acute episodes and in patients with a higher cardiovascular risk.Acute-phase protein serum parameters were determined in a sample of 100 outpatients with schizophrenia (n = 50) or bipolar disorder (n = 50) so as to assess differences in pro-inflammatory state. Metabolic state was assessed through BMI, waist c…

Is melatonin an adjunctive stabilizer?

MELATONIN (MLT) IS a main synchronizer of the sleep/wake cycle control. We performed a prospective naturalistic study that included 14 euthymic bipolar patients that suffered from insomnia (six type I, six type II and two schizoaffective disorder) according to DSM-IV-TR criteria.1 After giving their written consent, patients began the treatment with MLT. Evaluation tools used were: Oviedo Sleep Questionnaire (OSQ),2 Chinese Polarity Inventory (CPI),3 Numeric Evaluation Scale (NES),4 and Clinical Global Impressions Scale foruse in bipolar illness (CGI-BP-M).5 Side-effects and time until improvement of sleep were evaluated. Euthymia had to be confirmed by a score <30 on the CPI-Depression and…

A clinical staging model for bipolar disorder: longitudinal approach

AbstractBipolar disorder (BD) has been identified as a life-course illness with different clinical manifestations from an at-risk to a late stage, supporting the assumption that it would benefit from a staging model. In a previous study, we used a clustering approach to stratify 224 patients with a diagnosis of BD into five clusters based on clinical characteristics, functioning, cognition, general health, and health-related quality of life. This study was design to test the construct validity of our previously developed k-means clustering model and to confirm its longitudinal validity over a span of 3 years. Of the 224 patients included at baseline who were used to develop our model, 129 (…

The effects of reward and frustration in patients with bipolar disorder: Evidence from a computerized task with non-contingent feedback.

Abstract Background: Bipolar disorder (BD) is characterized by mood changes that implies alterations in reward sensitivity and frustration tolerance. This study examined the effects of monetary reward and frustration on attentional performance and on affective experience across mood states in BD. Methods: An Affective Posner Task in which the nature of contingencies are divided in the three successive blocks (baseline condition, monetary reward and non-contingent feedback) was applied to BD individuals in their different episodes: mania (n = 30), depression (n = 30), and euthymia (n =  30) as well as to a group of healthy controls (n = 30). Results: Monetary reward improved performance (in …

Sex differences in bipolar disorder: Impact of lifetime cannabis use on clinical course, functioning, and quality of life in bipolar disorder.

Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex.Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life.A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p0.005) than those without L…

El punto de vista de los familiares de pacientes con trastorno bipolar.

Como consecuencia de la desinstitucionalización de los pacientes psiquiátricos, el papel de los cuidadores ha adquirido un interés relevante a lo largo de los últimos años. Con el objetivo de conocer el impacto de la enfermedad en los cuidadores, 88 familiares de pacientes diagnosticados de trastorno bipolar (DSM-IV) completaron un cuestionario autoadministrado que recogía información sobre variados aspectos clínicos, sociodemográficos, carga experimentada, actitudes y conocimientos acerca de la enfermedad, entre otras cuestiones. Encontramos que los familiares necesitaban con frecuencia ayuda psiquiátrica por el estrés generado por la enfermedad, ercibían afectación en los planos laboral, …

Real-World Evidence from a European Cohort Study of Patients with Treatment Resistant Depression: Healthcare Resource Utilization: Healthcare resource utilization

Background: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. Methods: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a que…

Classification of patients with bipolar disorder using k-means clustering.

Introduction Bipolar disorder (BD) is a heterogeneous disorder needing personalized and shared decisions. We aimed to empirically develop a cluster-based classification that allocates patients according to their severity for helping clinicians in these processes. Methods Naturalistic, cross-sectional, multicenter study. We included 224 subjects with BD (DSM-IV-TR) under outpatient treatment from 4 sites in Spain. We obtained information on sociodemography, clinical course, psychopathology, cognition, functioning, vital signs, anthropometry and lab analysis. Statistical analysis: k-means clustering, comparisons of between group variables, and expert criteria. Results and discussion We obtain…

Real-world evidence from a European cohort study of patients with treatment resistant depression : Baseline patient characteristics

Journal of affective disorders 283, 115-122 (2021). doi:10.1016/j.jad.2020.11.124

Real-world evidence from a European cohort study of patients with treatment resistant depression:Healthcare resource utilization

Journal of affective disorders 298, Part A 442-450 (2022). doi:10.1016/j.jad.2021.11.004 special issue: "Special Issue on Corona Virus / Edited by Allan Young, Ron Acierno, Xiang Yang Zhang"

Spanish validation of the Empirically Developed Clinical Staging Model (EmDe-5) for patients with bipolar disorder

Abstract Introduction Bipolar disorder (BD) has been reconceptualised as a progressive disorder that develops from mild to severe presentations. An empirical staging model – the Empirically Developed Clinical Staging Model for BD (EmDe-5) – was developed in a previous study. This study aims to further validate that model using a larger and more representative Spanish sample. Material and methods 183 BD outpatients were recruited at 11 sites in Spain. Assessment included clinical characteristics of the BD (number of hospitalisations, number of suicide attempts, comorbid personality disorders), physical health (BMI, metabolic syndrome, number of physical illnesses), cognition (SCIP), function…

Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperati…

Attentional biases to emotional scenes in schizophrenia: An eye-tracking study

Attentional biases to emotional information may play a key role in the onset and course of schizophrenia. The aim of this experiment was to examine the attentional processing of four emotional scenes in competition (happy, neutral, sad, threatening) in 53 patients with schizophrenia and 51 controls. The eye movements were recorded in a 20-seconds free-viewing task. The results were: (i) patients showed increased attention on threatening scenes, compared to controls, in terms of attentional engagement and maintenance; (ii) patients payed less attention to happy scenes than controls, in terms of attentional maintenance; (iii) whereas positive symptoms were associated with a late avoidance of …

Real-world evidence from a European cohort study of patients with treatment resistant depression: Treatment patterns and clinical outcomes.

Abstract Background Treatment resistant depression (TRD) characterizes a subgroup of 10–30% of patients with major depressive disorder, and is associated with considerable morbidity and mortality. A consensus treatment for TRD does not exist, which often leads to wide variations in treatment strategies. Real-world studies on treatment patterns and outcomes in TRD patients in Europe are lacking and could help elucidate current treatment strategies and their efficacy. Methods This non-interventional cohort study of patients with TRD (defined as treatment failure on ≥2 oral antidepressants given at adequate dose and duration) with moderate to severe depression collected real-world data on trea…

Impulsivity, sensation seeking and aggressiveness in patients with bipolar I and II disorder

Abstract Objective Although impulsivity may seem to be strongly linked to bipolar disorder, few studies have directly measured this phenomenon. To determine its implications for the prognosis of this illness, we studied the relationship between impulsivity and other aspects that are probably related, such as sensation seeking and aggressiveness, and different clinical variables of bipolar disorder. Method Sixty-nine (type I, n = 42; type II, n = 27) outpatients from a unit specifically for bipolar patients in remission completed the Barratt Impulsiveness Scale (BIS), the Sensation Seeking Scale (SSS), the Buss–Durkee Hostility Inventory (BDHI) and the Bipolar Eating Disorder Scale (BEDS). S…

El papel de la pérdida en la génesis de los trastornos depresivos.

Introducción. En la investigación de la depresión, el papel de la pérdida ha sido examinado en detalle, puesto que constituye un aspecto central de la mayoría de los acontecimientos vitales que llevan a la depresión. Material y método. En el presente trabajo se realizó una revisión acerca de los estudios previos sobre la importancia de la pérdida centrándonos en diversos aspectos como sus diferentes tipos, la asociación con algunas enfermedades mentales, pérdida y pronóstico, relación entre desesperanza y pérdida, y variaciones de los acontecimientos de pérdida en función de diversos factores, considerando también la pérdida en la infancia. Resultados. La pérdida ejerce un papel clave en la…

Are affective temperaments determinants of quality of life in euthymic patients with bipolar disorder?

Background: Bipolar disorder (BD) is a disabling illness that is associated with low quality of life (QoL). This low QoL goes further than mood episodes, which suggests that stable traits, such as affective temperaments, can cause functional impairment. Objective: Our study analyses the impact of affective temperaments on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of QoL in euthymic BD patients. Methods: A multicentre study was conducted in 180 euthymic BD patients and 95 healthy controls. Firstly, statistical analyses were performed to compare QoL and affective temperaments between the two groups. Secondly, Adaptive Lasso Analysis was carried out to identify th…

Un posible marcador de rasgo y estado en el Trastorno Bipolar: el Electrorretinograma-Patrón

Introducción. La similitud entre las células retinianas y las neuronas del sistema nervioso central permite que métodos no invasivos de estudio de la función retiniana, como el Electrorretinograma- Patrón (PERG) se postulen como posibles biomarcadores, útiles y seguros en el estudio de patologías psiquiátricas como el Trastorno Bipolar (TB). El objetivo del presente estudio es caracterizar las diferencias en los resultados en el PERG de pacientes con TB y sujetos sanos, así como evaluar una posible correlación entre estos resultados y las descompensaciones afectivas del polo maniaco en el grupo de pacientes bipolares. Material y métodos. Se realizó un estudio transversal en una muestra de 3…

Manejo perioperatorio de los anticoagulantes orales directos en cirugía urgente y sangrado. Monitorización y tratamiento hemostático

There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial th…

[Variables associated with disability in elderly bipolar patients on ambulatory treatment].

Introduction: Studies on adult bipolar patients have demonstrated a disability associated with the bipolar disorder, even in euthymic patients, but there is a lack of data in the elderly population. Material and method: A cross-sectional, multicentre study on a consecutive sample of ambulatory bipolar patients (DSM-IV-TR criteria), aged 65 years or over. Retrospective and cross-sectional sociodemographic and clinical data were collected, as well as the Clinical Global Impression for Bipolar Modified scale (CGI-BP-M) and the level of disability using the World Health Organisation Disability Assessment Schedule (WHO/DAS). The disability was assessed globally and by areas. The presence of a mo…

Nuevos eutimizantes y ciclo reproductivo

Introduction. The use of new mood stabilizers in the treatment of bipolar disorder has supposed a revolution, especially due to its more favorable profile in many aspects. Nevertheless, therapeutic decisions on treatment during pregnancy and the breastfeeding period are still being debated. Since these new anticonvulsants appeared in the decade of 1990, less naturalistic experience in its use exists during these periods than with other older anticonvulsants. Methods. A Medline and Embase search was conducted from 1970 to 2003 to review the articles published on the use of the new mood stabilizers during pregnancy and breastfeeding, and its effects on contraception. Neurology and psychiatry …

Recomendaciones de manejo perioperatorio de antiagregantes plaquetarios en cirugía no cardíaca. Grupo de trabajo de la Sección de Hemostasia, Medicina Transfusional y Fluidoterapia de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR). Actualización de la Guía de práctica clínica 2018

The effect of concomitant benzodiazepine use on neurocognition in stable, long-term patients with bipolar disorder

Objective: Neurocognitive dysfunction is a common feature of bipolar disorder even in euthymia, and psychopharmacological treatment could have an effect on cognition. Long-term prescription of benzodiazepines in bipolar disorder is a common practice, and their effect on neurocognition has not been well studied in this population. The aim of this study was to evaluate the impact of concomitant benzodiazepine long-term use on neurocognitive function in stable euthymic bipolar disorder patients. Methods: Seventy-three euthymic bipolar disorder outpatients and 40 healthy individuals were assessed using a neurocognitive battery. Patients were classified in two groups according to the presence of…

Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most o…

Nosology, epidemiology and pathogenesis of bipolar disorder: Recent approaches

Bipolar disorder is a highly prevalent, chronic and deteriorating mental illness that requires medical, psychological and social care for life. Realizing that bipolar disorder is more common than initially thought, the associated disability and the heterogeneity in their clinical presentation, has strengthened the research on this topic. Recent advances in the field of nosology, epidemiology and pathogenesis have begun to unravel some of the complexity of this disorder and have had a marked influence on the changes in the way they are beginning to diagnose a broad spectrum of bipolar disorders according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM …

Discapacidad en pacientes bipolares ancianos en tratamiento ambulatorio. Variables asociadas

Resumen Introduccion Los estudios en pacientes bipolares adultos han demostrado una discapacidad asociada al trastorno bipolar, incluso en pacientes eutimicos, pero apenas hay datos en poblacion anciana. Material y metodo Estudio transversal y multicentrico, en una muestra de pacientes bipolares (criterios DSM-IV-TR) ambulatorios, consecutivos, con edad igual o superior a 65 anos. Se recogieron datos retrospectivos y transversales sociodemograficos y clinicos, ademas de la gravedad clinica global (ICG-BP-M) y el grado de discapacidad mediante la Escala de Discapacidad de la OMS (WHO/DAS). Se valoro la discapacidad global y por areas. Se considero variable dependiente la presencia de discapa…

Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder.

Background: Cognitive and psychosocial impairment has been associated with increased levels of C-reactive protein (CRP) and homocysteine in bipolar disorder, but gender differences have seldom been studied. Methods: Two hundred and twenty-four bipolar outpatients were included. Cognitive performance was assessed through the Screen for Cognitive Impairment in Psychiatry (SCIP). Psychosocial functioning was evaluated using the Functioning Assessment Short Test (FAST) and the General Assessment of Functioning (GAF). Homocysteine and CRP levels were determined. Separate analyses were performed by gender. Partial correlations were calculated to test for associations between biomarkers and cognit…

A case of antibiotic‐associated mania in a 67‐year‐old woman

Impulsividad, búsqueda de sensaciones y agresividad en pacientes bipolares tipo I y II

Resumen Introduccion Aunque la impulsividad puede aparecer fuertemente relacionada con el trastorno bipolar, pocos estudios han medido directamente este fenomeno. Con el objetivo de conocer sus implicaciones pronosticas, estudiamos la relacion entre la impulsividad y otros aspectos probablemente relacionados con ella, como son la busqueda de sensaciones y la agresividad y diferentes variables clinicas del trastorno bipolar. Metodos 69 pacientes ambulatorios en remision (tipo I, n = 42; tipo II, n = 27) de una unidad especifica de trastornos bipolares completaron la Escala de Impulsividad Barratt (BIS), la Escala de Busqueda de Sensaciones (SSS), el Inventario de Hostilidad de Buss-Durkee (B…

Attentional processing biases to threat in schizophrenia: Evidence from a free-viewing task with emotional scenes

Attentional biases to threatening stimuli have been suggested to play a key role in the onset and course of schizophrenia. However, current research has not completely demonstrated this assumption. The aim of this eye-tracking study was to shed light on the underlying psychological mechanisms of schizophrenia by examining the attentional processing of socio-emotional information. Forty-four individuals with schizophrenia and 47 healthy controls were assessed in a 3-s free-viewing task with a social scene (i.e., happy, threatening, or neutral) in competition with a non-social one to determine the effects of emotional information on the different stages of the attentional processing. The loca…

Is melatonin an adjunctive stabilizer?

Real-world evidence from a European cohort study of patients with treatment resistant depression: Baseline patient characteristics: Patient characteristics in treatment resistant depression

Background: Treatment resistant depression (TRD; failure to respond to ≥2 treatments) affects ~20% of patients with major depressive disorder (MDD). Real-world data could help describe patient characteristics and TRD disease burden, to assess the unmet needs of TRD patients in Europe. Methods: This observational study collected data from adults with moderate to severe TRD initiating a new treatment for depression, according to local standards of care. At baseline, socio-demographic characteristics, medical history, prior and current treatments were recorded. Disease severity, health-related quality of life (HRQoL), functionality and productivity were assessed. Results: Overall, 411 eligible…

Hypoesthesia in generalised anxiety disorder and major depression disorder

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia ro...

Do affective episodes modulate moral judgment in individuals with bipolar disorder?

Abstract Background Bipolar disorder (BD) patients experience altered emotional states and deficits in social adaptation that may also be involved in deontological moral judgments in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. Methods In the present study we compared the utilitarian responses of BD patients in their different states (euthymia, mania, depression) and healthy controls to moral dilemmas with low (impersonal dilemma) and high (personal dilemma) emotional saliency. Results Our findings revealed an increased tendency to utilitarian judgments in the three groups of BD patients in impersonal dilemmas relative to …

Comparative neurocognitive effects of lithium and anticonvulsants in long-term stable bipolar patients

Background: The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. Method: Three groups of BD patients were established according to their treatment: (i) lithium monotherapy (n=29); (ii) lithium together with one or more anticonvulsants (n=28); and (iii) one or more anticonvulsants (n=16). A group of healthy controls served as the control (n=25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Comple…

Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder.

Abstract Background In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. Aim To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. Methods A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B gro…