Showing papers by "Gabriel Rubio published in 2006"

Impulsivity and Sustained Attention in Pathological Gamblers: Influence of Childhood ADHD History

Abstract: Pathological gambling (PG) has been associated to both impulsiveness and attention deficit/hyperactivity disorder (ADHD) in different studies. Our objective was to compare different impulsivity and sustained attention variables, using both behavioural tasks and self-administered questionnaires, in a group of pathological gamblers with a history of childhood ADHD (PG-ADHD; n = 16), a group of pathological gamblers without this history (PG-non-ADHD; n = 39), and a control group (n = 40). As instruments of measure, we used the stop signal task (to evaluate inhibitory control/impulsivity), the differential reinforcement of Low Rate Responding Task (delay of gratification/impulsivity) and the Continuous Performance Test (sustained attention). The Barratt Impulsivity Scale (BIS-11) was used as a self-administered questionnaire to measure impulsiveness. Our results show that patients in the PG-ADHD group exhibit a significantly lower capacity to delay gratification than those in the PG-non-ADHD and control groups, and less inhibitory control than patients in the PG-non-ADHD group. On self-administered questionnaires such as the BIS-11 the PG-ADHD group obtained higher scores than the PG-non-ADHD and control groups. However, no differences were found with respect to sustained attention using the CPT. Our results suggest a possible selective implication of the prefrontal cortex in PG, which would be especially evident in those with a childhood history of ADHD.

Long-Acting Injectable Risperidone Compared with Zuclopenthixol in the Treatment of Schizophrenia with Substance Abuse Comorbidity

Abstract: Objective:This study aimed to compare the efficacy of long-acting risperidone and zuclopenthixol in subjects with schizophrenia and substance abuse.Method:A total of 115 subjects with schizophrenia...

(AAT)n repeat in the cannabinoid receptor gene, CNR1: association with schizophrenia in a Spanish population.

Abstract: The cannabinoid receptor 1 gene (CNR1) has been associated with addictive disorders and schizophrenia in different studies. We have compared the frequencies of the alleles for the 3′-UTR CNR1 microsatellite in a sample of 113 Spanish schizophrenic patients, including 68 with comorbid substance abuse, and 111 healthy controls. We report that the frequency of the allele 4 of this microsatellite is significantly lower in schizophrenia patients when compared with controls (χ2 = 7.858; df 1; P = 0.005). No differences have been found with respect to substance abuse. Thus, the allele 4 represents, in our sample, a protective factor against schizophrenia (odds ratio 0.468, 95% confidence interval (CI) 0.27–0.79). The population attributable genetic risk for the allele 4 absence is 30% (95% CI = 17–41%) and the attributable risk for the allele 4 absence in those with schizophrenia is 53% (95% CI = 20–73%). Our results suggest that, independent of substance abuse, differences in the cannabinoid system function could be involved in the vulnerability to schizophrenia in Spanish population.

Effects of lamotrigine in patients with bipolar disorder and alcohol dependence.

Abstract: Background: Bipolar disorder is significantly associated with alcohol use disorders. Anticonvulsant drugs are used in the treatment of bipolar disorder and they have also been used to treat alcohol dependence. The purpose of the present study was to evaluate tolerance and safety of lamotrigine in a dual-diagnosis population presenting bipolar disorder and alcohol dependence. Open-label lamotrigine was examined in 28 outpatients with DSM-IV bipolar disorder and alcohol dependence. Lamotrigine was added to existing medication regimens. Method: Lamotrigine was started at a dose of 25 mg/day and titrated to a maximum dose of 300 mg/day. Subjects received a baseline evaluation which included a Structured Clinical Interview for DSM-IV (SCID) and weekly assessments for 12 weeks with the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), Severity of Alcohol Dependence Scale (SADS), a Visual Analogue Scale for Craving severity (VASC), and alcohol consumption. The concentration of carbohydrate-deficient transferrin (CDT) was used as an indirect measure of alcohol consumption. The sample consisted of 18 men and 10 women diagnosed with alcohol dependence and bipolar disorder I (n = 21) or bipolar disorder II (n = 7), with a mean age of 36.5 ± 7.7 years. Results: Significant improvement was observed in HAM-D, YMRS, and BPRS scores (p < 0.01). Craving and CDT also significantly decreased (p < 0.001). Lamotrigine was well tolerated with no dropout subjects due to adverse events. Conclusion: Lamotrigine is safe and well tolerated in this sample and associated with improvement in mood, alcohol craving and alcohol consumption. A placebo-controlled study would be of interest.

C957T DRD2 polymorphism is associated with schizophrenia in Spanish patients.

Abstract: Objective: The objective was to confirm whether a homozygous genotype for the C957 allele of the C957T DRD2 gene single nucleotide polymorphism (SNP) is associated with schizophrenia in an independent study population. Method: We examined the genotypic distribution of this SNP in a set of clinically ascertained schizophrenic patients (n = 131) and age-matched control subjects (n = 364). Individuals were genotyped using automated analysis of fluorescently labeled PCR products. Results: The distribution of grouped genotypes for the C957T DRD2 SNP (CC vs. CT, TT) showed that C homozygote genotype was over-represented in our patient sample when compared with control subjects. This difference reaches the statistical significance (χ2 = 7.0; df = 1; P = 0.008; OR = 2.05; % CI 1.2–3.4). Conclusion: The findings of this study provide additional evidence that genetic variation at the DRD2 gene plays an important role in the vulnerability to schizophrenia.

Risperidone versus zuclopenthixol in the treatment of schizophrenia with substance abuse comorbidity: a long-term randomized, controlled, crossover study

Abstract: Background: Substance use disorders (SUDs) are present in more than 50% of subjects diagnosed with schizophrenia. However, there are no controlled studies assessing the efficacy of antipsychotic drugs in this subgroup of patients. The aim of the present work was to compare the efficacy of risperidone and zuclopenthixol in a sample of schizophrenic subjects with dual diagnosis. Method: Thirty-three male were selected for treatment with risperidone, while another 33 were treated with zuclopenthixol. Substances most commonly used were alcohol, cannabis (both 82%) and cocaine (32%). Patients were randomized and treated for the first six months with one antipsychotic and the second six months with the other antipsychotic. Psychopathological and clinical scales were used every two months. Participants received training on how to reduce their consumption of substances (Substance Abuse Management Module, SAMM). Results: During the first six months risperidone group patients presented fewer positive urine tests and showed better compliance with the SAMM programme. In the second period the patients treated with risperidone significantly improved their scores on the PANSS-negative subscale. Differences between the CGIs indicated that the subjects who moved from risperidone to zuclopenthixol worsened, while those who moved from zuclopenthixol to risperidone significantly improved. Conclusions: Risperidone was more effective than zuclopenthixol in improving the symptoms of schizophrenia and substance use.

Current situation of depression healthcare in Spain: results of a psychiatrists' survey

Abstract: Objective: To analyze the current situation of healthcare for depression in Spain, according to psychiatrists opinion, and how it has evolved over the last 20 years, comparativily with the results reported in previous studies of our group. Methods: Throughout 2002, we recorded the opinions of 101 specialists in psychiatry after asking them to fill out structured questionnaires in which they rated care, clinical, therapeutic and care quality. ' Results: The presence of depressive disorders in healthcare is substantial, despite the high figures for "concealed epidemiology", with an increase in these last 20 years of disorders comorbid with anxiety. Currently, most patients arrive at the psychiatrist having been referred by their general practitioners (GP), as there is now less reluctance in depressive patients to such referral. In the last years there has been an increase in pharmacological treatment, with adverse effects of the drugs representing the major obstacle to non-adherence to such treatment. Selective serotonin reuptake inhibitors (SSRIs) constitute the pharmacological group of choice, and are the drugs most commonly used in the treatment of depression, together with venlafaxine. Areas where there is a need for improvement are time devoted to consultation, coordination between GPs and psychiatrists, waiting lists, and resources available to Mental Health Units. Conclusions: Current situation of depression healthcare in Spain has substantially changed in recent years, improving in some aspects, thanks, in part, to the attitudes of GPs with this disorder and to evolution of pharmacological treatment.

TaqI-A polymorphism linked to the DRD2 gene and P300 in alcoholic patients

Abstract: Background and Objectives: Different studies carried out mainly in young non-consuming children of alcoholics show an association of P300 abnormalities with alcoholism and with the T aqI- A1 allele. Since the relationship between P300 and the T aqI- A1 allele has not been specifically studied in alcoholic patients, our objective was to investigate whether the association exits in this population. Methods: Our sample consisted of 176 recently detoxified male alcohol-dependent patients. These patients had been alcohol dependent from a mean age of 22.6 years and consumed on average 164.63 (± 142.99) cm 3 of alcohol daily. P300 was studied using an auditory paradigm. T aqI -A polymorphism genotyping was performed. The association between P300 and T aqI- A, and correlation with age and alcohol consumption, was studied. Results: The T aqI- A1 allele was found in 38.6% of our patients (n = 68). The latency and amplitude of P300 were 361.64 milliseconds and 17.53 microvolts, respectively. P300 wave latency in alcoholic patients was longer than the reference value obtained from a sample of healthy men of the Event-Related Potentials Unit (p < 0.001). Alcoholic patients who carried the T aqI -A1 allele showed more prolonged P300 latency than non-carriers, and these in turn more than the control subjects. P300 characteristics varied according to age, but an associa- tion with amount of alcohol or number of years consuming was not found. Conclusions: There is a relationship between the T aqI -A polymorphism and P300 wave characteristics in alcoholic patients. Further investigations need to be carried out in non- consuming alcoholic patients and in healthy control subjects to confirm this association and to clarify the possible influence of the neurotoxic effects of alcohol on P300 physiology.

Reboxetine addition in patients with mirtazapine-resistant depression : A case series

Abstract: Objectives: Treatment-resistant depression is a common occurrence in clinical practice as well as combination treatment with 2 different antidepressants. In the present case series, we study the effectiveness of the addition of reboxetine, during 12 weeks, to 14 outpatients diagnosed with major depressive disorder, according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria, who had previously failed to respond or who had only responded partially, over a period of 6 weeks, to conventional treatment with mirtazapine. Methods: Evaluation of antidepressant efficacy was carried out through the application of the 21-item Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impressions-Global Improvement Scale (CGI-I). Results: The percentages of responders (HDRS ≥50%), patients in remission (HDRS ≤10), and improving patients (CGI-I absolute value <4) were 35.7%, 28.6%, and 64.3%, respectively. No serious side effects were observed during combination therapy, being more frequent dry mouth (2 cases). Conclusions: The initial findings of our study show that reboxetine and mirtazapine may constitute an effective and low side effects combination.

A propósito de la locura del hidalgo Alonso Quijano en el marco de la medicina española tardorrenacentista

Abstract: Introduccion: El Quijote es una de las obras literarias mas analizadas desde la perspectiva psicopatologica, bien con el objetivo de obtener un diagnostico psiquiatrico de su principal personaje, Alonso Quijano, o de recabar datos para conocer mas profundamente el concepto de locura en la sociedad renacentista tardia espanola. En el presente trabajo se pretende efectuar un enfoque sintetico y revisionista a lo mucho que se ha escrito sobre el posible trastorno mental de Alonso Quijano, siempre en el contexto de la epoca en que fue escrita la novela, asi como analizar la evolucion de su conceptualizacion diagnostica a traves del tiempo: monomania, paranoia, trastorno delirante, mitomania histerica, trastorno bipolar, demencia presenil, etc. Tambien se analizan las posibles influencias cientificas en que se pudo inspirar Cervantes en este campo, fundamentalmente la obra de Juan Huarte de San Juan (Examen de ingenios para las ciencias) y de Erasmo de Rotterdam (Elogio de la locura), asi como los remedios terapeuticos a los que recurre el autor para el manejo de los sintomas psiquiatricos de su alienado personaje.

Evaluación del tratamiento antipsicótico como factor de riesgo de diabetes en la esquizofrenia: estudio de casos y controles

Abstract: Fundamento y objetivos Los antipsicoticos atipicos se han relacionado en los ultimos anos con la hiperglucemia, la diabetes mellitus, el aumento de peso y las alteraciones de lipidos en algunos pacientes. El objetivo de este estudio es analizar si el tratamiento continuado con risperidona, olanzapina o clozapina altera el metabolismo de los lipidos y la glucosa en los pacientes esquizofrenicos. Pacientes y metodo Este estudio incluyo a pacientes esquizofrenicos que habian recibido tratamiento psiquiatrico en monoterapia con clozapina, olanzapina o risperidona durante un periodo de 1-3 anos. Los pacientes diagnosticados de diabetes durante el tratamiento psiquiatrico y los que presentaron cifras de glucemia en ayunas ≥ 126 mg/dl en dos determinaciones consecutivas constituyeron el grupo de casos. Los demas pacientes esquizofrenicos en tratamiento que no presentaron estas alteraciones fueron incluidos en el grupo control. Resultados Segun el analisis ajustado de regresion logistica multivariante para determinar el efecto del tratamiento antipsicotico sobre la presencia de diabetes –que incluyo tambien como factores de evaluacion la edad y el indice de masa corporal– la odds ratio (OR) para olanzapina respecto de risperidona fue de 2,22 (intervalo de confianza [IC] del 95%, 1,12-4,22; p = 0,0228); y para clozapina en relacion con risperidona, de 2,87 (IC del 95%, 1,19-6,93; p = 0,0192). Ambos resultados muestran que los pacientes tratados con olanzapina o clozapina presentan un riesgo de diabetes mellitus significativamente superior en comparacion con los pacientes tratados con risperidona. El riesgo de aumento de trigliceridos vario significativamente en los pacientes tratados con olanzapina (OR = 1,34; p = 0,0075) o clozapina (OR = 1,58; p = 0,0028). Conclusiones El riesgo de diabetes mellitus en los pacientes tratados con olanzapina es dos veces veces mas elevado que el de los tratados con risperidona y, en el caso de los tratados con clozapina, el riesgo es praticamente tres veces superior al de risperidona. La risperidona ofrece al parecer un mejor perfil de seguridad a largo plazo respecto al riesgo de alteraciones del metabolismo de los lipidos y la glucosa.