Publications by authors named "José Manuel Montes"

36 Publications

Assessment Tool of Bipolar Disorder for Primary Health Care: The SAEBD.

Int J Environ Res Public Health 2021 08 6;18(16). Epub 2021 Aug 6.

Instituto Universitario de Integración en la Comunidad (INICO), Faculty of Psychology, Universidad de Salamanca, 37005 Salamanca, Spain.

Mixed states are highly prevalent in patients with bipolar disorder and require comprehensive scales. Considering this, the current study aims to develop a measure to assess the full spectrum of clinical manifestations of bipolar disorder. A sample of 88 patients was evaluated; the Hamilton Depression Scale (HAM-D), Montgomery-Asberg Depression Scale (MADRS), and the Young Mania Rating Scale (YMRS) were applied, together with the preliminary version of the Scale for the Assessment of Episodes in Bipolar Disorder (SAEBD). After analyzing the appropriateness and statistical properties of the items, discriminant analysis and analysis of diagnostic capacity were performed. The discriminant functions correctly classified 100% of the cases in euthymia, predominant depressive symptoms or mixed symptoms, as well as 92.3% of the cases with predominant manic symptoms. Overall, the functions correctly classified 98.9% of the cases. The area under the curve (0.935) showed high capacity to discriminate between clinical and non-clinical cases (i.e., in euthymia). The SAEBD sensitivity was 0.95, specificity was 0.71, the Positive Predictive Value (PPV) was 0.88, the Negative Predictive Value (NPV) was 0.87, the Positive Likelihood Ratio (+LR) was 3.33, and the Negative Likelihood Ratio (-LR) was 0.07. In conclusion, the SAEBD is a promising scale that shows high reliability and validity, as well as diagnostic utility as a screening tool for use in diverse health care settings.
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http://dx.doi.org/10.3390/ijerph18168318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392302PMC
August 2021

Impact of the COVID-19 pandemic on acute inpatient psychiatric units in Spain.

Psychiatry Res 2021 10 24;304:114136. Epub 2021 Jul 24.

Department of Psychiatry, University Hospital Ramón y Cajal, Madrid, Spain.

Patients with more severe mental health symptoms are treated in acute inpatient psychiatric units (AIPUs), but the functioning of these units throughout Spain has been challenged by the COVID-19 pandemic. We therefore conducted a descriptive, cross-sectional study to assess the situation. An online survey was distributed to all hospitals with AIPUs in Spain and made accessible for 28 days. Two scientific coordinators were appointed to supervise the scientific and methodological aspects of the study. The most relevant findings include reductions in numbers of beds and staff, insufficient material resources, changes in action protocols and in admission processes, and limitations in routine therapies, such as group and occupational therapy, psychotherapy and psychoeducational programmes. The possibility of performing ECT was also seriously curtailed. This is the first study to evaluate the impact of the first wave of the COVID-19 pandemic on AIPUs. These data may help improve the quality of care of patients with mental illness in the future.
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http://dx.doi.org/10.1016/j.psychres.2021.114136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310392PMC
October 2021

Performance of a measure to assess distress in bipolar disorder.

Rev Psiquiatr Salud Ment (Engl Ed) 2020 Jul 15. Epub 2020 Jul 15.

Service of Psychiatry, University Hospital Ramón y Cajal, CIBERSAM, IRYCIS, University of Alcala, Madrid, Spain.

Introduction: Bipolar disorder is a condition that causes distress even for euthymic patients, having an impact on functional capabilities and quality of life. Personal and social variables are potential sources of distress. Yet, there is a lack of measures to identify specific distress in bipolar disorder. This study describes the development and evaluation of a brief measure for assessing distress in patients with bipolar disorder. We also identify associations with related constructs such as functioning, stigma, and personal beliefs regarding mental illness.

Material And Methods: We used a sample of 101 euthymic bipolar outpatients. Psychological assessment consisted of the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAM-D) to establish euthymia. Distress was assessed with Distress on Bipolar Patients-Short (DISBIP-S); associated variables were assessed with the Functioning Assessment Short Scale (FAST), the Internalized Stigma of Mental Illness (ISMI), and the Personal Beliefs about Illness Questionnaire (PBIQ).

Results: The DISBIP-S has strong internal consistency (Cronbach's alpha=0.90), and medium-high correlation coefficients with the time since last relapse (r=-0.401), predominant polarity (r=0.309), HDRS (r=-0.644), FAST (r=0.453), ISMI (r=0.789), and PBIQ (r=-0.796). Taken together, the scores on the ISMI, and PBIQ and the time since last relapse together explain 69.2% of the variability in distress.

Conclusions: The DISBIP-S can be used as a first step to develop interventions aimed at dealing with problematic personal beliefs and interpersonal sources of distress. Reducing distress experienced by bipolar disorder patients could help improve their quality of life and daily functioning.
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http://dx.doi.org/10.1016/j.rpsm.2020.05.007DOI Listing
July 2020

Understanding social withdrawal in euthymic bipolar patients: The role of stigma.

Psychiatry Res 2020 02 7;284:112753. Epub 2020 Jan 7.

Service of Psychiatry. University Hospital Ramón y Cajal. CIBERSAM, IRYCIS. University of Alcala. Madrid, Spain.

Social withdrawal acts as a risk factor in mental health, disturbing clinical management and quality of life in euthymic bipolar patients. However, no previous study has analyzed what variables might predict it. We conducted a cross-sectional study in which 49 euthymic bipolar patients were assessed. The analysis showed that taken together, stereotype endorsement, discrimination experience and control over illness as measured by the ISMI, together explained 80.4% of the variability in social withdrawal. In conclusion, an early assessment of self-stigma and perception of control over illness would help euthymic patients to improve their social situation, reducing social withdrawal.
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http://dx.doi.org/10.1016/j.psychres.2020.112753DOI Listing
February 2020

Expert consensus on information sheet proposals for patients under treatment with lithium.

Rev Psiquiatr Salud Ment (Engl Ed) 2021 Jan-Mar;14(1):27-39. Epub 2019 Dec 25.

Servicio de Psiquiatría, Hospital Universitari de Bellvitge-ICS, IDIBELL, CIBERSAM, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.

Introduction: Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium.

Material And Methods: A modified Delphi method in two rounds was used. The Scientific Committee-made up by nine psychiatrists-created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3].

Results: A high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists.

Conclusions: This study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.
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http://dx.doi.org/10.1016/j.rpsm.2019.11.001DOI Listing
December 2019

Psoas Abscess as a Differential Diagnosis of Neuroleptic Malignant Syndrome in a Schizoaffective Disorder Patient With Catatonic Symptoms.

Prim Care Companion CNS Disord 2018 Nov 1;20(6). Epub 2018 Nov 1.

Psychiatry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.

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http://dx.doi.org/10.4088/PCC.18l02289DOI Listing
November 2018

Management of asenapine treatment in clinical practice: Recommendations from a panel of experts.

Rev Psiquiatr Salud Ment (Engl Ed) 2019 Jul - Sep;12(3):163-169. Epub 2018 Jun 28.

Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España.

Introduction: The choice of an antipsychotic should be based on bipolar disorder (BD) symptoms and the particular needs of each patient, as well as the adverse events potentially associated with treatment. Asenapine is an atypical antipsychotic indicated for the management of type-I BD, with distinct pharmacokinetic and receptor affinity profiles.

Material And Methods: Recommendations document developed by a panel of experts with extensive experience in the use of asenapine in psychiatric care, including emergency department, hospital, and outpatient care. Recommendations were discussed in a single meeting and were based on both the clinical experience of the panel of experts and the empirical evidence provided in the scientific literature.

Results: The present document describes the patient profile that best suits the pharmacodynamic characteristics of asenapine, as well as the advantages and limitations of the pharmacokinetics associated with the sublingual route. The document also addresses the main safety issues of asenapine and suggests interventions aimed at mitigating the most frequent adverse reactions associated with asenapine treatment. Finally, the article provides advice on dosing and overall management of asenapine treatment, including the combination with other treatments and the switch from other antipsychotics to asenapine.

Conclusions: In this recommendations document, we provide clinicians with guidance on the use of asenapine in real-life practice, including the identification of patients who best suit the characteristics of this antipsychotic.
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http://dx.doi.org/10.1016/j.rpsm.2018.03.007DOI Listing
May 2020

A Review of Asenapine in the Treatment of Bipolar Disorder.

Clin Drug Investig 2018 Feb;38(2):87-99

Psychiatry Section of the Ramón y Cajal University Hospital, IRYCIS, CIBERSAM, University of Alcalá, Ctra. Colmenar Viejo, km. 9,100, 28034, Madrid, Spain.

Bipolar disorder places a significant burden on the affected individuals, their family, healthcare systems and the overall economy. More treatment options are needed, especially those with better efficacy and tolerability. Asenapine is a second-generation antipsychotic approved in Europe (brand name Sycrest) for the treatment of moderate-to-severe manic episodes associated with bipolar I disorder in adults, and in the US (brand name Saphris) for the treatment of manic or mixed episodes of bipolar I disorder in adults and children aged 10-17 years. It is the antagonistic activity at the D receptor that is likely responsible for the antimanic properties of asenapine. Clinical trials have demonstrated that asenapine mono- and add-on therapy is effective in the short- and long-term treatment of mania associated with bipolar I disorder in adult and paediatric patients. In addition, post hoc and pooled data analyses have shown that asenapine is effective in reducing clinically significant depressive symptoms in patients with bipolar I disorder. The most common adverse events associated with asenapine are somnolence, dizziness, extrapyramidal symptoms, increased bodyweight and oral hypoesthesia. However, the incidence of these events, particularly weight gain, is generally lower than with olanzapine. In one study, asenapine has been shown to improve health-related quality of life. Economic analyses indicate that the use of asenapine can, over time, lead to a reduction in the costs of treatment.
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http://dx.doi.org/10.1007/s40261-017-0592-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807471PMC
February 2018

[Acute lithium poisoning: epidemiology, clinical characteristics, and treatment].

Emergencias 2017 02;29(1):46-48

Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, UAH, REDinREN Madrid, España.

Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.
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February 2017

Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.

Eur Neuropsychopharmacol 2016 10 24;26(10):1562-78. Epub 2016 Aug 24.

Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Electronic address:

Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.
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http://dx.doi.org/10.1016/j.euroneuro.2016.08.008DOI Listing
October 2016

Cataplexy Possibly Associated With Lamotrigine.

J Clin Psychopharmacol 2016 Aug;36(4):400-2

Section of Neurology Hospital Universitario del Sureste Madrid, Spain Psychiatry Service Hospital Universitario Ramón y Cajal Universidad de Alcalá Madrid, Spain Section of Neurology Hospital Universitario del Sureste Madrid, Spain Section of Neurology Hospital Universitario del Sureste Madrid, Spain

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http://dx.doi.org/10.1097/JCP.0000000000000532DOI Listing
August 2016

Robust and sustained effect of ketamine infusions coadministered with conventional antidepressants in a patient with refractory major depression.

Case Rep Psychiatry 2015 4;2015:815673. Epub 2015 Mar 4.

Psychiatry Service, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, CIBERSAM, IRYCIS, Carretera Colmenar km. 9.1, 28034 Madrid, Spain.

Antidepressant treatments show low capacity to achieve full clinical remissions. Electroconvulsive therapy is an alternative treatment which has been shown to be more effective but it is not well tolerated and there are concerns regarding its safety. We present the case of a patient with resistant depression and modest and transient response to ECT and who showed a robust and maintained response after six i.v. ketamine (0.5 mg/kg) infusions without withdrawing her antidepressant regimen. Ketamine was very well tolerated. This case illustrates the potential role of ketamine as a booster to standard antidepressants.
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http://dx.doi.org/10.1155/2015/815673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364451PMC
March 2015

Deficits in recognition, identification, and discrimination of facial emotions in patients with bipolar disorder.

Braz J Psychiatry 2013 Oct-Dec;35(4):435-8. Epub 2013 Dec 23.

Hospital del Sureste, ArgandaMadrid, Spain.

Objective: To analyze the recognition, identification, and discrimination of facial emotions in a sample of outpatients with bipolar disorder (BD).

Methods: Forty-four outpatients with diagnosis of BD and 48 matched control subjects were selected. Both groups were assessed with tests for recognition (Emotion Recognition-40 - ER40), identification (Facial Emotion Identification Test - FEIT), and discrimination (Facial Emotion Discrimination Test - FEDT) of facial emotions, as well as a theory of mind (ToM) verbal test (Hinting Task). Differences between groups were analyzed, controlling the influence of mild depressive and manic symptoms.

Results: Patients with BD scored significantly lower than controls on recognition (ER40), identification (FEIT), and discrimination (FEDT) of emotions. Regarding the verbal measure of ToM, a lower score was also observed in patients compared to controls. Patients with mild syndromal depressive symptoms obtained outcomes similar to patients in euthymia. A significant correlation between FEDT scores and global functioning (measured by the Functioning Assessment Short Test, FAST) was found.

Conclusions: These results suggest that, even in euthymia, patients with BD experience deficits in recognition, identification, and discrimination of facial emotions, with potential functional implications.
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http://dx.doi.org/10.1590/1516-4446-2013-1086DOI Listing
July 2014

Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning.

Patient Prefer Adherence 2013 18;7:89-94. Epub 2013 Jan 18.

Department of Psychiatry, Hospital Universitario del Sureste.

Background: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes.

Methods: A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication.

Results: Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively).

Conclusion: A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.
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http://dx.doi.org/10.2147/PPA.S39290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553333PMC
February 2013

A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia.

Psychiatry Res 2012 Dec 17;200(2-3):89-95. Epub 2012 Aug 17.

Department of Psychiatry, Hospital Universitario del Sureste, CIBERSAM, Madrid, Spain.

Background: The aim of this study was to assess the impact of a short message service (SMS)-based strategy on adherence to antipsychotic treatment.

Methods: A multicentre, randomised, open-label, controlled, 6-month study with clinically stabilised outpatients with schizophrenia was conducted. The patients assigned to the intervention received daily SMS reminders to take their medication for 3 months. Self-reported medication adherence was determined using the Morisky Green Adherence Questionnaire (MAQ). Secondary outcomes were severity of illness, attitude towards medication, insight into illness and health-related quality of life.

Results: A total of 254 patients were analysed. A significantly greater improvement in adherence was observed among patients receiving SMS text messages compared with the control group. The mean change in MAQ total score from baseline to month 3 was -1.0 (95% confidence interval (CI) -1.02, -0.98) and -0.7 (95%CI -0.72, -0.68), respectively (P=0.02). Greater improvement in negative, cognitive and global clinical symptoms at month 3 was observed. Attitude towards medication also significantly improved across the study in the intervention group versus the controls.

Conclusions: An SMS-based intervention seems feasible and acceptable for enhancing medication adherence. Further studies are needed to confirm whether this kind of intervention could be a complementary strategy to optimise adherence in schizophrenia.
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http://dx.doi.org/10.1016/j.psychres.2012.07.034DOI Listing
December 2012

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

Rev Psiquiatr Salud Ment 2012 Jul-Sep;5(3):183-90. Epub 2011 Jun 30.

Servicio de Psiquiatría, Hospital Universitario La Princesa, Madrid, España.

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 moderate to maximum disability compared to a mild to no disability was considered a dependent variable.

Results: A moderate to maximum global disability was present in 43.6% of the sample. By areas, occupational functioning was the area most frequently affected, and personal care the least affected. The only variables which were associated with disability were the presence of medical comorbidity (P = .01), increased age (P = .005) global clinical severity (P = .0001) and in the depressive pole (P = .03). There was no relationship between clinical subtype, duration of the disease, number of previous episodes, number of hospitalisations, or other clinical variables and the degree of disability.

Conclusions: These data underline the need to establish specific therapeutic strategies in the approach to depressive symptoms and medical comorbidity, with the aim of minimising the disability in elderly bipolar patients. Given the lack of current data, new studies are needed with larger samples and control groups.
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http://dx.doi.org/10.1016/j.rpsm.2011.04.004DOI Listing
October 2013

[Opinions and beliefs of the Spanish population on serious mental illnesses (schizophrenia and bipolar disorder)].

Rev Psiquiatr Salud Ment 2012 Apr-Jun;5(2):98-106. Epub 2012 Mar 2.

Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España.

Introduction: To find out the opinions, beliefs and concerns of the Spanish population on serious mental diseases: schizophrenia and bipolar disorder.

Material And Methods: An ad-hoc questionnaire was constructed for the survey. A panel of seven experts extracted the contents. The Societies that involved were: ASAENES, ABBA, FEAFES-ANDALUCÍA, AMAFE, and AFAEM-5 advocacy societies were also involved. The questionnaire contained 12 questions about: knowledge of the diseases, diagnostic difficulties, symptoms, triggering factors, interference, treatments and effectiveness, beliefs and concerns. The questionnaire was administered during the IV Campaign of Social Awareness about Serious Mental Illness (Madrid and Seville, September-October 2009).

Results: A total of 5,473 questionnaires were collected, 55.8% in Seville. The majority (66.2%) of the sample were women, and the mean age was 35 years (SD=14.5). Both illnesses were known by 82% of the population, but 51% did not known any symptom of schizophrenia. Other notable opinions were; they are difficult to diagnose (59%), they were not diagnosed due to social rejection (27%), interfered quite a lot with daily life (49%) or prevented a normal life (42%), the effective treatments are psychological (72%). Beliefs were: social rejection, family burden, and patient suffering. Concerns included: dangerousness, social rejection, lack of information, and scarcity of resources.

Conclusions: There is a lack of knowledge of the symptoms. The majority do not know about specific symptoms and highlight the negative ones. Combined pharmacological-psychological treatment is believed to be most effective. Social stigma and family and personal burden are concerns.
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http://dx.doi.org/10.1016/j.rpsm.2012.01.002DOI Listing
October 2013

Impulsivity differences in recreational cannabis users and binge drinkers in a university population.

Drug Alcohol Depend 2012 Aug 15;124(3):355-62. Epub 2012 Mar 15.

Dept. Neurociencia y Ciencias de la Salud, Universidad de Almería, 04120 Almería, Spain.

Background: Recreational cannabis use and alcohol binge drinking are the most common drug consumption patterns in young adults. Impulsivity and several psychopathological signs are increased in chronic drug users, but the implications of recreational use are still poorly understood.

Methods: We evaluated impulsivity, sensation-seeking traits, impulsive decision-making, inhibitory control and possible symptoms of depression, anxiety and psychosis in three groups of young university adults: recreational cannabis users (N=20), alcohol binge drinkers (N=22) and non-drug users (N=26).

Results: The cannabis and binge drinking groups had increased scores for impulsivity and sensation-seeking traits. Both groups also exhibited increased impulsive decision-making on the two-choice task and the Iowa gambling task; however, only the cannabis group was significantly different from the non-drug group regarding inhibitory control (go/no-go and stop tasks). The cannabis and binge drinking groups did not show differences in the psychopathological symptoms evaluated.

Conclusions: Our observations of this population of non-dependent drug users are consistent with the increased impulsivity traits and behaviors that have been described previously in chronic drug abusers. In this study, compared to no drug use, the recreational use of cannabis was associated with a major dysfunction of the different facets of impulsive behaviors. However, alcohol binge drinking was related only to impulsive decision-making. These results suggest that impulsivity traits and behaviors are present not only in chronic drug abusers but also in recreational drug users. Future work should continue to investigate the long-term effects of these common consumption patterns on various impulsive behaviors and psychopathological symptoms.
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http://dx.doi.org/10.1016/j.drugalcdep.2012.02.011DOI Listing
August 2012

Social cognition and global functioning in bipolar disorder.

J Nerv Ment Dis 2012 Feb;200(2):135-41

Principe de Asturias University Hospital, University of Alcala, Madrid, Spain.

The purpose of this study was to assess the role of social cognition, together with other relevant clinical variables and measures of general cognition, in the global functioning of euthymic bipolar patients. Thirty-nine euthymic outpatients fulfilling DSM-IV-TR criteria for bipolar disorder type I or II were recruited and were divided in two groups: high (n = 19) and low (n = 20) global functioning. Both groups' performance was compared in verbal and nonverbal social cognition (Faux pas test and Facial Emotion Recognition test), sustained attention and executive function. The low-functioning group showed a significant impairment in both verbal and nonverbal measurements of social cognition compared with the high-functioning group. Globally, both bipolar groups showed a significant impairment in facial emotion recognition compared with a similar sample of healthy volunteers. Social cognition may play a significant role in the clinical-functional gap of bipolar patients.
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http://dx.doi.org/10.1097/NMD.0b013e3182438eaeDOI Listing
February 2012

Practical guidance for prescribing ziprasidone in acute manic or mixed episodes of bipolar I disorder.

Expert Opin Pharmacother 2011 Oct 30;12(14):2245-63. Epub 2011 Jul 30.

Hospital Dr Rodríguez Lafora, Department of Psychiatry, Cra de Colmenar, Viejo Km 13.8, 28049 Madrid, Spain.

Introduction: Limited information is available on the clinical issues and strategies for optimal clinical usage of ziprasidone in the treatment of adult patients with acute manic or mixed episodes of bipolar disorder.

Areas Covered: To address those issues, information from clinical trials addressing the efficacy and tolerability of ziprasidone in acute bipolar mania was reviewed and supplemented with the input from an expert faculty of European psychiatrists with extensive experience in treating patients with bipolar mania, both in clinical trials and in everyday clinical practice.

Expert Opinion: Effective use of oral ziprasidone in the treatment of acute bipolar mania requires rapid titration to doses in the range 120 - 160 mg/day and administration with meals of ≥ 500 kcal. As in the clinical trials, temporary short-term use of benzodiazepines (in particular lorazepam for agitation or temazepam for insomnia) could be advisable. Available evidence from randomized clinical trials in combination with clinical experience supports the use of ziprasidone as one of the first-line effective and safe treatments for acute manic or mixed episodes associated with bipolar I disorder.
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http://dx.doi.org/10.1517/14656566.2011.605787DOI Listing
October 2011

Factors associated with the effectiveness of a telephone-based nursing strategy for enhancing medication adherence in schizophrenia.

Clin Pract Epidemiol Ment Health 2011 9;7:117-9. Epub 2011 Jun 9.

Department of Psychiatry, Hospital del Sureste, Arganda del Rey, Madrid, Spain.

A post hoc analysis was made to identify factors associated with success following a 4-month telephone-based strategy for enhancing adherence to antipsychotic treatment in schizophrenia. A total of 928 stable outpatients were randomized to receive a monthly telephone call provided by a nurse or routine clinical care. Logistic regression with a backward stepwise procedure was used. A higher percentage of patients in the intervention group (25.7%, n=109) improved adherence at the end of the study compared with the control group (16.8%, n=74) (p=0.0013). The intervention was significantly associated with adherence improvement in those patients with a previous negative attitude towards medication (OR=4.7, 95% CI =2.4-9.0, p<0.0001). A slight concordance was obtained between adherence improvement and improvement in patient perception of treatment (kappa=0.21; 95% CI=0.15-0.27). The identification of factors related to the effectiveness of a specific intervention would offer clinicians the opportunity to more adequately select patients who are eligible for such intervention.
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http://dx.doi.org/10.2174/1745017901107010117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134976PMC
November 2011

Switching among antipsychotics in everyday clinical practice: focus on ziprasidone.

Postgrad Med 2011 Jan;123(1):135-59

Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy.

Objectives: This article addresses points to consider when switching patients to the second-generation antipsychotic (SGA), ziprasidone, in everyday clinical practice: 1) the pharmacologic properties of the pre-switch antipsychotic and of ziprasidone; 2) switch and dosing strategies to ensure maintenance or attainment of efficacy; 3) recognition and management of possible rebound effects of the pre-switch medication discontinuation; 4) recognition and management of potential side effects of ziprasidone; and 5) education and support for patients/caregivers concerning correct ziprasidone administration.

Methods: A Medline search (up to July 7, 2010) identified studies in which adult patients with schizophrenia were switched to ziprasidone from another antipsychotic. In addition, based on their extensive clinical experience, an expert faculty of European psychiatrists provided advice on identifying patients who may be appropriate candidates for switching to ziprasidone, and on establishing optimal strategies for switching to ziprasidone in everyday clinical practice.

Results: Data from 10 studies, in which 1395 patients were switched to ziprasidone, showed that switching from first-generation antipsychotics (FGAs) or SGAs generally resulted in maintenance or improvement of efficacy across all studied symptom domains, improvements in tolerability, and acute and long-term benefits regarding cardiometabolic parameters, including body weight. Maintenance of efficacy is most likely to be achieved using a plateau cross-titration strategy, with a rapid uptitration of ziprasidone to a dose range of 60 to 80 mg administered twice daily with food. Temporary coadministration of benzodiazepines, anticholinergics, or beta-blockers should be considered for the management of potential rebound effects.

Conclusion: Optimal switching of patients with schizophrenia from FGAs or SGAs to ziprasidone requires careful attention to differences in the pharmacological profiles of the pre-switch medication and of ziprasidone, which may impact efficacy and tolerability. Good communication between the clinician and patient/caregiver about the goals of switching, the importance of adherence to the chosen switch strategy, and the correct administration of ziprasidone are essential.
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http://dx.doi.org/10.3810/pgm.2011.01.2255DOI Listing
January 2011

Telephone-based nursing strategy to improve adherence to antipsychotic treatment in schizophrenia: A controlled trial.

Int J Psychiatry Clin Pract 2010 Nov 14;14(4):274-81. Epub 2010 Sep 14.

Department of Psychiatry, Hospital del Sureste, Arganda del Rey, Madrid, Spain.

Abstract Objective. Adherence to prescribed antipsychotic medication is a major factor in achieving optimal long-term clinical outcomes. The aim of this study was to evaluate the impact of a telephone-based strategy provided by a nurse on adherence to antipsychotic treatment among patients with schizophrenia. Methods. A total of 928 clinically stable outpatients with schizophrenia were randomized to receive a monthly telephone call by a nurse or routine clinical care. Telephone calls were performed at weeks 4, 8, and 12, consisting of a standardized interview to detect and assess therapeutic adherence and subjective attitude towards medication. Patients were followed for 4 months. A cut-point of ≥ 60% of prescribed dose was used to classify patients as being adherent. Results. At week 16, a significantly higher percentage of patients who received a telephone-based follow-up (96.7%, n = 410) were classified as adherent compared to the control group (91.2%, n = 402) (P = 0.0007). Patients in the intervention group were significantly more likely to be adherent than control group (adjusted OR = 3.3 95% CI 1.6-6.6, P = 0.0001). Conclusions. Telephone-based nursing strategy showed a significant improvement in adherence to antipsychotic drugs. Further studies are necessary to confirm if this kind of intervention could be a complementary strategy to optimize adherence in patients with schizophrenia.
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http://dx.doi.org/10.3109/13651501.2010.505343DOI Listing
November 2010

Strategies for successful clinical management of schizophrenia with ziprasidone.

Expert Opin Pharmacother 2010 Sep;11(13):2199-220

University of Siena School of Medicine, Department of Neuroscience, Viale Bracci 1, 53100 Siena, Italy.

Importance Of The Field: This review addresses practical clinical issues related to the use of ziprasidone in the treatment of schizophrenia using information from clinical trials, unpublished data, manufacturer's information, and input from an expert faculty of European psychiatrists with extensive experience of the use of ziprasidone, both in clinical trials and in everyday clinical practice.

Areas Covered In This Review: A Medline search of published data (1998 - 2010) was carried out, together with a review of unpublished data and manufacturer's information. In addition, expert opinion was sought from psychiatrists with extensive experience of ziprasidone in the treatment of schizophrenia in clinical settings across Europe.

What The Reader Will Gain: This review has been undertaken to determine how the information from clinical trials can be optimally translated into 'real-life' practice and to establish how a decade of experience with ziprasidone in clinical practice can inform its optimal use to maximize effectiveness and minimize side effects.

Take Home Message: Effective use of ziprasidone in everyday clinical practice usually requires rapid titration to doses in the range of 120 - 160 mg/day and administration with proper meals, thereby achieving the high levels of schizophrenia symptom control reported in clinical trials. Additional guidance is provided about effective management of side effects, and appropriate coadministration of benzodiazepines and other agents, to achieve desired outcomes.
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http://dx.doi.org/10.1517/14656566.2010.507630DOI Listing
September 2010

Unexplained liver laceration after metastasis radiofrequency ablation.

World J Gastroenterol 2009 Oct;15(40):5103-5

Medical Oncology Service, Clinical University Hospital of Valladolid, C/Ramon y Cajal 3, Valladolid 47005, Spain.

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the first. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768892PMC
http://dx.doi.org/10.3748/wjg.15.5103DOI Listing
October 2009

Unexplained liver laceration after metastasis radiofrequency ablation.

World J Gastroenterol 2009 Oct;15(40):5103-5

Medical Oncology Service, Clinical University Hospital of Valladolid, C/Ramon y Cajal 3, Valladolid 47005, Spain.

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the first. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768892PMC
http://dx.doi.org/10.3748/wjg.15.5103DOI Listing
October 2009

Theory of mind deficit in bipolar disorder: is it related to a previous history of psychotic symptoms?

Psychiatry Res 2008 Dec 8;161(3):309-17. Epub 2008 Nov 8.

Psychiatry Department, Principe de Asturias University Hospital, University of Alcalá, Madrid, Spain.

It has been hypothesized that a Theory of Mind (ToM) deficit could be a vulnerability marker for psychosis. Recent studies, however, have shown ToM deficits in affective relapses of bipolar disorder as well as in the euthymic phase. This study analyzes the relationship between ToM and a previous history of psychotic symptoms in bipolar disorder. ToM, sustained attention and executive functions were analyzed in 75 bipolar euthymic patients with three or more previous relapses (42 of them had a history of psychotic symptoms and 33 did not) and 48 healthy subjects. ToM was assessed with the Advanced Test by Happé. ToM performance was similar in bipolar patients with or without a history of psychotic symptoms, and in both cases it was significantly reduced as compared with the healthy control group. Similarly, both bipolar groups showed impaired sustained attention and executive functions. This general cognitive deficit partially explains the differences obtained in ToM. The ToM instrument used shows low sensitivity for assessing ToM in bipolar patients and it could partially reflect general cognitive functioning rather than a specific deficit in psychosis. ToM deficit is not a trait marker for psychosis, given that it is present in bipolar disorder regardless of a previous history of psychotic symptoms.
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http://dx.doi.org/10.1016/j.psychres.2007.08.009DOI Listing
December 2008

Cardiovascular risk in patients with bipolar disorder.

J Affect Disord 2009 Jun 26;115(3):302-8. Epub 2008 Oct 26.

Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.

Background: To date, little is known about cardiovascular risk (CVR) in terms of coronary heart disease (CHD) and cardiovascular mortality risk (CMR) in patients with bipolar disorder. This study provides data on the overall risk of any fatal or non-fatal coronary heart disease (CHD) and on the cardiovascular mortality risk (CMR) within 10 years in these patients.

Methods: Naturalistic, cross-sectional, multicenter study conducted in Spain. Patients were evaluated for cardiovascular risk using the Framinghan function (CHD) and the Systematic COronary Risk Evaluation (SCORE) function (CMR).

Results: The mean age was 46.6 years and 49% were male. Forty-six percent were in remission. Ten-year CHD risk was 7.6% (males 10.2% versus females 4.7%, p<0.001) and 10-year CMR was 1.8% (males 2.2% versus females 1.3%, p 0.161). Fifty-one percent smoked and 34% was obese. Metabolic syndrome was present in 22.4% of the sample (35.6% according to AHA and NHLBI criteria). Cardiovascular risk significantly increases with age, body mass index and presence of metabolic syndrome.

Limitations: The cross-sectional design of the study.

Conclusions: Cardiovascular risk is high in patients with bipolar disorder. It is associated with age, body mass index and metabolic syndrome. Psychiatrists should be aware of this issue and carefully monitor these patients for cardiovascular risk factors, including cigarette smoking, as part of the standard of care when treating them.
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http://dx.doi.org/10.1016/j.jad.2008.09.008DOI Listing
June 2009

Usefulness of the Spanish version of the mood disorder questionnaire for screening bipolar disorder in routine clinical practice in outpatients with major depression.

Clin Pract Epidemiol Ment Health 2008 May 22;4:14. Epub 2008 May 22.

Department of Psychiatry, La Paz University Hospital, Madrid, Spain.

Background: According to some studies, almost 40% of depressive patients - half of them previously undetected - are diagnosed of bipolar II disorder when systematically assessed for hypomania. Thus, instruments for bipolar disorder screening are needed. The Mood Disorder Questionnaire (MDQ) is a self-reported questionnaire validated in Spanish in stable patients with a previously known diagnosis. The purpose of this study is to evaluate in the daily clinical practice the usefulness of the Spanish version of the MDQ in depressive patients.

Methods: Patients (n = 87) meeting DSM-IV-TR criteria for a major depressive episode, not previously known as bipolar were included. The affective module of the Structured Clinical Interview (SCID) was used as gold standard.

Results: MDQ screened 24.1% of depressive patients as bipolar, vs. 12.6% according to SCID. For a cut-off point score of 7 positive answers, sensitivity was 72.7% (95% CI = 63.3 - 82.1) and specificity 82.9% (95% CI = 74.9-90.9). Likelihood ratio of positive and negative tests were 4,252 y 0,329 respectively.

Limitations: The small sample size reduced the power of the study to 62%.

Conclusion: Sensitivity and specificity of the MDQ were high for screening bipolar disorder in patients with major depression, and similar to the figures obtained in stable patients. This study confirms that MDQ is a useful instrument in the daily clinical assessment of depressive patients.
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http://dx.doi.org/10.1186/1745-0179-4-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426693PMC
May 2008

Improvement in antipsychotic-related metabolic disturbances in patients with schizophrenia switched to ziprasidone.

Prog Neuropsychopharmacol Biol Psychiatry 2007 Mar 28;31(2):383-8. Epub 2006 Nov 28.

CSM Fuenlabrada, Avenida de la Comunidad de Madrid 10, Fuenlabrada 28945, Madrid, Spain.

Purpose: This study evaluated changes in weight, glucose and lipid metabolism in patients with schizophrenia and antipsychotic-related metabolic disturbances who were switched to ziprasidone.

Methods: Eighty-four outpatients with schizophrenia or schizoaffective disorder also having glucose intolerance, diabetes, dyslipidemia or weight gain related to their antipsychotic treatment were switched to ziprasidone. Clinical status was assessed using the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I) scales and the Positive and Negative Syndrome Scale (PANSS). Assessment scales, weight, glucose and lipids were measured at baseline and at three and six months of ziprasidone treatment.

Results: Significant baseline to endpoint reductions were seen in mean weight (-5.1 kg), Body Mass Index (BMI; -1.6 kg/m(2)), serum glucose (-14.0 mg/dL), total cholesterol (-24.1 mg/dL), and triglyceride leves (-46.2 mg/dL). Mean PANSS total score improved 13.9% after 6 months of treatment with ziprasidone. A proportion (34.3%) of patients were classified as much improved in the CGI-I.

Conclusions: Switching patients with schizophrenia to ziprasidone when metabolic disturbances are detected may improve these side effects and result in an improved overall outcome.
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http://dx.doi.org/10.1016/j.pnpbp.2006.10.002DOI Listing
March 2007
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