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Delgado-Parada E, Alonso-Sánchez M, Ayuso-Mateos JL, Robles-Camacho M, Izquierdo A. Liaison psychiatry before and after the COVID-19 pandemic. Psychiatry Res 2022; 314:114651. [PMID: 35640325 PMCID: PMC9124364 DOI: 10.1016/j.psychres.2022.114651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
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Affiliation(s)
- E Delgado-Parada
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain
| | - M Alonso-Sánchez
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain.
| | - J L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
| | - M Robles-Camacho
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain
| | - A Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
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Rodríguez-Gómez I, Sánchez-Martín C, García-García FJ, García-Esquinas E, Miret M, Vicente-Rodriguez G, Gusi N, Mañas A, Carnicero JA, Gonzalez-Gross M, Ayuso-Mateos JL, Rodríguez-Artalejo F, Rodríguez-Mañas L, Ara Royo I. The medium-term consequences of COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary, cardiovascular, and musculoskeletal-diseases, depression, and cancer. Epidemiol Health 2022; 44:e2022026. [PMID: 35209708 DOI: 10.4178/epih.e2022026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To assess the influence of different chronic diseases on lifestyle and health behaviours changes after COVID-19 lockdown in Spanish older people compared to people without these diseases and compare the differences in these changes between both periods. Methods 1092 participants (80.3±5.6y;66.5%women) from two Spanish cohorts were included. Telephone-based questionaries were used to evaluate health risk behaviours and lifestyle during lockdown and 7-months later. Self-reported physician-based diagnosis of chronic diseases was also reported. Cox-proportional models adjusted for main confounders were applied. Results Improvements concerning lifestyle were found in older people with chronic diseases, although they worsened the physical component (except cancer). When they were compared to those without these diseases, hypertension was associated with a lower frequency of increased alcohol consumption (Hazard ratio:0.73[95% confidence interval:0.55;0.99]). Pulmonary diseases were associated with a lower risk of both decreased sedentary time (0.58[0.39;0.86]) and worsening sleep quality (0.56[0.36;0.87]), while CVD was only associated with a lower frequency of decreased sedentary time (0.58[0.38;0.88]). Depression was linked to a higher risk of increasing diet quality (1.53[1.00;2.36]). Cancer was less likely to worsen sleep quality (0.44[0.22;0.89]), but more likely to worsen their social contact frequency (2.05[1.05;3.99]). No significant association related to musculoskeletal diseases. Conclusion Beneficial changes in health risk behaviours and lifestyle after the COVID-19 lockdown in older people with chronic diseases were found. Particularly, older people with hypertension, pulmonary disease and cancer showed beneficial changes after lockdown compared to their counterparts without diseases. Those with CVD and depression showed lifestyles that could involve a health risk.
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Affiliation(s)
| | | | | | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Korea
| | - Marta Miret
- Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Narcís Gusi
- Instituto Internacional de Investigación e Innovación en Envejecimiento, Universidad de Extremadura, Cáceres, Spain
| | - Asier Mañas
- Universidad de Castilla-La Mancha, Toledo, Spain
| | | | | | - José L Ayuso-Mateos
- Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid , Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Gabarrell-Pascuet A, Moneta MV, Ayuso-Mateos JL, Miret M, Lara E, Haro JM, Olaya B, Domènech-Abella J. The effect of loneliness and social support on the course of major depressive disorder among adults aged 50 years and older: A longitudinal study. Depress Anxiety 2022; 39:147-155. [PMID: 35029840 DOI: 10.1002/da.23236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Previous research indicates that social support, loneliness, and major depressive disorder (MDD) are interrelated. Little is known about the potential pathways among these factors, in particular in the case of adults aged 50 years and older and suffering from MDD. The objective was to investigate whether loneliness mediates the association between low social support and recurrent episodes of MDD. METHODS We used data from a cohort of the Spanish general population interviewed at three time-points over a 7-year period. We included 404 individuals aged 50+ suffering from MDD in the baseline assessment. A 12-month major depressive episode was assessed with the Composite International Diagnostic Interview (CIDI) at each interview. The University of California, Los Angeles Loneliness Scale was used to measure loneliness, whereas social support was assessed through the Oslo Social Support Scale. We tested cross-lagged and autoregressive longitudinal associations using structural equation modeling. RESULTS We identified two significant longitudinal mediation patterns: lower social support predicted higher subsequent levels of loneliness (Coef. = -0.16; p < .05), which in turn predicted an increase in MDD recurrence (Coef. = 0.05; p < .05). CONCLUSIONS Interventions focused on promoting social support among older adults suffering from MDD may decrease feelings of loneliness and prevent recurrent episodes of MDD.
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Affiliation(s)
- Aina Gabarrell-Pascuet
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - María V Moneta
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - José L Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elvira Lara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Josep M Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Domènech-Abella
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Sociology, Universitat de Barcelona, Barcelona, Spain
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Rodríguez-Gómez I, Sánchez-Martín C, García-García FJ, García-Esquinas E, Miret M, Jiménez-Pavón D, Guadalupe-Grau A, Mañas A, Carnicero JA, Casajus JA, Ayuso-Mateos JL, Rodríguez-Artalejo F, Rodríguez-Mañas L, Ara I. The Medium-Term Changes in Health-Related Behaviours among Spanish Older People Lifestyles during Covid-19 Lockdown. J Nutr Health Aging 2022; 26:485-494. [PMID: 35587761 PMCID: PMC9020156 DOI: 10.1007/s12603-022-1781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim was to evaluate general changes and investigate the association between diet quality, physical activity (PA), and sedentary time (ST) during COVID-19 lockdown and the subsequent 7-month changes in health-related behaviours and lifestyles in older people. PARTICIPANTS 1092 participants (67-97y) from two Spanish cohorts were included. DESIGN Telephone-based questionaries were used to evaluate health-related behaviours and lifestyle. Multinomial logistic regression analyses with diet quality, PA, and ST during lockdown as predictors for health-related behaviours changes post-lockdown were applied. RESULTS Diet quality, PA, and ST significantly improved post-lockdown, while physical component score of the SF-12 worsened. Participants with a low diet quality during lockdown had higher worsening of post-lockdown ST and anxiety; whereas those with high diet quality showed less likelihood of remaining abstainers, worsening weight, and improving PA. Lower ST was associated with a higher likelihood of remaining abstainers, and worsening weight and improving social contact; nevertheless, higher ST was linked to improvement in sleep quality. Lower PA was more likely to decrease alcohol consumption, while higher PA showed the opposite. However, PA was more likely to be associated to remain abstainers. CONCLUSIONS Despite improvements in lifestyle after lockdown, it had health consequences for older people. Particularly, lower ST during lockdown seemed to provide the most medium-term remarkable lifestyle improvements.
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Affiliation(s)
- I Rodríguez-Gómez
- Ignacio Ara Royo, PhD, GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III, s/n, 45071, Toledo, Spain, Tel: +34 925268800 (Ext.5543); E-mail: ; @iara_royo
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Kogan CS, Maj M, Rebello TJ, Keeley JW, Kulygina M, Matsumoto C, Robles R, Huang J, Zhong N, Chakrabarti S, Figueira ML, Stein DJ, Strakowski SM, Garcia-Pacheco JA, Burns S, Montoya M, Andrade L, Ayuso-Mateos JL, Arango I, Balhara YPS, Bryant R, Cournos F, Porto JAD, Meyer TD, Medina-Mora ME, Gureje O, First MB, Gaebel W, Khoury B, Krasnov VN, de Jesus Mari J, Maruta T, Pike KM, Roberts MC, Sharan P, Zhao M, Reed GM. A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines. J Affect Disord 2021; 295:1138-1150. [PMID: 34706426 DOI: 10.1016/j.jad.2021.08.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Tahilia J Rebello
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Chihiro Matsumoto
- National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Jingjing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Subho Chakrabarti
- Dept. Of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, - 160012, India
| | - Maria Luisa Figueira
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1699, Lisboa Codex, Portugal
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, J-Block, Anzio Road, Observatory 7925, South Africa
| | - Stephen M Strakowski
- Dell Medical School, University of Texas at Austin, Health Learning Building, 1501 Red River St., Austin, Texas, 78712, USA
| | - José A Garcia-Pacheco
- Centro de Investigación y Docencia Económica, Carr. México-Toluca 3655, Santa Fe, Altavista, Álvaro Obregón, 01210, Ciudad de México, México
| | - Samantha Burns
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Madeline Montoya
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Laura Andrade
- Institute of Psychiatry, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, 01246903, Brazil
| | - José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ivan Arango
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | | | - Francine Cournos
- Departments of Epidemiology and Psychiatry, Columbia University Medical Center, 722 West 168th St, 10032, New York, NY
| | - José Alberto Del Porto
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Thomas D Meyer
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, 1941 East Road, Houston, Texas, 77054, USA
| | - Maria-Elena Medina-Mora
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, University College Hospital, PMB, 5116 Ibadan, Nigeria
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 722 West 168th St, 10032, New York, NY
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Bergische Landstr. 2, 40629, Düsseldorf, Germany
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, P.O. Box 11-0236 - Riad El Solh 1107 2020 Beirut, Lebanon
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Toshimasa Maruta
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Kathleen M Pike
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael C Roberts
- University of Kansas, Clinical Child Psychology Program, Dole Human Development Center, Lawrence, KS, 66045, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, and Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Ayuso-Mateos JL, Mediavilla R, Rodriguez KR, Bravo MF. Informing the response to COVID-19 in Spain: priorities for mental health research. Rev Psiquiatr Salud Ment (Engl Ed) 2021; 14:79-82. [PMID: 33992223 PMCID: PMC8114090 DOI: 10.1016/j.rpsm.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/01/2023]
Affiliation(s)
- J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa),, Madrid, Spain.
| | - R Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - K R Rodriguez
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain
| | - M F Bravo
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, Hospital Universitario La Paz, Madrid, Spain
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Ayuso-Mateos JL, Mediavilla R, Rodriguez KR, Bravo MF. Informing the response to COVID-19 in Spain: priorities for mental health research. Rev Psiquiatr Salud Ment (Engl Ed) 2021; 14:79-82. [PMID: 34127209 PMCID: PMC8193968 DOI: 10.1016/j.rpsmen.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/12/2023]
Affiliation(s)
- J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa),, Madrid, Spain.
| | - R Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - K R Rodriguez
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain
| | - M F Bravo
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, Hospital Universitario La Paz, Madrid, Spain
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Evans SC, Roberts MC, Keeley JW, Rebello TJ, de la Peña F, Lochman JE, Burke JD, Fite PJ, Ezpeleta L, Matthys W, Youngstrom EA, Matsumoto C, Andrews HF, Medina-Mora ME, Ayuso-Mateos JL, Khoury B, Kulygina M, Robles R, Sharan P, Zhao M, Reed GM. Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5. J Child Psychol Psychiatry 2021; 62:303-312. [PMID: 32396664 PMCID: PMC7657976 DOI: 10.1111/jcpp.13244] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches. METHODS Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. RESULTS Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. CONCLUSIONS The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Michael C. Roberts
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Jared W. Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tahilia J. Rebello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA;,Behavioral Health Services and Policy Research, Research Foundation for Mental Hygiene, New York, NY, USA
| | | | - John E. Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jeffrey D. Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Paula J. Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Lourdes Ezpeleta
- Research Group Epidemiology and Diagnosis in Developmental Psychopathology, Autonomous University of Barcelona, Barcelona, Spain
| | - Walter Matthys
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mayya Kulygina
- Alekseev Mental Health Clinic №1, Moscow, Russian Federation
| | - Rebeca Robles
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Pratap Sharan
- Department of Psychiatry, ll India Institute of Medical Sciences, New Delhi, India
| | - Min Zhao
- Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA;,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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9
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Martín-María N, Caballero FF, Lara E, Domènech-Abella J, Haro JM, Olaya B, Ayuso-Mateos JL, Miret M. Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study. Int J Geriatr Psychiatry 2021; 36:76-85. [PMID: 32791563 DOI: 10.1002/gps.5397] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/22/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time. METHODS A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression. RESULTS Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one. CONCLUSIONS Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.
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Affiliation(s)
- Natalia Martín-María
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Francisco F Caballero
- Department of Preventive Medicine, Public Health and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública. CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Elvira Lara
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Joan Domènech-Abella
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Haro
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Olaya
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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10
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de la Torre-Luque A, de la Fuente J, Sanchez-Niubo A, Caballero FF, Prina M, Muniz-Terrera G, Haro JM, Ayuso-Mateos JL. Stability of clinically relevant depression symptoms in old-age across 11 cohorts: a multi-state study. Acta Psychiatr Scand 2019; 140:541-551. [PMID: 31566713 DOI: 10.1111/acps.13107] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 12/12/2022]
Abstract
AIMS To study the temporal dynamics of depression symptom episodes in old-age and the related influence of risk factors. METHODS Data from 41 362 old adults (54.61% women; mean age = 75.30, SD = 6.20) from the Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project were used. Depressive symptoms were followed over an 18-year period. A multi-state model, comprising three statuses (no depression, new clinically relevant episode of symptoms and episode persistence), was fitted. Multinomial regression was used to study the role of risk factors in status transition. RESULTS Almost 85% of participants showed no depression, but prevalence became lower over time (B = -0.25, P < 0.001). New episode point prevalence was over 5.30% with a significant probability of moving to persistence status (transition probability = 0.27). Episode persistence became evident in 9.86% of episode status transitions, with increasing rate over time (B = 0.54, P < 0.01). Loneliness was proven to be the strongest predictor of episode emergence (OR = 17.76) and persistence (OR = 5.93). CONCLUSIONS The course of depression tends to become chronic and unremitting in old-age. This study may help to plan interventions to tackle symptom escalation and risk factor influence.
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Affiliation(s)
- A de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - J de la Fuente
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - A Sanchez-Niubo
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - F F Caballero
- Department of Preventive Medicine, Public Health, and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain.,Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M Prina
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - G Muniz-Terrera
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - J M Haro
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - J L Ayuso-Mateos
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
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11
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Mayoral-van Son J, Juncal-Ruiz M, Ortiz-García de la Foz V, Cantarero-Prieto D, Blázquez-Fernández C, Paz-Zulueta M, Paras-Bravo P, Ayuso-Mateos JL, Crespo-Facorro B. Understanding the direct and indirect costs of a first episode of psychosis program: Insights from PAFIP of Cantabria, Spain, during the first year of intervention. Early Interv Psychiatry 2019; 13:1182-1190. [PMID: 30311416 DOI: 10.1111/eip.12752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 11/29/2022]
Abstract
AIM Early intervention psychiatric services for patients with psychosis aim to limit the most damaging outcomes and reduce the patient's risk of social drift, decreasing illness severity and thus containing healthcare costs. There is a scarcity of studies that focus on first-episode psychosis (FEP), and those few that have been published only looked at direct health costs, but not at indirect costs, which make up the bulk of the budget. Our study aims to explore the short-term (1-year follow-up) economic cost of a FEP Program, including both direct and indirect costs. METHODS Data were collected retrospectively from the clinical records of 157 patients included in the Programa Atención Fases Iniciales de Psicosis, from Marqués de Valdecilla University Hospital, Santander. Our data collection sheet collated data from direct and indirect costs associated with the illness. Data were also extracted from the Cantabria Health Service Records. STATA 15.0 was used for statistical analysis. RESULTS On average, the total costs during the first year were €48 353.51 per patient, with direct healthcare costs being €13 729.47 (28.39%), direct non-medical costs €108.6 (0.22%), and indirect costs €34 515.44 (71.39%). We found that hospitalization costs were higher in males (p = 0.081) and in cannabis users (p = 0.032). The number of relapses increased both, hospitalization and treatment costs (r = 0.40 p = 0.000; r = 0.24 p = 0.067, respectively). CONCLUSIONS Intensive Early Intervention in Psychosis Services may result in cost savings by decreasing hospitalization, premature mortality, disability, unemployment, and legal problems; however, the first year after diagnosis would represent the one with the highest costs.
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Affiliation(s)
- Jacqueline Mayoral-van Son
- Department of Psychiatry, Sierrallana Hospital, Torrelavega, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain
| | - María Juncal-Ruiz
- Department of Psychiatry, Sierrallana Hospital, Torrelavega, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain
| | | | | | | | - María Paz-Zulueta
- Nursing School, University of Cantabria, IDIVAL, GI Derecho Sanitario y Bioética. GRIDES. Cantabria, Spain
| | - Paula Paras-Bravo
- Nursing School, University of Cantabria, IDIVAL, GI Derecho Sanitario y Bioética. GRIDES. Cantabria, Spain
| | - José L Ayuso-Mateos
- Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain.,Department Psychiatry, University Hospital La Princesa, Autonomous University of Madrid, Madrid, Spain
| | - Benedicto Crespo-Facorro
- School of Medicine, University of Cantabria, Santander, Spain.,Instituto de Investigación Sanitaria Valdecilla. IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red en Salud Mental CIBERSAM, Spain.,Department of Psychiatry, University Hospital Marqués Valdecilla, Santander, Spain
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12
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Sanchez-Moreno J, Bonnin CM, González-Pinto A, Amann BL, Solé B, Balanzá-Martinez V, Arango C, Jiménez E, Tabarés-Seisdedos R, Garcia-Portilla MP, Ibáñez A, Crespo JM, Ayuso-Mateos JL, Martinez-Aran A, Torrent C, Vieta E. Factors associated with poor functional outcome in bipolar disorder: sociodemographic, clinical, and neurocognitive variables. Acta Psychiatr Scand 2018; 138:145-154. [PMID: 29726004 DOI: 10.1111/acps.12894] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The current investigation aimed at studying the sociodemographic, clinical, and neuropsychological variables related to functional outcome in a sample of euthymic patients with bipolar disorder(BD) presenting moderate-severe levels of functional impairment. METHODS Two-hundred and thirty-nine participants with BD disorders and with Functioning Assessment Short Test(FAST) scores equal or above 18 were administered a clinical and diagnostic interview, and the administration of mood measure scales and a comprehensive neuropsychological battery. Analyses involved preliminary Pearson bivariate correlations to identify sociodemographic and clinical variables associated with the FAST total score. Regarding neuropsychological variables, a principal component analysis (PCA) was performed to group the variables in orthogonal factors. Finally, a hierarchical multiple regression was run. RESULTS The best fitting model for the variables associated with functioning was a linear combination of gender, age, estimated IQ, Hamilton Depression Rating Scale (HAM-D), number of previous manic episodes, Factor 1 and Factor 2 extracted from the PCA. The model, including all these previous variables, explained up to 29.4% of the observed variance. CONCLUSIONS Male gender, older age, lower premorbid IQ, subdepressive symptoms, higher number of manic episodes, and lower performance in verbal memory, working memory, verbal fluency, and processing speed were associated with lower functioning in patients with BD.
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Affiliation(s)
- J Sanchez-Moreno
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C M Bonnin
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - A González-Pinto
- Álava University Hospital, CIBERSAM, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - B L Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Department of Psychiatry, Parc de Salut Mar, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - B Solé
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - V Balanzá-Martinez
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain.,Department of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - C Arango
- Child and Adolescent Psychiatry Department, Hospital Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - E Jiménez
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Tabarés-Seisdedos
- Department of Medicine, CIBERSAM, INCLIVA, University of Valencia, Valencia, Spain
| | - M P Garcia-Portilla
- Department of Psychiatry, School of Medicine, CIBERSAM Instituto de Neurociencias del Principado de Asturias, INEUROPA, Servicio de Salud del Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
| | - A Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERSAM, Universidad de Alcalá, Madrid, Spain
| | - J M Crespo
- Department of Psychiatry, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, University Hospital of Bellvitge, Barcelona, Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry, IIS-IP, CIBERSAM, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Martinez-Aran
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - C Torrent
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - E Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
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13
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Canal-Rivero M, López-Moríñigo JD, Setién-Suero E, Ruiz-Veguilla M, Ayuso-Mateos JL, Ayesa-Arriola R, Crespo-Facorro B. Predicting suicidal behaviour after first episode of non-affective psychosis: The role of neurocognitive functioning. Eur Psychiatry 2018; 53:52-57. [PMID: 29929113 DOI: 10.1016/j.eurpsy.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Suicide has been recognised as one of the major causes of premature death in psychosis. However, predicting suicidal behaviour (SB) is still challenging in the clinical setting and the association of neurocognition with SB in psychosis remains poorly understood. This study aimed to investigate the role of neurocognitive performance as predictor of SB. Also, we sought to explore differences in the evolution of clinical and neurocognitive functioning between participants with/without history of suicide attempts (SA) over follow-up period. METHODS The sample of the study is composed by 517 patients. Sociodemographic, clinical, functional and neurocognitive measures were evaluated at baseline as well as 1-year and 3 years after first episode of psychosis. Bivariate and multivariate analyses explored the influence of these variables as putative baseline predictors of SB. Repeated measures analyses of variance tested differences in clinical and neurocognitive outcomes at 1- and 3-year follow-up. RESULTS Global cognitive functioning (GCF) (OR = 1.83, 95% CI = 1.25-2.67) and severe depressive symptoms (OR = 1.17, 95% CI = 1.07-1.28) predicted SB. Longitudinal analyses revealed that patients with SB at follow-up presented with higher levels of remission in terms of positive psychotic symptoms and depression. In addition, those with a history of SB had worse GCF and visual memory than those without such antecedents. CONCLUSIONS GCF was found to be the most robust predictor of SB along with severe depressive symptomatology. Hence, poorer cognitive performance in FEP appears to emerge as a risk factor for suicidal behaviour from early stages of the illness and a comprehensive neurocognitive assessment may contribute to risk assessment.
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Affiliation(s)
- M Canal-Rivero
- Department of Psychiatry. Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - J D López-Moríñigo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Setién-Suero
- Department of Psychiatry. Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - M Ruiz-Veguilla
- Seville Biomedicine Institute Neurodevelopment and Psychosis Group (IBIS), Virgen del Rocío University Hospital, CSIC, University of Seville, UGC Mental Health HVR, Spain
| | - J L Ayuso-Mateos
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry. Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - B Crespo-Facorro
- Department of Psychiatry. Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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14
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Kamenov K, Twomey C, Cabello M, Prina AM, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychol Med 2017; 47:1337. [PMID: 28007047 DOI: 10.1017/s003329171600341x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Kamenov K, Cabello M, Nieto M, Bernard R, Kohls E, Rummel-Kluge C, Ayuso-Mateos JL. Research Recommendations for Improving Measurement of Treatment Effectiveness in Depression. Front Psychol 2017; 8:356. [PMID: 28337167 PMCID: PMC5343004 DOI: 10.3389/fpsyg.2017.00356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Despite the steadily escalating psychological and economic burden of depression, there is a lack of evidence for the effectiveness of available interventions on functioning areas beyond symptomatology. Therefore, the main objective of this study was to give an insight into the current measurement of treatment effectiveness in depression and to provide recommendations for its improvement. Materials and Methods: The study was based on a multi-informant approach, comparing data from a systematic literature review, an expert survey with representatives from clinical practice (130), and qualitative interviews with patients (11) experiencing depression. Results: Current literature places emphasis on symptomatic outcomes and neglects other domains of functioning, whereas clinicians and depressed patients highlight the importance of both. Interpersonal relationships, recreation and daily activities, communication, social participation, work difficulties were identified as being crucial for recovery. Personal factors, neglected by the literature, such as self-efficacy were introduced by experts and patients. Furthermore, clinicians and patients identified a number of differences regarding the areas improved by psychotherapeutic or pharmacological interventions that were not addressed by the pertinent literature. Conclusion: Creation of a new cross-nationally applicable measure of psychosocial functioning, broader remission criteria, report of domain-specific information, and a personalized approach in treatment decision-making are the first crucial steps needed for the improvement of the measurement of treatment effectiveness in depression. A better measurement will facilitate the clinical decision making and answer the escalating burden of depression.
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Affiliation(s)
- Kaloyan Kamenov
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERMadrid, Spain; Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
| | - María Cabello
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERMadrid, Spain; Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain
| | - Mónica Nieto
- Instituto de Investigación de La Princesa (IIS-IP), Hospital Universitario de La Princesa Madrid, Spain
| | - Renaldo Bernard
- Department of Medical Informatics, Biometry and Epidemiology - IBE, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München Munich, Germany
| | - Elisabeth Kohls
- Faculty of Medicine, Department of Psychiatry, Leipzig University Leipzig, Germany
| | | | - José L Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBERMadrid, Spain; Department of Psychiatry, Universidad Autónoma de MadridMadrid, Spain; Instituto de Investigación de La Princesa (IIS-IP), Hospital Universitario de La PrincesaMadrid, Spain
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Grande I, Sanchez-Moreno J, Sole B, Jimenez E, Torrent C, Bonnin CM, Varo C, Tabares-Seisdedos R, Balanzá-Martínez V, Valls E, Morilla I, Carvalho AF, Ayuso-Mateos JL, Vieta E, Martinez-Aran A. High cognitive reserve in bipolar disorders as a moderator of neurocognitive impairment. J Affect Disord 2017; 208:621-627. [PMID: 28029429 DOI: 10.1016/j.jad.2016.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD). METHODS 102 patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS≤6 and HDRS≤8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR. RESULTS Participants with BD with high CR displayed a better performance in measures of attention (digits forward: F=4.554, p=0.039); phonemic and semantic verbal fluency (FAS: F=9.328, p=0.004; and Animal Naming: F=8.532, p=0.006); and verbal memory (short cued recall of California Verbal Learning Test: F=4.236, p=0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms. LIMITATIONS The cross-sectional design of the study does not allow the establishment of causal inferences. Additionally, the small size of the sample may have limited some results. CONCLUSIONS High cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.
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Affiliation(s)
- I Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J Sanchez-Moreno
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Sole
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Jimenez
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Torrent
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C M Bonnin
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Varo
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - R Tabares-Seisdedos
- Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain
| | - V Balanzá-Martínez
- La Fe University and Polytechnic Hospital, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - E Valls
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Morilla
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Fortaleza, CE, Brazil
| | - J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, CIBERSAM, Madrid, Spain
| | - E Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - A Martinez-Aran
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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17
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Anaya C, Torrent C, Caballero FF, Vieta E, Bonnin CDM, Ayuso-Mateos JL. Cognitive reserve in bipolar disorder: relation to cognition, psychosocial functioning and quality of life. Acta Psychiatr Scand 2016; 133:386-98. [PMID: 26719018 DOI: 10.1111/acps.12535] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cognitive reserve (CR) is a concept that was postulated as a protective factor for some clinical symptoms after the observation that there is not a direct relationship between the degree of brain damage and its clinical manifestation. This study aimed to explore the association between CR and the main outcomes in bipolar disorder (BD): cognitive functions, psychosocial functioning and perceived quality of life. METHOD A sample of 224 euthymic bipolar patients was assessed with a neuropsychological battery, the Functioning Assessment Short Test and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CR was calculated through three proxies: estimated premorbid Intelligent Quotient, educational level and occupational attainment. Relationships between CR and cognitive functions, psychosocial functioning and quality of life were assessed by multiple linear regression models. RESULTS Higher CR was associated with better cognitive functioning (P < 0.001 in processing speed, working memory, verbal and visual memory, and executive function; P = 0.026 in attention) and better psychosocial functioning (P = 0.008). For quality of life, CR was positively associated with the physical component of the SF-36 (P = 0.016) but negatively associated with the mental component (P = 0.004). CONCLUSION The results suggest that CR may play an important role in the course and prognosis of bipolar patients and it should be considered in both clinical and research settings related to BD.
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Affiliation(s)
- C Anaya
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Torrent
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - F F Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - E Vieta
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - C Del Mar Bonnin
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
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Bonnin CM, Torrent C, Arango C, Amann BL, Solé B, González-Pinto A, Crespo JM, Tabarés-Seisdedos R, Reinares M, Ayuso-Mateos JL, García-Portilla MP, Ibañez Á, Salamero M, Vieta E, Martinez-Aran A. Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome. Br J Psychiatry 2016; 208:87-93. [PMID: 26541692 DOI: 10.1192/bjp.bp.114.162123] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/25/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder. AIMS To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline. METHOD This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668). RESULTS There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group (F = 3.071, d.f. = 2, P = 0.049). CONCLUSIONS Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.
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Affiliation(s)
- C M Bonnin
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Torrent
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - C Arango
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B L Amann
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Solé
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A González-Pinto
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J M Crespo
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - R Tabarés-Seisdedos
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Reinares
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - J L Ayuso-Mateos
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M P García-Portilla
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Á Ibañez
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Salamero
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Martinez-Aran
- Caterina del Mar Bonnin, PhD, Carla Torrent, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Celso Arango, MD, PhD, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Benedikt L. Amann, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, CIBERSAM, Barcelona; Brisa Solé, PsyD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Ana González-Pinto, MD, PhD, Álava University Hospital, CIBERSAM, University of the Basque Country, Kronikgune, Vitoria; Jose Manuel Crespo, MD, PhD, Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona; Rafael Tabarés-Seisdedos, MD, PhD, Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia; Maria Reinares, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia; Jose Luis Ayuso-Mateos, MD, PhD, Department of Psychiatry, Autonomous University of Madrid, Research Institute of the Hospital de la Princesa, CIBERSAM, Madrid; M. Paz García-Portilla, MD, PhD, Department of Psychiatry, University of Oviedo, CIBERSAM; Ángela Ibañez, MD, PhD, Department of Psychiatry, Ramon y Cajal University Hospital, University of Alcala, IRYCIS, CIBERSAM, Madrid; Manel Salamero, MD, PhD, Eduard Vieta, MD, PhD, Institute of Neurosciences, University of Barcelona, Hospital Clinic i Provincial, Catalonia; Anabel Martinez-Aran, PhD, Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Bonnin CM, Reinares M, Martínez-Arán A, Balanzá-Martínez V, Sole B, Torrent C, Tabarés-Seisdedos R, García-Portilla MP, Ibáñez A, Amann BL, Arango C, Ayuso-Mateos JL, Crespo JM, González-Pinto A, Colom F, Vieta E. Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory. Psychol Med 2016; 46:291-301. [PMID: 26387583 DOI: 10.1017/s0033291715001713] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. METHOD A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. RESULTS Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). CONCLUSIONS Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.
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Affiliation(s)
- C M Bonnin
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | - M Reinares
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | - A Martínez-Arán
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | | | - B Sole
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | - C Torrent
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | | | | | - A Ibáñez
- Department of Psychiatry,Ramon y Cajal University Hospital, University of Alcala,IRYCIS,CIBERSAM,Madrid,Spain
| | - B L Amann
- FIDMAG Hermanas Hospitalarias Research Foundation,CIBERSAM,Barcelona,Spain
| | - C Arango
- Child and Adolescent Psychiatry Department,Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense,IiSGM,CIBERSAM,Madrid,Spain
| | - J L Ayuso-Mateos
- Department of Psychiatry,Universidad Autonoma de Madrid,IIS-IP,CIBERSAM,Madrid,Spain
| | - J M Crespo
- Department of Psychiatry,University Hospital of Bellvitge,Bellvitge Biomedical Research Institute (IDIBELL),CIBERSAM,Barcelona,Spain
| | - A González-Pinto
- Álava University Hospital,CIBERSAM,University of the Basque Country,Kronikgune,Vitoria,Spain
| | - F Colom
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
| | - E Vieta
- Bipolar Disorders Unit,Hospital Clinic,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona, Catalonia,Spain
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Lara E, Olaya B, Garin N, Miret M, Ayuso-Mateos JL, Moneta MV, Haro JM. Is cognitive impairment associated with suicidality? A population-based study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso-Mateos JL. Evidence for the early clinical relevance of hallucinatory-delusional states in the general population. Acta Psychiatr Scand 2013; 127:482-93. [PMID: 22943634 DOI: 10.1111/acps.12010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. METHOD General population-based household surveys of randomly selected adults between 18 and 65 years of age were carried out. SETTING 52 countries participating in the World Health Organization's World Health Survey were included. PARTICIPANTS 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. RESULTS Compared with isolated delusions and hallucinations, co-occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92-0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0-3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5-14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3-22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9-12.4). Co-occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8-2.3). CONCLUSION The results suggest that the co-occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.
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Affiliation(s)
- R Nuevo
- Department of Psychiatry, Universidad Autonoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
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Ayuso-Mateos JL, Avila CC, Anaya C, Cieza A, Vieta E. Development of the International Classification of Functioning, Disability and Health core sets for bipolar disorders: results of an international consensus process. Disabil Rehabil 2013; 35:2138-46. [PMID: 23586666 DOI: 10.3109/09638288.2013.771708] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The International Classification of Functioning, Disability and Health (ICF) is a tool of the World Health Organization (WHO) designed to be a guide to identify and classify relevant domains of human experience affected by health conditions. The purpose of this article is to describe the process for the development of two Core Sets for bipolar disorder (BD) in the framework of the ICF. The Comprehensive ICF Core Set for BD intends to be a guide for multidisciplinary assessment of patients diagnosed with this condition, while the Brief ICF Core Set for BD will be useful when rating aspects of patient's experience for clinical practice or epidemiological studies. METHODS An international consensus conference involving a sample of experts with different professional backgrounds was performed using the nominal group technique. Various preparatory studies identified a set of 743 potential ICF categories to be included in the Core Sets. RESULTS A total of 38 ICF categories were selected to be included in the Comprehensive Core Set for BD. A total of 19 ICF categories from the Comprehensive Core Set were chosen as the most significant to constitute the Brief Core Set for BD. CONCLUSIONS The formal consensus process integrating evidence and expert opinion on the ICF led to the formal adoption of the ICF Core Sets for BD. The most important categories included are representative of the characteristics usually associated with BD. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings. Implications for Rehabilitation Bipolar disorder (BD) is a prevalent condition that has a great impact on people who suffer it, not only in health but also in daily functioning and quality of life. No standard has been defined so far regarding the problems in functioning of persons with BDs. The process described in this article defines the set of areas of functioning to be addressed in clinical assessments of persons with BD and establish the starting point for the development of condition-specific outcome measures.
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Affiliation(s)
- José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Princesa , Madrid , Spain
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Reinares M, Papachristou E, Harvey P, Mar Bonnín C, Sánchez-Moreno J, Torrent C, Ayuso-Mateos JL, Ploubidis GB, Vieta E, Frangou S. Towards a clinical staging for bipolar disorder: defining patient subtypes based on functional outcome. J Affect Disord 2013; 144:65-71. [PMID: 22862890 DOI: 10.1016/j.jad.2012.06.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/03/2012] [Accepted: 06/04/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND The functional outcome of Bipolar Disorder (BD) is highly variable. This variability has been attributed to multiple demographic, clinical and cognitive factors. The critical next step is to identify combinations of predictors that can be used to specify prognostic subtypes, thus providing a basis for a staging classification in BD. METHODS Latent Class Analysis was applied to multiple predictors of functional outcome in a sample of 106 remitted adults with BD. RESULTS We identified two subtypes of patients presenting "good" (n=50; 47.6%) and "poor" (n=56; 52.4%) outcome. Episode density, level of residual depressive symptoms, estimated verbal intelligence and inhibitory control emerged as the most significant predictors of subtype membership at the p<0.05 level. Their odds ratio (OR) and confidence interval (CI) with reference to the "good" outcome group were: episode density (OR=4.622, CI 1.592-13.418), level of residual depressive symptoms (OR=1.543, CI 1.210-1.969), estimated verbal intelligence (OR=0.969; CI 0.945-0.995), and inhibitory control (OR=0.771, CI 0.656-0.907). Age, age of onset and duration of illness were comparable between prognostic groups. LIMITATIONS The longitudinal stability or evolution of the subtypes was not tested. CONCLUSIONS Our findings provide the first empirically derived staging classification of BD based on two underlying dimensions, one for illness severity and another for cognitive function. This approach can be further developed by expanding the dimensions included and testing the reproducibility and prospective prognostic value of the emerging classes. Developing a disease staging system for BD will allow individualised treatment planning for patients and selection of more homogeneous patient groups for research purposes.
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Affiliation(s)
- María Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Sánchez-Portocarrero J, Jiménez-Escrig A, Pérez-Cecilia E, Ayuso-Mateos JL, Roca V, Yague MR, Barquero M, Ramirez C, Seijas EV. AIDS dementia complex: incidence, clinical profile and impact of zidovudine treatment*. Eur J Neurol 2012; 3:191-7. [PMID: 21284769 DOI: 10.1111/j.1468-1331.1996.tb00422.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aimed to determine the incidence of AIDS dementia complex (ADC), the clinical data which distinguish it from other neurological complications of HIV infection, and the impact of zidovudine (AZT) therapy on the appearance and course of this condition. Data on the neurological complications of HIV patients treated at a community hospital from 1988 to 1992 were collected prospectively. Out of 500 AIDS patients treated at the hospital, there were 142 patients with neurological complications, with an average of 1.42 complications/patient There were 23 patients diagnosed as having ADC; with an estimated incidence of 4.6%, it was the most frequent neurological complication, after cerebral toxoplasmosis. Age was higher in patients with ADC as first manifestation of AIDS with respect to ADC patients with previous AIDS diagnosed. Compared with the group of patients suffering from other neurological complications, patients with ADC showed significant differences in several biological markers of progression to AIDS, such as hemoglobin, hematocrit, global lymphocyte count, serum β2-microglobulin and serum IgA. CD4 count was similar in both groups. Ten ADC patients had been treated previously with AZT. Dementia continued progressing in seven of these patients and remained stable in three. Of the other 13 cases not treated previously with the drug, eight received AZT therapy, and a favourable response was obtained in three patients (p = 0.068). ADC represents a major neurological complication in AIDS patients. AZT therapy may delay the appearance of ADC, but not prevent it. A trend towards a favourable response to AZT was observed in ADC patients who had not been treated with it previously.
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Affiliation(s)
- J Sánchez-Portocarrero
- Department of Neurology, Hospital Universitario San Carlos, Madrid, SpainHIV Unit, Hospital Universitario San Carlos, Madrid, SpainDepartment of Internal Medicine, Hospital Universitario San Carlos, Madrid, SpainDepartment of Neurology, Hospital Ramón y Cajal, Madrid, SpainDepartment of Medicine and Psychiatry, Cantabria University, Cantabria, Spain
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Abstract
The Madrid Declaration is being promoted by representatives from seven nationally funded mental health research networks, along with leaders of ongoing European Union-funded mental health projects. It advocates the creation of a Network of Excellent Networks, based on a dynamic and adaptive cross-European network of distinctly qualified research centres.
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Dowrick C, Shiels C, Page H, Ayuso-Mateos JL, Casey P, Dalgard OS, Dunn G, Lehtinen V, Salmon P, Whitehead M. Predicting long-term recovery from depression in community settings in Western Europe: evidence from ODIN. Soc Psychiatry Psychiatr Epidemiol 2011; 46:119-26. [PMID: 20035318 DOI: 10.1007/s00127-009-0179-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To test the impact of socio-economic and psychological adversity and healthcare on long-term recovery from depression. METHOD A community sample of 347 people with depressive disorders was followed up after 9 years. Baseline socio-economic adversity, social support, healthcare use, and psychiatric history were identified. Respondents completed self-report instruments on current depressive status (Beck depression inventory) and longstanding psychosocial adversity (sexual, physical or emotional abuse). Univariate analyses tested for association between recovery and respondent characteristics. RESULTS Follow-up was achieved for 182 (52%) of the sample, of whom 75 (41%) indicated recovery from depression. Psychological adversity definitely and socio-economic adversity probably were associated with lack of recovery. Baseline healthcare had no apparent impact on outcome. Rurality and support after life events were associated with recovery. History of depression was associated with non-recovery. CONCLUSION Psychological adversity is, and socio-economic adversity may be, associated with long-term non-recovery from depression in community settings.
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Affiliation(s)
- Christopher Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
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Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry 2011; 198:11-6, sup 1. [PMID: 21200071 PMCID: PMC3014462 DOI: 10.1192/bjp.bp.109.076448] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Depression is a common condition that has been frequently treated with psychotropics. AIMS To review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression. METHOD A systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias. RESULTS Six studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81-1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR=1.06, 95% CI 0.65-1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses. CONCLUSIONS There is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.
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Affiliation(s)
- Corrado Barbui
- Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico GB Rossi, 37134 Verona, Italy.
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Nuevo R, Leighton C, Dunn G, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Vázquez-Barquero JL, Ayuso-Mateos JL. Impact of severity and type of depression on quality of life in cases identified in the community. Psychol Med 2010; 40:2069-2077. [PMID: 20146833 DOI: 10.1017/s0033291710000164] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level. METHOD A sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36. RESULTS Statistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent). CONCLUSIONS These results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.
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Affiliation(s)
- R Nuevo
- Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Abstract
BACKGROUND A previous meta-analysis of data from clinical trials showed an association between antiepileptic drugs and suicidality (suicidal ideation, behavior, or both). We used observational data to examine the association between the use or nonuse of antiepileptic drugs and suicide-related events (attempted suicides and completed suicides) in patients with epilepsy, depression, or bipolar disorder. METHODS We used data collected as part of the clinical care of patients who were representative of the general population in the United Kingdom to identify patients with epilepsy, depression, or bipolar disorder and to determine whether they received antiepileptic drugs. We estimated the incidence rate of suicide-related events and used logistic regression to compute odds ratios, controlling for confounding factors. RESULTS In a cohort of 5,130,795 patients, the incidence of suicide-related events per 100,000 person-years was 15.0 (95% confidence interval [CI], 14.6 to 15.5) among patients without epilepsy, depression, bipolar disorder, or antiepileptic-drug treatment, 38.2 (95% CI, 26.3 to 53.7) among patients with epilepsy who did not receive antiepileptic drugs, and 48.2 (95% CI, 39.4 to 58.5) among patients with epilepsy who received antiepileptic drugs. In adjusted analyses, the use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy (odds ratio, 0.59; 95% CI, 0.35 to 0.98) or bipolar disorder (1.13; 95% CI, 0.35 to 3.61) but was significantly associated with an increased risk among patients with depression (1.65; 95% CI, 1.24 to 2.19) and those who did not have epilepsy, depression, or bipolar disorder (2.57; 95% CI, 1.78 to 3.71). CONCLUSIONS The current use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy, but it was associated with an increased risk of such events among patients with depression and among those who did not have epilepsy, depression, or bipolar disorder.
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Luciano JV, Ayuso-Mateos JL, Aguado J, Fernandez A, Serrano-Blanco A, Roca M, Haro JM. The 12-item World Health Organization Disability Assessment Schedule II (WHO-DAS II): a nonparametric item response analysis. BMC Med Res Methodol 2010; 10:45. [PMID: 20487526 PMCID: PMC2881065 DOI: 10.1186/1471-2288-10-45] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 05/20/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies have analyzed the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHO-DAS II) using classical omnibus measures of scale quality. These analyses are sample dependent and do not model item responses as a function of the underlying trait level. The main objective of this study was to examine the effectiveness of the WHO-DAS II items and their options in discriminating between changes in the underlying disability level by means of item response analyses. We also explored differential item functioning (DIF) in men and women. METHODS The participants were 3615 adult general practice patients from 17 regions of Spain, with a first diagnosed major depressive episode. The 12-item WHO-DAS II was administered by the general practitioners during the consultation. We used a non-parametric item response method (Kernel-Smoothing) implemented with the TestGraf software to examine the effectiveness of each item (item characteristic curves) and their options (option characteristic curves) in discriminating between changes in the underliying disability level. We examined composite DIF to know whether women had a higher probability than men of endorsing each item. RESULTS Item response analyses indicated that the twelve items forming the WHO-DAS II perform very well. All items were determined to provide good discrimination across varying standardized levels of the trait. The items also had option characteristic curves that showed good discrimination, given that each increasing option became more likely than the previous as a function of increasing trait level. No gender-related DIF was found on any of the items. CONCLUSIONS All WHO-DAS II items were very good at assessing overall disability. Our results supported the appropriateness of the weights assigned to response option categories and showed an absence of gender differences in item functioning.
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Affiliation(s)
- Juan V Luciano
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, RedIAPP, Barcelona, Spain
| | - José L Ayuso-Mateos
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Servicio de Psiquiatría, Hospital Universitario de la Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Madrid, Spain
| | - Jaume Aguado
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain
| | - Ana Fernandez
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, RedIAPP, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, RedIAPP, Barcelona, Spain
| | - Miquel Roca
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, RedIAPP, Barcelona, Spain
- Institut Universitari d'Investigació en Ciències de la Salut, Universitat de les Illes Balears & Unidad de Psiquiatría y Psicología Clinica - Hospital Juan March, Palma de Mallorca, Spain
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Salud Mental, CIBERSAM, Madrid, Spain
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Abstract
BACKGROUND Nosological boundaries for depressive disorders as well as the prevalence and impact of 'subsyndromal' depression remain unclear. AIMS To examine the impact of subsyndromal depressive disorders on health status and to assess if depressive disorders lie on a continuum of severity. METHOD The sample was composed of randomly selected respondents from the general population in 68 countries from across the world participating in the World Health Organization's World Health Survey. RESULTS The pattern of risk factors for depressive disorders was consistent across all types of depression (subsyndromal, brief depressive episode and depressive episode): odds ratios for females ranged between 1.49 and 1.80, and for the unemployed from 1.19 to 1.25. All types of depression produced a significant decrement in health status compared with no depression after controlling for demographic variables, income and country. CONCLUSIONS Subthreshold depressive disorders occur commonly all across the world and are associated with the same risk factors everywhere. They produce significant decrements in health and do not qualitatively differ from full-blown episodes of depression as currently defined, and lie on a continuum with more severe forms of depressive episodes but are distinct from normal mood changes.
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Affiliation(s)
- José L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
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Luciano JV, Ayuso-Mateos JL, Fernández A, Serrano-Blanco A, Roca M, Haro JM. Psychometric properties of the twelve item World Health Organization Disability Assessment Schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode. J Affect Disord 2010; 121:52-8. [PMID: 19464735 DOI: 10.1016/j.jad.2009.05.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychometric information on the World Health Organization Disability Assessment Schedule II (WHO-DAS II) in depressive primary care (PC) patients is scarce and has been obtained with the 36-item version of the instrument. The main objective of this study was to analyse the dimensionality, internal consistency and construct validity of the 12-item WHO-DAS II in a large sample of Spanish PC patients with a first diagnosed major depressive episode. METHOD Data were collected between December 2006 and July 2007. A total of 3615 adult (18 years or older) PC patients from 17 regions of Spain with a first diagnosed major depressive episode participated in the study. The 12-item WHO-DAS II and a battery of instruments assessing sociodemographic characteristics, depression severity (PHQ-9), quality of life (EQ-5D) and chronic health conditions were administered by the family physician during the consultation. RESULTS The principal component analysis and the subsequent confirmatory factor analysis indicated that the 12-item WHO-DAS II is one-dimensional. The instrument showed adequate internal consistency (alpha=0.89) and construct validity because it was significantly associated with quality of life and depression severity (convergent validity) and was able to discriminate between patients on sick leave and those that were working (discriminative validity). LIMITATIONS The test-retest reliability and sensitivity to change of the instrument was not examined due to the cross-sectional design of the study. CONCLUSIONS The 12-item WHO-DAS II is a reliable, valid and useful tool for assessing overall disability in PC patients with depression.
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Affiliation(s)
- Juan V Luciano
- Sant Joan de Déu, Servicios de Salud Mental, Sant Boi de Llobregat, Barcelona, Spain.
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Sanchez-Moreno J, Martinez-Aran A, Tabarés-Seisdedos R, Torrent C, Vieta E, Ayuso-Mateos JL. Functioning and disability in bipolar disorder: an extensive review. Psychother Psychosom 2009; 78:285-97. [PMID: 19602917 DOI: 10.1159/000228249] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 10/17/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bipolar disorder has generally been regarded as having a better functional outcome than schizophrenia. However, studies have suggested low functioning in bipolar patients even when they are in clinical remission. Our aim was to determine the degree of functioning and disability in bipolar patients. Secondly, we reviewed factors potentially associated with the low functioning of bipolar patients. METHOD The authors conducted an extensive Medline and Pubmed search of the published literature from 1980 up to December 2007, using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Articles that reported clinically significant findings on functioning and disability, and research reports were reviewed in detail. RESULTS From these articles, we determined that bipolar disorder is associated with significant impairment in work, family and social life, beyond the acute phases of the illness. The aspects that appear to increase the risk of low functioning and disability in bipolar patients are mainly subsyndromal symptoms and neurocognitive impairment, among others. CONCLUSIONS Suitable pharmacological and psychological interventions may improve the level of functioning and reduce the disability in bipolar patients. Potential targets to be considered for intervention should be residual symptoms, comorbid conditions and neurocognitive deficits. Further research is required to better identify the factors that best predict functioning in bipolar patients.
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Affiliation(s)
- J Sanchez-Moreno
- Clinical Institute of Neuroscience, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
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Abstract
BACKGROUND For some phenomena the mean of population distributions predicts the proportion of people exceeding a threshold value. AIMS To investigate whether in depression, too, the population mean predicts the number of individuals at the extreme end of the distribution. METHOD We used data from the European Outcome in Depression International Network (ODIN) study from populations in Finland, Norway and the UK to create models that predicted the prevalence of depression based on the mean Beck Depression Inventory (BDI) score. The models were tested on data from Ireland and Spain. RESULTS Mean BDI score correlated well with the prevalence of depression determined by clinical interviews. A model based on the beta distribution best fitted the BDI distribution. Both models predicted the depression prevalence in Ireland and Spain fairly well. CONCLUSIONS The mean of a continuous population distribution of mood predicts the prevalence of depression. Characteristics of both individuals and populations determine depression rates.
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Affiliation(s)
- J L Veerman
- The University of Queensland, School of Population Health, Herston Road, Herston Qld 4006, Australia.
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Rosa AR, Franco C, Martínez-Aran A, Sánchez-Moreno J, Reinares M, Salamero M, Arango C, Ayuso-Mateos JL, Kapczinski F, Vieta E. Functional impairment in patients with remitted bipolar disorder. Psychother Psychosom 2009; 77:390-2. [PMID: 18716425 DOI: 10.1159/000151520] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Martorell A, Gutierrez-Recacha P, Pereda A, Ayuso-Mateos JL. Identification of personal factors that determine work outcome for adults with intellectual disability. J Intellect Disabil Res 2008; 52:1091-1101. [PMID: 18557967 DOI: 10.1111/j.1365-2788.2008.01098.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Access to employment for people with intellectual disability (ID) has become a social priority. The aim of the present study is to try to determine which variables [sociodemographic variables, intelligence quotient (IQ), presence or absence of a psychiatric disorder, functioning, self-determination, and behavioural problems] could most reliably account for access to remunerated employment of people with ID. METHODS Two groups of people with ID participated in this study: (1) 69 workers in a sheltered-employment programme; and (2) 110 clients of programmes in sheltered workshops. Both programmes were run by the Pardo-Valcarce Foundation in Madrid (Spain). The following variables were assessed for every participant: IQ, functioning, behavioural problems, self-determination and presence of psychiatric symptoms. A binary logistic regression analysis was carried out in order to identify the variables that best explained work outcome (sheltered workshop programme vs. sheltered employment programme). RESULTS Although IQ showed no significant differences between the two groups of participants, the remaining variables did: behavioural problems, functioning, psychiatric symptoms and self-determination significantly explained work outcome. As for sociodemographic variables, whereas gender did not show any significant relationship with the labour status of the participants, significant differences were found when considering variables such as age and pension benefits. CONCLUSIONS All the main variables considered, except IQ, turned out to be significant. Our findings should be considered encouraging, as they apparently show that both personal and social efforts can help individuals to overcome their low intellectual functioning in order to achieve access to employment. Such study highlights the importance of a prior psychopathological evaluation and efforts to enhance self-determination in order to improve work inclusion for people with ID.
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Affiliation(s)
- A Martorell
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.
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Gutiérrez-Rojas L, Gurpegui M, Ayuso-Mateos JL, Gutiérrez-Ariza JA, Ruiz-Veguilla M, Jurado D. Quality of life in bipolar disorder patients: a comparison with a general population sample. Bipolar Disord 2008; 10:625-34. [PMID: 18657247 DOI: 10.1111/j.1399-5618.2008.00604.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the Quality of Life (QoL) of bipolar disorder (BD) patients with that of the general population; and, within the BD patients, to find the demographic and clinical variables associated with low QoL, controlling for the effects of potential confounders. METHODS Based on the 25th percentile of the physical (PCS) and the mental (MCS) component scores (PCS <53 and MCS < 50, respectively) of the Medical Outcomes Survey 36-item Short-Form Health-Survey (SF-36) of a general population representative sample (n = 1,210), we compared by logistic regression the QoL of 48 euthymic and 60 non-euthymic BD outpatients and the general population. Within BD patients, we analyzed the clinical and course-of-illness variables associated with low physical and mental QoL, including manic and depressive symptoms and consumption of addictive substances; in addition, we calculated the partial correlation of the different variables with the dimensional PCS and MCS through multiple linear regression. RESULTS Low physical QoL was significantly more frequent among both euthymic [odds ratio (OR) = 3.5; 95% confidence interval (CI): 1.9-6.5] and non-euthymic (OR = 4.0; 95% CI: 2.3-7.0) BD patients than in the general population; the respective values for low mental QoL were OR = 2.2; 95% CI: 1.2-4.0 and OR = 8.5; 95% CI: 4.6-15.7. Low mental QoL was more frequent among non-euthymic than euthymic BD patients (OR = 3.9; 95% CI: 1.6-9.1). Within BD patients, low mental QoL was associated with the length of illness (or early onset), the presence of depressive symptoms, nicotine dependence and the lack of social support. CONCLUSIONS Among the BD patients, who experience lower physical and mental QoL even in a euthymic period, the optimal control of depressive symptoms as well as the availability of social support may enhance their well-being.
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Martorell A, Pereda A, Salvador-Carulla L, Ochoa S, Ayuso-Mateos JL. Validation of the Subjective and Objective Family Burden Interview (SOFBI/ECFOS) in primary caregivers to adults with intellectual disabilities living in the community. J Intellect Disabil Res 2007; 51:892-901. [PMID: 17910541 DOI: 10.1111/j.1365-2788.2007.00962.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is little information on the psychometric properties of instruments for assessing family care burden in adults with intellectual disabilities (ID). The aim of this study is therefore to analyse the usefulness of the 'Subjective and Objective Family Burden Interview' (SOFBI) in the assessment of principal caregivers in Spain. METHODS The SOFBI was administered to 166 principal caregivers of adults with ID in a vocational centre. The psychometric analysis included: internal consistency, inter-rater and test-retest reliability, construct validity, convergent validity with the World Health Organization's Disability Assessment Schedule II, and feasibility. RESULTS The Cronbach's alpha was 0.88 for the overall interview and always above 0.7 in the quantitative subdomains. The Kappa coefficients for test-retest were between 0.5 and 0.8, whereas inter-rater agreement was nearly perfect. Maximum-likelihood factor analysis showed four well-defined factors, which fitted the previously designed domains. Feasibility was also good. CONCLUSIONS The SOFBI is a multi-domain, modular instrument which is feasible, reliable and valid for measuring the burden of family caregivers to adults with ID living in the community.
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Affiliation(s)
- A Martorell
- Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
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Abstract
OBJECTIVE Care planning integrates a growing number of disciplines, research fields and analysis techniques. A framework of the main areas of interest with regard to evidence-based health care in mental health is provided here. METHOD The framework is based on the experience of working with data analysts and health and social decision makers at the PSICOST/RIRAG network, a Spanish research association which includes psychiatrists, health economists and health policy experts, as well as on a review of the literature. RESULTS Three main areas have been identified and described here: outcomes management, knowledge discovery from data, and decision support systems. Their use in mental health care is reviewed. CONCLUSION It is important to promote bridging strategies among these new fields in order to enhance communication and information transfer between the different parts involved in mental health decision making: i) clinicians and epidemiologists, ii) data analysts, iii) care policy makers and other end-users.
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Ayuso-Mateos JL, Pereda A, Dunn G, Vazquez-Barquero JL, Casey P, Lehtinen V, Dalgard O, Wilkinson G, Dowrick C. Predictors of compliance with psychological interventions offered in the community. Psychol Med 2007; 37:717-725. [PMID: 17094818 DOI: 10.1017/s0033291706009317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study sought to evaluate the acceptance of two brief psychological interventions for depressed individuals, contacted through a community survey, and to look for predictors of adherence at the patient level. METHOD The authors used data from the Outcomes of Depression International Network (ODIN) study, which included a randomized controlled trial in which depressed individuals from five European countries, and nine geographical areas were assigned to one of three groups: individual problem-solving treatment, group psychoeducation, or control group. In this analysis, we included all of the individuals who had been assigned to one of the psychological interventions. Compliance with intervention was defined in two different ways. Multiple logistic regression was used to see which variables might predict an individual's compliance with psychological treatment. RESULTS Psychological intervention was offered to 236 subjects. Treatment was completed by 128 subjects and not by 108 (compliance definition A). Three variables were found to have an effect on compliance A: the presence of a confidant, the use of antidepressant medication during the previous 6 months, and the previous use of any social or health services. On the other hand, 164 subjects had agreed to at least start the treatment, and 72 had not (compliance definition B). The three factors associated with compliance B were presence of a confidant, previous use of services, and the 'desire for change' score. CONCLUSIONS Social support and previous use of services are the main predictors of compliance with a psychological treatment in depressed individuals from the community. Implications for clinical practice and community programs are discussed.
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Affiliation(s)
- J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain.
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Vieta E, Cieza A, Stucki G, Chatterji S, Nieto M, Sánchez-Moreno J, Jaeger J, Grunze H, Ayuso-Mateos JL. Developing core sets for persons with bipolar disorder based on the International Classification of Functioning, Disability and Health. Bipolar Disord 2007; 9:16-24. [PMID: 17391346 DOI: 10.1111/j.1399-5618.2007.00322.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Functioning is increasingly being taken into account when assessing the impact of bipolar disorder (BD) on the individual, as well as the effectiveness of treatments. With the International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally agreed-upon framework and system for classifying the typical spectrum of problems in functioning, given the environmental context in which subjects live. ICF Core Sets are subgroups of ICF items selected to capture those aspects of functioning that are most likely to be affected by specific disorders. Within a given disorder, both Brief and Comprehensive Core Sets can be established to serve specific purposes. OBJECTIVE The aim of this paper is to outline the development process of the ICF Core Sets for BD. METHODS The final definition of ICF Core Sets for BD will be determined at an ICF Core-Sets Consensus Conference, which will integrate evidence from preliminary studies, namely (a) semi-structured interviews with people with BD in different countries, (b) a Delphi exercise with international experts participating and (c) a cross-sectional study. CONCLUSION ICF Core Sets are being designed with the goal of providing useful standards for research, clinical practice and teaching. We believe that these ICF Core Sets for BD will stimulate research leading to improved understanding of functioning, disability and health in BD. Such research, we hope, will lead to interventions and accommodations to improve restoration and maintenance of functioning and minimise disability among people with BD throughout the world.
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Affiliation(s)
- E Vieta
- Bipolar Disorders Programme, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
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Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea JM, Salamero M, Malhi GS, Gonzalez-Pinto A, Daban C, Alvarez-Grandi S, Fountoulakis K, Kaprinis G, Tabares-Seisdedos R, Ayuso-Mateos JL. Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord 2007; 9:103-13. [PMID: 17391354 DOI: 10.1111/j.1399-5618.2007.00327.x] [Citation(s) in RCA: 382] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few studies have examined the clinical, neuropsychological and pharmacological factors involved in the functional outcome of bipolar disorder despite the gap between clinical and functional recovery. METHODS A sample of 77 euthymic bipolar patients were included in the study. Using an a priori definition of low versus good functional outcome, based on the psychosocial items of the Global Assessment of Functioning (GAF, DSM-IV), and taking also into account their occupational adaptation, the patients were divided into two groups: good or low occupational functioning. Patients with high (n = 46) and low (n = 31) functioning were compared on several clinical, neuropsychological and pharmacological variables and the two patient groups were contrasted with healthy controls (n = 35) on cognitive performance. RESULTS High- and low-functioning groups did not differ with respect to clinical variables. However, bipolar patients in general showed poorer cognitive performance than healthy controls. This was most evident in low-functioning patients and in particular on verbal memory and executive function measures. CONCLUSIONS Low-functioning patients were cognitively more impaired than highly functioning patients on verbal recall and executive functions. The variable that best predicted psychosocial functioning in bipolar patients was verbal memory.
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Affiliation(s)
- A Martinez-Aran
- Institute of Neurosciences, University Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
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43
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Gutierrez-Recacha P, Chisholm D, Haro JM, Salvador-Carulla L, Ayuso-Mateos JL. Cost-effectiveness of different clinical interventions for reducing the burden of schizophrenia in Spain. Acta Psychiatr Scand 2006:29-38. [PMID: 17087813 DOI: 10.1111/j.1600-0447.2006.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of interventions for reducing the burden of schizophrenia in Spain. METHOD The study examined the cost-effectiveness of seven different types of clinical interventions at the level of Spanish population: i) current situation; ii) older antipsychotics alone; iii) new antipsychotics alone (risperidone); iv) older antipsychotics plus psychosocial treatment; v) new antipsychotics plus psychosocial treatment; vi) older antipsychotics plus case management and psychosocial treatment; vii) new antipsychotics plus case management and psychosocial treatment. RESULTS Interventions based on the combination of haloperidol with psychosocial treatment or psychosocial treatment plus case management proved to be the most efficient strategies. CONCLUSION The relatively modest additional cost of concurrent psychosocial treatment has significant health gains, thereby making such a combined strategy for schizophrenia more cost-effective than pharmacology alone.
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Affiliation(s)
- P Gutierrez-Recacha
- Department of Psychiatry, Hospital Universitario de la Princesa, Autónoma University, Madrid, Spain
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44
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Abstract
Serotonin syndrome, which occurs as a result of enhanced serotonin concentration in the central nervous system, is a well-known adverse effect of serotonin-active medications. The concomitant use of antidepressant drugs associated with lithium as a co-adjuvant seems to increase the risk of this adverse reaction. We report a case of the serotonin syndrome during treatment with lithium and venlafaxine, an antidepressant with a dual selective re-uptake inhibition mechanism, and review the literature for similar cases. A 71-year-old woman developed serotonin syndrome while receiving treatment with moderate doses of lithium and venlafaxine for refractory depression. She had been taking higher doses of venlafaxine during the previous months with no significant secondary effects. Use of the Naranjo adverse drug reaction probability algorithm indicated a probable relationship between serotonin syndrome and treatment with lithium and venlafaxine.
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Affiliation(s)
- J Adan-Manes
- Service of Psychiatry, Hospital Universitario de la Princesa, Madrid, Spain
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45
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Ayuso-Mateos JL, Gutierrez-Recacha P, Haro JM, Chisholm D. Estimating the prevalence of schizophrenia in Spain using a disease model. Schizophr Res 2006; 86:194-201. [PMID: 16859895 DOI: 10.1016/j.schres.2006.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 05/28/2006] [Accepted: 06/05/2006] [Indexed: 11/20/2022]
Abstract
There are two main sources of information on the epidemiology of schizophrenia: prevalence and incidence studies. Prevalence rates can be estimated from incidence figures, and vice versa. The present article aims to provide an estimate of the prevalence of schizophrenia in Spain, calculated from epidemiological and demographic data, using a disease model of schizophrenia which applies the specific methodology of the WHO Global Burden of Disease project. Our model assumes a causal relationship between incidence and prevalence, but takes into account other competing risk factors of mortality; this approach is more realistic than one assuming a simple linear relationship between both parameters. Our findings indicate an estimated mean prevalence of 3.0 per 1000 inhabitants per year for men, but slightly lower for women: 2.86 per 1000. Our model enables us to compare incidence figures with those provided by prevalence studies and obtain accurate estimates of the distribution of schizophrenia in the general population, which can be used to better identify treatment needs and the consequent allocation of resources.
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Affiliation(s)
- J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, c/ Diego de Leon 62 28006, Madrid, Spain.
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Ayuso-Mateos JL, Nieto-Moreno M, Sánchez-Moreno J, Vázquez-Barquero JL. Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF): aplicabilidad y utilidad en la práctica clínica. Med Clin (Barc) 2006; 126:461-6. [PMID: 16620734 DOI: 10.1157/13086326] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- José L Ayuso-Mateos
- Servicio de Psiquiatría, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
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47
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Ayuso-Mateos JL, Salvador-Carulla L, Chisholm D. [Use of quality of life measures in mental health economics and care planning]. Actas Esp Psiquiatr 2006; 34:1-6. [PMID: 16525899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Quality of life measurement is a key element in health economics and healthcare planning, particularly in chronic diseases associated to high morbidity and disability (i.e., mental disorders). This paper provides a critical review on the theoretical background of utility, on the methods for developing measures based on health preferences or values, and the composite indexes derived from them (DALY and QALY). Then the practical use in mental health is revised both in burden of disease studies and cost-utility analysis. There is an important requirement on the part of mental health researchers and policy makers alike to pay close attention to the underlying methods and construction of utility-based estimates of health outcome.
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Affiliation(s)
- J L Ayuso-Mateos
- Departamento de Psiquiatría, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid.
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48
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Adán J, Escosa M, Ayuso-Mateos JL. [Vagus nerve stimulation and psychosis. A single case report]. Actas Esp Psiquiatr 2005; 33:130-4. [PMID: 15768321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The appearance of behavioral disorders in the context of a decrease in the number of seizures in epileptic patients is a fact that was already described in Landolt's theory of forced normalization in the middle of the XX century. Through this clinical case, we propose several mechanisms that aim to give a general explanation to the physiopathology of this condition. Among them, the theory which suggests increased alertness as a result of inhibitory mechanisms secondary to a long lasting epileptic condition stands out. In addition, we consider the possibility that left vagus nerve stimulation (VNS), a procedure used as a second line treatment in epileptic patients refractory to multiple drug therapy, may cause an inhibitory reaction of similar characteristics as the previously described, and could therefore lead to different psychiatric disorders. Lastly, we bring up several alternatives that will try to throw some light on the physiopathological condition that leads to the chronification of this disease, the theory regarding a cognitive deterioration associated to the appearance of negative symptoms in patients with temporal lobe epilepsy standing out.
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Affiliation(s)
- J Adán
- Servicio de Psiquiatría, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid.
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Abstract
BACKGROUND The initial Global Burden of Disease study found that depression was the fourth leading cause of disease burden, accounting for 3.7% of total disability adjusted life years (DALYs) in the world in 1990. AIMS To present the new estimates of depression burden for the year 2000. METHOD DALYs for depressive disorders in each world region were calculated, based on new estimates of mortality, prevalence, incidence, average age at onset, duration and disability severity. RESULTS Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, accounting for almost 12% of all total years lived with disability worldwide. CONCLUSIONS These data on the burden of depression worldwide represent a major public health problem that affects patients and society.
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Affiliation(s)
- T B Ustün
- Global Programme on Evidence for Health Policy, WHO, Geneva, Switzerland.
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50
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Fewtrell LJ, Prüss-Ustün A, Landrigan P, Ayuso-Mateos JL. Estimating the global burden of disease of mild mental retardation and cardiovascular diseases from environmental lead exposure. Environ Res 2004; 94:120-33. [PMID: 14757375 DOI: 10.1016/s0013-9351(03)00132-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The disease burden from exposure to lead resulting in mild mental retardation (due to IQ point decreases) and cardiovascular outcomes (due to increases in blood pressure) was estimated at a global level. Blood lead levels were compiled from the literature for 14 geographical regions defined by the World Health Organization according to location and adult and child mortality rates. Adjustments were applied to these levels, where appropriate, to account for recent changes relating to the implementation of lead-reduction programs and the lower levels seen in rural populations. It is estimated that mild mental retardation and cardiovascular outcomes resulting from exposure to lead amount to almost 1% of the global burden of disease, with the highest burden in developing regions. This estimate can be used to assess the magnitude of the benefits that could be accrued by increasing the global coverage of lead-reduction programs.
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Affiliation(s)
- L J Fewtrell
- Centre for Research into Environment and Health, University of Wales, Aberystwyth, UK
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