Our findings suggest that patients and providers have a variety of options for choosing an effective treatment for PTSD. Substantial differences in study design and study participant characteristics make identification of a single best treatment difficult. Not all medications or psychotherapies are effective.
IntroductionRecent epidemiological studies suggest that the prevalence of bipolar disorder might be misdiagnosed initially as unipolar depression due to the difficulty to detect episodes of hypomania. The Hypomania Checklist (HCL-32), validated in Spanish, is a self-report questionnaire with 32 hypomania items designed to screen for hypomanic episodes.ObjectivesTo examine the prevalence of hypomania in patients with unipolar depression. Corroborate the efficacy of the HCL-32 to detect symptoms of hypomania.MethodsThe presence of hypomanic symptoms was assessed by the HCL-32 in a sample of 128 subjects diagnosed with bipolar I disorder (n = 30), bipolar II disorder (n = 1), unipolar depression (n = 57), and anxiety disorder (n = 15) according to DSM-IV-TR criteria. A control group of healthy subjects was selected (n = 25).ResultsThe discriminative capacity was analyzed by the ROC curve. The AUC was 0.65 which did not indicate a good capacity. The sensitivity (S), specificity (E) and prevalence (P) of hypomania in unipolar patients for the following cut-off points were :14: S = 81.6%,95%CI(69.8, 93.5); E = 30.1%,95%CI(19.7,40.6); P = 74.1%; 15: S = 77.6%,95%CI(64.9,90.3); E = 37.4%,95%CI(26.3,48.4); P = 67.2%; 16: S = 59.2%,95%CI(44.4,73.9); E = 55.4%,95%CI(44.1,74.0); P = 51.7%; 17: S = 55.1%,95%CI(40.2,70.1); E = 57.8%,95%CI(46.6,69.1); P = 48.3%.ConclusionsThe HCL-32 has a high sensitivity but a low specificity as screening instrument. This might explain the high proportion of hypomania found in this study. The difference with previous studies is that our sample was heterogeneous, unstable and serious. This suggests that the HCL-32 is not valid for any psychiatric sample. Future research should develop more specific instruments with better external validity.
IntroductionThe studies about the comorbidity of major depressive disorder (MDD) and bipolar disorder (BD) have increased in the last years. The comorbidity with Axis I psychiatric disorders complicates the diagnosis, prognosis and treatment.ObjectivesTo analyze the prevalence of affective disorders associated with another Axis I psychiatric disorders to treat correctly from the beginning of the diagnosis and to improve the course of the disorder and the quality of life of these patientsMethodsThe subjects who participated in the study were diagnosed of bipolar I disorder, bipolar II disorder and MDD, according to DSM-IV-TR criteria. The sample (n = 114) was divided into three groups: MDD (n = 58), BD (n = 31) and a control group of healthy subjects (n = 25). The diagnosis and stability were assessed using the MINI International Neuropsyquiatric Interview and the Hamilton Depression Rating Scale (HDRS).ResultsBD had a significantly association with risk of suicide (38%), anxiety disorder (3.3%) and social phobia (12.9%). It was also reported a significant association between MDD and risk of suicide (71%), manic/hypomanic episodes (25.9%), anxiety disorder (37.9%), social phobia (25.9%) and generalized anxiety disorder (37.9%).ConclusionsIt is necessary for clinical practice an integrative model which takes into account the comorbidity of affective disorders to improve the response to treatment and the prognosis of these mental disorders
IntroductionAlcohol abuse causes dopamine release in the mesolimbic system, which activates the reward circuit. This is linked to an interdependent opioid, serotonergic and endocannabinoid system. Nalmefene is a modulator of the endogenous opioid system, with antagonistic effect on mu and delta receptors, and a partial agonist activity kappa. This means that reduces the reinforcing effects of alcohol consumption through the cortical-mesolimbic system. Therefore, when a patient takes nalmefene, the satisfaction obtained when he drinks is lower, which increases the possibility to have more control over drinking.The efficacy of nalmefene was evaluated in two profiles of patients: 1. No abstinence in alcohol dependence disorder and continuous relapses, 2. Cocaine dependence disorder associated to alcohol abuse.ObjectivesImproving the quality of life and compliance rates due to the difficulties of following a strict treatment to achieve the abstinence. Furthermore, in cases of patients with cocaine dependence disorder and alcohol abuse, the objective is to avoid cocaine use by reducing previous alcohol consumption.Conclusionnalmefene offers the possibility of treating the addiction from a new perspective. Our current clinical experience has been able to treat subjects with conventional treatments failures and those who need to achieve the necessary control to reduce cocaine use.Disclosure of interestThe authors have not supplied their declaration of competing interest.
INTRODUCTION: patients with dual pathology have worse clinical evolution and worse therapeutic response. The repeated administration of substances sensitizes the dopaminergic systemwith downregulation of the reward circuit. When the drug use stops, the exposureto stimuli produces a dopamine increase and craving appears. AIMS: to prove usefulness of paliperidone in dual pathology for craving andfor drug abuse.MATERIALS AND METHODS: 18 patients diagnosed with dual pathology. They were treated with paliperidone and all of them were interviewed about craving andsubstance use. RESULTS: 4 groups: Cannabis (5%). Cannabis and cocaine (16.66%). Cannabis andother two or more substances (16.66%). Cocaine and alcohol (16.66%). All ofthem were diagnosed of dual pathology: induced psychotic disorder (33.33%),personality disorder (27.77%), conduct disorder (16.66%), paranoid schizophrenia (11.11%), bipolar disorder (5.55%), and dysmorphic disorder(5.55%). 38.89% achieved abstinence. 50% reduced significantly substance use.77.78% verbalized a decrease in craving.DISCUSSION: cannabis disables the gabaergic interneurons, which stop inhibiting the dopaminergic neurons and a large amount of dopamine is released from the accumbens nucleus. Cocaine increases dopamine and 5-HT levels on thebrain. Paliperidone presents an affinity for D2 and 5TH2a receptors, so this might explain the results, because it blocks the enhancer effect, which contributes to the craving decrease and to the drug withdrawal. CONCLUSIONS: paliperidone seems to be a good choice in dual pathologydue to the improvement on craving and drug abuse
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