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The aim of this study was to examine the temperament and character profile as risk factors of interferon and ribavirin (IFN+RBV) induced psychopathology in chronic hepatitis C patients. According to the Cloninger's biosocial model (TCI), the temperament dimension harm avoidance (HA) is suggested to indicate central serotonergic turnover, which is further correlated with depressive/anxiety states.
198 patients with chronic hepatitis C in treatment with IFN+RBV were evaluated at baseline and 4, 12 and 24 weeks of treatment. All subjects were assessed by the Patient Health Questionnaire (PHQ), the Hospital Scale of Anxiety and Depression (HADS) and the Temperament and Character Inventory-revised (TCI-R) questionnaire (at basal level).
At baseline, 32 patients had a psychiatric syndrome (16.1%). During the first six months of IFN+RBV treatment the incidence of depression/anxiety syndromes was 37.9% (n=63/166). The personality factors associated (p<0.001, corrected) were: HA dimension; fatigability subscale (HA4), anticipatory worry subscale (HA1); self-directedness dimension (SD); congruent subscale (SD5); and; social acceptance subscale (C1). By logistic regression analysis the independent variables that most predict the induced cases (PHQ+) (dependent variable) were: previous history of mood disorder (p<0.001; Exp(b)=5.655), and both HA4 (p<0.001; Exp(b)=1,104) and C1 (p<0.001; Exp(b)=0.845) subscales.
The assessment of personality traits (HA, C) and previous history of psychiatric disorders before start the IFN+RBV treatment in chronic hepatitis C patients might identify the patients at risk of induced depression/anxiety disorders during the treatment.
This study has been done in part with grants: Instituto-Carlos III (G03/02) (Red-Hepatología) and (GO3/184) (Red-Genotipación/Psiquiatría Genética).
The hepatitis C virus infection (HVC) represents a public health problem that affects the 3% of world population. The currently recommended treatment is Pegylated Interferon (PegIFN) alpha and Ribavirin (RBV) during 24 or 48 weeks. This treatment has been associated with high rates of neuropsychiatric side effects, mainly depression. Recent studies have documented impairment in health related quality of life (SF-36) in these patients.
To study the induced depression and quality of life of chronic HVC patients under antiviral treatment.
Three hundred seventeen consecutive HCV patients, who received PegIFN alpha and RBV, were assessed using the SCID interview for DSM-IV. Moreover, the PHQ, the HADS and the SF-36 were administered at baseline, 4, 12, 24, and/or 48 weeks of treatment.
Two hundred twenty-four (64.7%) of patients were men, the mean (SD) age was 43.6 (10.6), and 130 (40.1%) had history of mood disorder. One-hundred eleven (41%) of the sample had a depressive disorder during the treatment. There was a significant difference in the total SF-36 score and in all subscales (p < 0.001). HADS subscale of depression was highly correlated with SF-36 total score (p < 0.001).
During the antiviral treatment, HVC patients had a higher incidence of induced depression. Both physical and mental component scores of SF-36 in induced depressed patients were significantly worse.
This study has been supported in part by Spanish grants: FIS E08/00268, Dra. Martín-Santos, and Dr. Solà.
Chronic hepatitis C infection (CHC) represents a public health problem that affects around 3% of population worldwide. Pegylated Interferon-alpha (PegIFN-α) and Ribavirin (RBV) is the recommended treatment reaching about 40–80% of sustained virological response. However, a common treatment side-effect is induced-depression that impairs patient's quality of life and treatment adherence (1,2). This paper showed polymorphisms in HTR1A, NCR1, TPH2 genes as predictive variables of IFN-induced depression.
396 consecutive, euthymic, CHC outpatients treated with PegIFN-α/RBV were included. Patients were assessed at baseline, 4, 12, 24 and 48 weeks of treatment using PHQ and MINI-DSM-IV-R interview to diagnose depression. Survival analysis was performed. in the univariated analysis functions were compared using logrank test. Significative variables (0.1 level) were extracted for the multivariated model, using a Weibull regression model.
The incidence of induced-depression along the treatment was 39.4%. Polimorphisms on HTR1A (P = 0.0104), TPH2 (P = 0.0231) and NRC1 (P = 0.0702) genes predicted IFN-induced depression.
Genes related with serotonine and inflamation system may play an important role in the pathogenesis of IFN-induced depression. Knowledge of predictive variables for IFN-induced depression may help to better manage patients at risk.
Long-acting injectable antipsychotics in early-onset schizophrenia improve treatment adherence, and this may lead to decreased rates of hospital admission, better rates of clinical remission and better psychosocial adjustment.
To compare clinical remission rates, number of hospital readmissions and personal and social functioning after two years between patients with early-onset schizophrenia (EOS;≤ 2 years), either in treatment with long-acting injectable risperidone (LAIR) or oral antipsychotics (OA).
This is a case-control study comparing patients with EOS who initiated LAIR between 2004–2008 (n = 26 cases) with a control group with EOS matched for age and sex (n = 26 controls) treated with OA. The PANSS was administered at baseline; after two years the PANSS, the Personal and Social Functioning Scale (PSP) and the Andreasen remission criteria were administered.
The PANSS score comparison at baseline showed no significant differences between LAIR and OA groups (79.9 vs. 88.5, respectively; CI 95%: −21.6, 4.3; p = 0.185). There were statistical significant differences after two years of treatment in the PANSS scores (47.7 vs. 66.2, respectively; CI 95%: −27.2, −9.8; p < 0.001), the PSP scores (72.4 vs. 59.7, respectively; CI 95%: 4.9, 20.7; p = 0.002) and the clinical remission rates (65.4% vs. 38.5, respectively; p = 0.05). Although no statistically significant, there were differences between hospital readmission rates (19,5% vs. 42.3%, respectively).
Despite case-control studies limitations, data suggest that treatment with LAIR instead of OA in EOS might improve clinical, remission and social functioning rates. This improved effectiveness might be due to a greater treatment adherence achieved with LAIR.
Involuntary admissions continue to be a controversial topic in psychiatry. However, it is well known that psychosocial rehabilitation treatment is more successful when the patient is involved in it improving awareness and adherence to treatment.
This study examined admissions patterns, including voluntary, involuntary, and partly voluntary admissions to a subacute psychiatric hospital.
This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Patients's basic sociodemographic and clinical data were collected and compiled in a database. Descriptive statistics were performed using SPSS Software.
A total of 88 patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Among 88 patients, 44 (50%) had voluntary admissions, 16 (18.2%) had involuntary admissions, 27 (30.7%) had partly voluntary admissions and just one patient (1.1%) had partly involuntary admissions. Seventy-one (80.1%) patients had voluntary admissions at discharge, and only one of them escape from hospital and did not finish the treatment.
In the short term involuntary hospitalization has benefits, however also can have adverse long-term consequences for the patient-therapist allegiance, breaking the psychotherapeutic relationship and making the patient abandon treatment. It's important to reassess the condition of admission and work with the patient the need to engage in treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Several studies report that Clozapine is more effective in reducing symptoms of schizophrenia, producing clinically meaningful improvements and postponing relapse than other antipsychotic strategies.
To analyze the prescription of Clozapine in a sample of 88 inpatients admitted to a subacute psychiatric hospitalization unit.
This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Data about socio-demographical status and clinical situation were obtained and compiled in a database. This study compares patients receiving clozapine treatment with those who receive other psychopharmacologic treatment. Statistics were performed using SPSS Software.
Eighty-eight patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Within the 51 patients with Schizophrenia o Schizoaffective Disorder, 16 of them (31.4%) received Clozapine. Comparing clozapine group vs non-clozapine group, there were no significant differences between the groups in terms of sex, civil state or working state. Instead, Clozapine group patients were older, had a major number of previous hospitalization admissions and had a larger trajectory of their disorder.
Patients requiring treatment with Clozapine had a major number of hospital admissions and had more often committed suicide attempts, suggesting a more severe course of the disorder. They were older than the non-clozapine group. Clozapine is delayed in its use among resistant-treatment patients. It is worth highlighting that only 16 cases of Schizophrenia inpatients received Clozapina. It could mean that Clozapine is underprescribed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.
To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.
A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12–26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.
Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR=2.26, 95% CI 1.60–3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR=2.21, 95% CI 1.21–4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.
Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
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