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Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys
- Alan E. Kazdin, Meredith G. Harris, Irving Hwang, Nancy A. Sampson, Dan J. Stein, Maria Carmen Viana, Daniel V. Vigo, Chi-Shin Wu, Sergio Aguilar-Gaxiola, Jordi Alonso, Corina Benjet, Ronny Bruffaerts, José Miguel Caldas-Almeida, Graça Cardoso, Elisa Caselani, Stephanie Chardoul, Alfredo Cía, Peter de Jonge, Oye Gureje, Josep Maria Haro, Elie G. Karam, Viviane Kovess-Masfety, Fernando Navarro-Mateu, Marina Piazza, José Posada-Villa, Kate M. Scott, Juan Carlos Stagnaro, Margreet ten Have, Yolanda Torres, Cristian Vladescu, Ronald C. Kessler
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- Journal:
- Psychological Medicine / Volume 54 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 14 September 2023, pp. 67-78
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Background
Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.
MethodsFace-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.
Results10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.
ConclusionDropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
Coronavirus disease 2019 is associated with long-term depressive symptoms in Spanish older adults with overweight/obesity and metabolic syndrome
- Sangeetha Shyam, Carlos Gómez-Martínez, Indira Paz-Graniel, José J. Gaforio, Miguel Ángel Martínez-González, Dolores Corella, Montserrat Fitó, J. Alfredo Martínez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Francisco J. Tinahones, José Manuel Santos-Lozano, J. Luís Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, María Ortiz Ramos, Josep Vidal, Maria Mar Alcarria, Lidia Daimiel, Emilio Ros, Fernando Fernandez-Aranda, Stephanie K. Nishi, Oscar García Regata, Estefania Toledo, Jose V. Sorli, Olga Castañer, Antonio Garcia-Rios, Rafael Valls-Enguix, Napoleon Perez-Farinos, M. Angeles Zulet, Elena Rayó-Gago, Rosa Casas, Mario Rivera-Izquierdo, Lucas Tojal-Sierra, Miguel Damas-Fuentes, Pilar Buil-Cosiales, Rebeca Fernández-Carrion, Albert Goday, Patricia J. Peña-Orihuela, Laura Compañ-Gabucio, Javier Diez-Espino, Susanna Tello, Ana González-Pinto, Víctor de la O, Miguel Delgado-Rodríguez, Nancy Babio, Jordi Salas-Salvadó
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- Psychological Medicine / Volume 54 / Issue 3 / February 2024
- Published online by Cambridge University Press:
- 05 September 2023, pp. 620-630
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Background
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
MethodsParticipants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
ResultsCOVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
ConclusionsCOVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
Smoking treatments for patients with mental illness: case presentation and a brief literature review
- F. Garcia Sanchez, M. Gutierrez Rodriguez, C. Moreno Menguiano, M. A. Corral Alonso, J. J. Vazquez Vazquez, S. M. Bañon Gonzalez, V. Voces Domingo, J. A. Casado de la Hera
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S756
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Introduction
Smoking prevalence in patients with mental illness ranges between two to 4 times higher than general population. This higher prevalence has a multifactorial origin, and some of the possible causes are still unknown.
They have a higher prevalence of tobacco-associated diseases and higher mortality.
Additionally, these patients have greater difficulty in treating and quitting smoking.
A relationship has been found between severity of mental illness and smoking. Risk of suicide seems to be higher in patients with higher tobacco consumption. Schizophrenia is the mental illness that has been most closely related to smoking, with a prevalence close to 90%.
ObjectivesThe aim of this work is reviewing the current bibliography referring to smoking treatments for patients with mental illness
MethodsA literature search using electronic manuscripts available in PubMed database published during the last ten years and further description and discussion of a single-patient clinical case
ResultsThe treatment of tobacco dependence in patients with mental illnesses is sometimes waited until there is psychiatric stability, which can take a long time in those cases with more severe mental disorders, which can have negative physical and psychiatric consequences.
The combined treatment of cognitive behavioral therapy and pharmacological treatment is the most effective approach. Nicotine replacement therapy can be useful, while combined use of antidepressants or anxiolytics is also recommended.
Bupropion has shown efficacy. In patients with schizophrenia it does not seem to worsen positive symptomatology, but improving the negative one. It should not be used in patients with bipolar disorder or bulimia.
Varenicline has shown efficacy in the general population, but limitations were established in patients with mental illness, although it is the drug that has shown greater efficacy. However, is not currently available in our country.
Cytisine is a drug with limited number of studies in the psychiatric population but it may be a reasonable treatment alternative.
ConclusionsThe prevalence of tobacco use in patients with mental illness is higher than the general population, especially in paranoid schizophrenia. The consequences on physical health and the evolution of psychiatric illness are very relevant. Based on above, a multidisciplinary and coordinated management involving psychiatrists and other specialists in the treatment of these patients should be desirable.
Disclosure of InterestNone Declared
From rags to riches? An illusory semantic change in ancient Greek
- Alcorac Alonso Déniz, Julián V. Méndez Dosuna
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- Journal:
- The Journal of Hellenic Studies / Volume 143 / November 2023
- Published online by Cambridge University Press:
- 13 July 2023, pp. 189-201
- Print publication:
- November 2023
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The rare word λάκος occurs in an oracular enquiry from Dodona. Although it is likely to mean ‘a (bundle) of rags’, some scholars believe that the consultation concerns the theft of a garment in good condition. However, the evidence for a semantic change ‘tatters’ > ‘garment’ or vice versa in ancient Greek is weak. In this paper, we assess the evidence of some nouns (Aeolic βράκος and poetic λαῖφος, λαίφη, σπϵῖρον) that allegedly combine the meanings ‘(bundle of) tatters, rags’ and ‘piece of clothing, garment’. Drawing from the evidence provided by papyri and inscriptions, we propose two alternative hypotheses for λάκος in the Dodonaean enquiry: it may refer either to a ragged garment kept as an offering in a temple or to some tattered cloth used for wrapping various valuable items.
Students’ attitudes to animal welfare and rights in Europe and Asia
- CJC Phillips, S Izmirli, SJ Aldavood, M Alonso, Bl Choe, A Hanlon, A Handziska, G Illmann, L Keeling, M Kennedy, GH Lee, V Lund, C Mejdell, VR Pelagic, T Rehn
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- Journal:
- Animal Welfare / Volume 21 / Issue 1 / February 2012
- Published online by Cambridge University Press:
- 01 January 2023, pp. 87-100
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A survey of attitudes towards the welfare and rights of animals was conducted in universities in 11 European and Asian countries, to improve understanding of cultural differences that might impact on trade and international relations. Collaborators’ universities were recruited in each country to assist in the design, translation and administration of the survey via the internet in a convenient selection of the country's universities, providing 3,433 student responses from at least 103 universities. Respondents rated the acceptability of 43 major concerns about animals (focused on type of use, animal integrity, killing animals, animal welfare, experimentation on animals, changes in animal genotypes, the environment for animals and societal attitudes towards animals). Students from European countries had more concern for animal welfare than students from Asian countries, which may be partly explained by increased affluence of European students as there was a positive correlation between student expenditure and concern for animal welfare and rights. Southern and central European countries had most concern for animal rights and unnatural practices. Those in communist or former communist countries in Asia and Europe had most concern about killing animals and those in northern European countries the least. Regional similarities between neighbouring countries were evident in responses to animal issues and there were no differences between ethnic groups within a country. Thus, there were national and continental differences in European and Asian students’ attitudes to animals’ welfare and rights, which appear to arise as a result of the socio-political situation in regions rather than religious or other differences.
Prevalence of depression in Europe using two different PHQ-8 scoring methods
- J. Arias De La Torre, G. Vilagut, A. Ronaldson, A. Serrano-Blanco, J. Valderas, V. Martín, A. Dregan, I. Bakolis, J. Alonso
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S299
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Introduction
The prevalence of depression based on the Patient Health Questionnaire-8 (PHQ-8) may vary depending on the scoring method.
Objectives1) To describe the prevalence of depression in Europe using two PHQ-8 scoring methods. 2) To identify the countries with the highest prevalence according to each method.
MethodsData from 27 countries included in the European Health Survey (EHIS-2) for the year 2014/2015 were used (n=258,888). All participants who completed the PHQ-8 were included. The prevalence of depression and its 95% Confidence Interval (95%CI) were calculated overall for the whole of Europe and for each country using a PHQ-8≥10 cut-off point and the PHQ-8 algorithm scoring method. Weights derived from the complex sample design were considered for their calculation.
ResultsThe overall prevalence of depression for all Europe was lower using the PHQ-8>=10 cut-off point (6.38%, 95%CI 6.24-6.52) than the PHQ-8 algorithm (7.01%, 95%CI, 6.86-7.16). Using the PHQ-8≥10 cut-off point, the highest prevalence was observed in Iceland (10.33%, 95%CI, 9.33-11.32), Luxembourg (9.74%, 95%CI, 8.76-10.72) and Germany (9.24%, 95%CI, 8.82-9.66). Using the PHQ-8 algorithm the highest rates were observed in Hungary (10.99%, 95%CI,10.14-11.84), Portugal (10.63%, 95%CI, 9.96-11.29) and Iceland (9.80%, 95%CI, 8.77-10.83).
ConclusionsThere is variability in the prevalence of depression rates in Europe according to the PHQ-8 scoring method. These findings suggest the necessity of identify the method of choice for each country comparing with a gold standard measure (clinical diagnosis). Countries with consistent higher prevalence of depression based on PHQ-8 regardless of scoring method deserve further study.
DisclosureThis work has been funded by CIBERESP (ESP21PI05)
Dietary diversity and depression: cross-sectional and longitudinal analyses in Spanish adult population with metabolic syndrome. Findings from PREDIMED-Plus trial
- Naomi Cano-Ibáñez, Lluis Serra-Majem, Sandra Martín-Peláez, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, Camille Lassale, Jose Alfredo Martínez, Ángel M Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Ana María Gómez-Pérez, José Lapetra, Fernando Fernández-Aranda, Aurora Bueno-Cavanillas, Josep A Tur, Naiara Cubelos, Xavier Pintó, José Juan Gaforio, Pilar Matía-Martín, Josep Vidal, Cristina Calderón, Lidia Daimiel, Emilio Ros, Alfredo Gea, Nancy Babio, Ignacio Manuel Gimenez-Alba, María Dolores Zomeño-Fajardo, Itziar Abete, Lucas Tojal Sierra, Rita P Romero-Galisteo, Manoli García de la Hera, Marian Martín-Padillo, Antonio García-Ríos, Rosa M Casas, JC Fernández-García, José Manuel Santos-Lozano, Estefanía Toledo, Nerea Becerra-Tomas, Jose V Sorli, Helmut Schröder, María A Zulet, Carolina Sorto-Sánchez, Javier Diez-Espino, Carlos Gómez-Martínez, Montse Fitó, Almudena Sánchez-Villegas
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- Journal:
- Public Health Nutrition / Volume 26 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 19 July 2022, pp. 598-610
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Objective:
To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms.
Design:An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used.
Setting:Spanish older adults with metabolic syndrome (MetS).
Participants:A total of 6625 adults aged 55–75 years from the PREDIMED-Plus study with overweight or obesity and MetS.
Results:Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (β = 0·70, 95 % CI (0·05, 1·35)).
Conclusions:According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.
Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study
- M. Espinola-Nadurille, M. Restrepo-Martínez, L. Bayliss, E. Flores-Montes, V. Rivas-Alonso, S. Vargas-Cañas, L. Hernández, I. Martínez-Juarez, A. Gonzalez-Aguilar, R. Solis-Vivanco, G. L. Fricchione, J. Flores-Rivera, J. Ramirez-Bermudez
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- Psychological Medicine / Volume 53 / Issue 9 / July 2023
- Published online by Cambridge University Press:
- 10 May 2022, pp. 4266-4274
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Background
Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments.
MethodsA prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF.
ResultsAfter obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia.
ConclusionsOur study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.
Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey
- J. Alonso, G. Vilagut, I. Alayo, M. Ferrer, F. Amigo, A. Aragón-Peña, E. Aragonès, M. Campos, I. del Cura-González, I. Urreta, M. Espuga, A. González Pinto, J. M. Haro, N. López Fresneña, A. Martínez de Salázar, J. D. Molina, R. M. Ortí Lucas, M. Parellada, J. M. Pelayo-Terán, A. Pérez Zapata, J. I. Pijoan, N. Plana, M. T. Puig, C. Rius, C. Rodriguez-Blazquez, F. Sanz, C. Serra, R. C. Kessler, R. Bruffaerts, E. Vieta, V. Pérez-Solá, P. Mortier, MINDCOVID Working group
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 31 / 2022
- Published online by Cambridge University Press:
- 29 April 2022, e28
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Aims
Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.
Methods8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.
Results4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.
ConclusionsOur study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565
Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report
- Alan E. Kazdin, Chi-Shin Wu, Irving Hwang, Victor Puac-Polanco, Nancy A. Sampson, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Corina Benjet, José-Miguel Caldas-de-Almeida, Giovanni de Girolamo, Peter de Jonge, Silvia Florescu, Oye Gureje, Josep M. Haro, Meredith G. Harris, Elie G. Karam, Georges Karam, Viviane Kovess-Masfety, Sing Lee, John J. McGrath, Fernando Navarro-Mateu, Daisuke Nishi, Bibilola D. Oladeji, José Posada-Villa, Dan J. Stein, T. Bedirhan Üstün, Daniel V. Vigo, Zahari Zarkov, Alan M. Zaslavsky, Ronald C. Kessler, the WHO World Mental Health Survey collaborators
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- Journal:
- Psychological Medicine / Volume 53 / Issue 4 / March 2023
- Published online by Cambridge University Press:
- 23 September 2021, pp. 1583-1591
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Background
The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.
MethodsFace-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.
Results3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.
ConclusionADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
Pending challenges to e-mental health in the COVID-19 era: Acceptability of a smartphone-based ecological momentary assessment application among patients with schizophrenia spectrum disorders
- J.-D. Lopez-Morinigo, B.-E. Maria Luisa, A. Porras-Segovia, A. Sánchez-Escribano Martínez, P.-J. Escobedo-Aedo, V. González Ruiz-Ruano, L. Mata-Iturralde, L. Muñoz-Lorenzo, S. Sánchez-Alonso, A. Artés-Rodríguez, E. Baca-Garcia
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S343
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Introduction
Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.
ObjectivesTo investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.
MethodsSample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.
ResultsSample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).
Multivariable binary logistic regression model on ‘user’ as outcome β SE Wald p OR 95% CI Age -0.075 0.038 3.910 0.048 0.928 0.861-0.999 Education level -0.967 1.289 0.563 0.453 0.380 0.030-4.755 Early adolescence premorbid adjustment -0.285 0.110 6.695 0.010 0.752 0.606-0.933 Trail Making Test A -0.030 0.025 1.488 0.222 0.970 0.924-1.018 Trail Making Test B -0.005 0.010 0.278 0.598 0.995 0.976-1.014 Cognitive Insight 0.062 0.061 1.043 0.307 1.064 0.944-1.200 X2=25.296,df=6,p<0.001. Nagelkerke-R2=44.7%. Correctly classified: 76.9%, users:54.5%, non-users:88.4%.
ConclusionsAcceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
Thirty-day suicidal thoughts and behaviours in the Spanish adult general population during the first wave of the Spain COVID-19 pandemic
- P. Mortier, G. Vilagut, M. Ferrer, I. Alayo, R. Bruffaerts, P. Cristóbal-Narváez, I. del Cura-González, J. Domènech-Abella, M. Felez-Nobrega, B. Olaya, J. I. Pijoan, E. Vieta, V. Pérez-Solà, R. C. Kessler, J. M. Haro, J. Alonso, MINDCOVID Working group
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 30 / 2021
- Published online by Cambridge University Press:
- 17 February 2021, e19
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Aims
To investigate the prevalence of suicidal thoughts and behaviours (STB; i.e. suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain coronavirus disease 2019 (COVID-19) pandemic (March−July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains.
MethodsCross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project). A nationally representative sample of 3500 non-institutionalised Spanish adults (51.5% female; mean age = 49.6 [s.d. = 17.0]) was taken using dual-frame random digit dialing, stratified for age, sex and geographical area. Professional interviewers carried out computer-assisted telephone interviews (1–30 June 2020). Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale. Distal (i.e. pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions and pre-pandemic lifetime mental disorders; proximal (i.e. pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic. Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and 30-day STB. All data were weighted using post-stratification survey weights.
ResultsEstimated prevalence of 30-day STB was 4.5% (1.8% active suicidal ideation; n = 5 [0.1%] suicide attempts). STB was 9.7% among the 34.3% of respondents with pre-pandemic lifetime mental disorders, and 1.8% among the 65.7% without any pre-pandemic lifetime mental disorder. Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP = 49.1%) and current mental disorders (total PARP = 58.4%), i.e. major depressive disorder (OR = 6.0; PARP = 39.2%), generalised anxiety disorder (OR = 5.6; PARP = 36.3%), post-traumatic stress disorder (OR = 4.6; PARP = 26.6%), panic attacks (OR = 6.7; PARP = 36.6%) and alcohol/substance use disorder (OR = 3.3; PARP = 5.9%). Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32.7–42.6%%), and having loved ones infected with COVID-19 (OR = 1.7; PARP = 18.8%). Up to 74.1% of STB is potentially attributable to the joint effects of mental disorders and adverse events−experiences related to the pandemic.
ConclusionsSTB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events−experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress. There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload.
Study registration numberNCT04556565
First experiments on ICRF discharge generation by a W7-X-like antenna in the Uragan-2M stellarator
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- V. E. Moiseenko, Yu. V. Kovtun, T. Wauters, A. Goriaev, A. I. Lyssoivan, A. V. Lozin, R. O. Pavlichenko, A. N. Shapoval, S. M. Maznichenko, V. B. Korovin, E. D. Kramskoy, M. M. Kozulya, N. V. Zamanov, Y. V. Siusko, A. Yu. Krasiuk, V. S. Romanov, A. Alonso, R. Brakel, A. Dinklage, D. Hartmann, Ye. Kazakov, H. Laqua, J. Ongena, T. Stange, the Uragan-2M Team
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- Journal:
- Journal of Plasma Physics / Volume 86 / Issue 5 / October 2020
- Published online by Cambridge University Press:
- 28 October 2020, 905860517
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In support of the ICRF experiments planned on the Wendelstein 7-X (W7-X) stellarator, i.e. fast ion generation, wall conditioning, target plasma production and heating, a first experimental study on plasma production has been made in the Uragan-2M (U-2M) stellarator using W7-X-like two-strap antenna. In all the experiments, antenna monopole phasing was used. The W7-X-like antenna operation with launched radiofrequency power of ~100 kW have been performed in helium (p = (4–14) × 10−2 Pa) with the vacuum vessel walls pre-loaded with hydrogen. Production of plasma with a density higher than 1012 cm−3 was observed near the first harmonic of the hydrogen cyclotron frequency. Operation at first hydrogen harmonic is feasible in W7-X future ICRF experiments.
Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries
- J. J. McGrath, C. C. W. Lim, O. Plana-Ripoll, Y. Holtz, E. Agerbo, N. C. Momen, P. B. Mortensen, C. B. Pedersen, J. Abdulmalik, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, E. J. Bromet, R. Bruffaerts, B. Bunting, J. M. C. de Almeida, G. de Girolamo, Y. A. De Vries, S. Florescu, O. Gureje, J. M. Haro, M. G. Harris, C. Hu, E. G. Karam, N. Kawakami, A. Kiejna, V. Kovess-Masfety, S. Lee, Z. Mneimneh, F. Navarro-Mateu, R. Orozco, J. Posada-Villa, A. M. Roest, S. Saha, K. M. Scott, J. C. Stagnaro, D. J. Stein, Y. Torres, M. C. Viana, Y. Ziv, R. C. Kessler, P. de Jonge
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 29 / 2020
- Published online by Cambridge University Press:
- 12 August 2020, e153
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Aims
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
MethodsThe WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
ResultsEach prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
ConclusionsSurvey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
Antipsychotic treatment and the need for hospitalization: advantages of long-acting neuroleptics
- M. Perez Garcia, M. Paramo Fernandez, V. Prado Robles, J. Alonso San Gregorio, J. Perez Perez, I. Tortajada Bonasselt
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- European Psychiatry / Volume 22 / Issue S1 / March 2007
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- 16 April 2020, pp. S131-S132
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Introduction:
At present,the need of antipsychotic treatments for the improvement of the condition of people with psychotic disorders is unquestionable.Despite the current availability of highly effective drugs with few secondary effects,the main cause behind hospitalization is still the lack of compliance.
Objectives:Analysis of the determining variables behind the need for hospitalization and the influence of the types of antipsychotic treatments.
Methods:Retrospective and follow-up analysis of psychotic patients hospitalized in the Psychiatric Ward of the Hospital de Conxo (1998-2005).Three groups of patients:with Oral neuroleptics(170), with Depot typical neuroleptics (238),with Long-Acting Risperidone(60);and comparison based on treatment maintenance.
Results:Males,day-to-day living with the family of origin and single status are predominant in all three groups,although in a higher proportion in the Long-Acting Risperidone one(75,71 and 85%respectively).Only 7% of the patients with Long-Acting Risperidone completed their university studies,62% were pensioners.The average duration of hospitalization periods is 21 days for the patients with Long-Acting Risperidone,23.3 days in the Oral group,29.5 days in the Depot group.The main cause behind re-hospitalization is the lack of compliance(68% in Depot group),whilst after the introduction of Long-Acting Risperidone,no compliance rate is 59%.If we compare the number of hospitalizations/year of the patients with Long-Acting Risperidone,before and after its introduction,the rate is reduced significantly from 0.89 to 0.73.
Conclusions:Despite the fact that patients treated with Long-Acting Risperidone show a more seriously ill condition and less social capacity,they have less need for hospitalization than patients treated with Depot neuroleptics.Median lengths of stay were shorter than patients in the other two groups,and are less re-hospitalized after the introduction of this treatment.
Religion and Spiritual Advice as Surrogate Care Provision for Mental Health Problems in the ESEMED Survey
- V. Kovess, R. de Graaf, J.M. Haro, R. Bruffaerts, F. Gilbert, X. Briffault, J. Coldony, J. Alonso
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- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E166
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Objective:
To complete missing information on the influence of spiritual and religious advisors as informal providers for mental health problems in Europe.
Methods:Recourse to religious practice or belief when coping with mental health problems was evaluated using data from the ESEMED survey. This was a stratified, multistage, clustered-area probability sample survey of mental health carried out in six European countries which included 8796 subjects. Between countries differences in sociodemographic characteristics, religious affiliation, and prevalence of mental disorders and management of mental disorders were evaluated.
Results:Religion appears to play a limited role in coping with mental health problems in Europe. Only 7.9% of individuals seeking help for such problems turned to a religious advisor. This proportion differed between countries from 13% in Italy, 12.5% in Germany, 10.5% in the Netherlands, 5.8% in France, 4.7% in Belgium to 4% in Spain. In addition, seeking help exclusively from religion was reported by only 1.3% of subjects. Practicing religion at least once a week and considering religion as important in daily life were predictors of using religion versus conventional health care only. Use of religion was not influenced by gender and age. Non-Christian respondents and individuals with alcohol disorders were more likely to use religion. In Spain, the use of religion is much lower than average.
Conclusions:Unlike the situation in the United States, organised religion does not provide alternative informal mental health care in Europe. At best, it could be considered as an adjunct to conventional care.
Psychosis in patients with systemic lupus erythematosus
- S. Yelmo Cruz, V. Barrau Alonso, M. Salinas Muñoz
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- European Psychiatry / Volume 26 / Issue S2 / March 2011
- Published online by Cambridge University Press:
- 16 April 2020, p. 895
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Introduction
Systemic Lupus Erythematosus (SLE) can affect central nervous system (CNS), leading to neurological and/or psychiatric disorders. The use of corticosteroids for the management of SLE may induce psychiatric disorders.
ObjectivesDifferential diagnosis of the origin of psychosis in patients with SLE (CNS lupus vs. induced by corticosteroid therapy).
Methods and resultsA 22 year old female patient presented asthenia, oral bleeding, epistaxis, metrorrhagia, bicytopenia, hypoalbuminemia, low complement, with anti-DNA > 300, ANA, IgG Anticardiolipin, Anti-Sm, anti-RNP, anti-Ro, Anti-La and Anti-Histone positive.
A diagnosis of SLE was made. She presented also diffuse grade IV nephritis. There were administered 3 iv 6-methylprednisolone pulse therapies (750 mg/day) with a cycle of cyclophosphamide. Subsequently she continued with oral prednisone 60 mg/day. Four days after the end of the pulses, the patient developed anxiety, suspicion, injury delusions, auditory hallucinations and behavioral disinhibition. A MRI was normal. Risperidone was started up to 6 mg/day and oral prednisone was tapered. After a progressive improvement she was discharged.
ResultsCorticosteroids induce psychiatric disorders in 3–10% of patients. Low levels of complement, hypoalbuminemia and a positive ratio (≥ 9) of albumin in CSF x103/serum albumin are indicators of blood brain barrier damage and psychosis induced by corticosteroids. The presence of ac Antiribosoma P, ac antineuronals, MRI or EEG abnormals suggest the diagnosis of CNS lupus (lupus psychosis)
ConclusionsDifferential diagnosis between lupus psychosis vs. psychosis induced by corticosteroids is complicated. In case of doubt, some authors advocate increasing the dose of steroids and awaiting a clinical response. Others advocate rapid tapering and stopping steroids.
P-1036 - Ekbom's Syndrome. a Case Report
- V. Barrau Alonso, A. Hernandez-Dorta, R. Cejas-Mendez, J. Monzon-Diaz, E. Vera-Barrios
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- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Ekbom's syndrome or delusional parasitosis (DP), is an “uncommon psychiatric syndrome” characterized by the presence of delusion of infestation.
The syndrome may be seen in association wiht a number of neuropsychiatric conditions, including bipolar disorder, paranoia,schizophrenia, dementia, depression as well as abuse of drugs, such as cocaine or amphetamines. Previously, DP was often considered to be a monosymptomatic hypochondraical psychosis. Delusions of parasitosis has also been reported in association with a number of medical conditions that are characterized by itching.
ObjectiveTo review the literature through a case report.
Case reportA 52 year-old female, unmarried who lives alone, was admitted for parasitosis delusions that had started in the last two months. She complained of vermins crawling through her skin, mainly on her face and scalp. The illness began with pricking and itching sensations on her head. She used to put the “little animals” in a piece of paper to prove their existence. Risperodone was started up to 3 mg per day. She had a progressive clinical improvement and in one week was discharged.
ConclusionsIn conclusion, rather than a unique illness, DP is a neuropsychiatric syndrome that can follow primary psychotic and depressive disorders, dementia or other organic diseases. The typical patient is an elderly woman who is unmarried or living along.
There have been no double-blind studies confirming that atypical antipsychotics are more effective than pimozide in the treatment of DP. Further trials are warranted to study the true efficacy of atypical antipsychotics in the treatment of DP.
EPA-1652 – Sexuality and Emotional Life in People with Severe Long-term Mental Disorders
- A.L. Montejo, C. Montero Fernandez, J. Pol Rodriguez, I. Esquer Terrazas, O. Romero del Río, L.C. Fernandez Martin, V. Dutil Muñoz, J.A. Alonso, A. Martín, V. Gomez Warletta
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- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Sexuality and emotional life are rarely focus on attention in people suffering from severe long-term mental diseases like schizophrenia and bipolar disorder.
Methods53 patients and 47 matched controls were studied using a new questionnaire (SEXSAM Scale) measuring relevance of sexual and emotional relationships in patients’ daily life. A specific Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX Montejo 2001-2008), Sexual Activity Assessment Scale modified from Kinsey (Montejo 2006) and the HONOS Scale measuring bio-psychosocial functioning were also applied.
ResultsSexuality (physic and emotional) was scored as high valuable and the main motivation for sexual activity was looking for love and fondness in both groups. No differences were found in the value of more affective behaviours such as kissing, caressing, hugging or massaging. Global satisfaction in sexual and emotional life was significantly superior in control group and linked to the higher frequency of sexual relations. Many patients suffered for sexual dysfunction related to the treatment use and many of then were dissatisfied with their sexual life. Just a few numbers of patients had regular sexual intercourses. Patients describe an improvement in the self-perception of mood, appetite, sleep, anxiety level, humour sense and self-esteem when they have sexual relations. Predominant sexual activity for patients was masturbation. Prostitution use was higher in patient group. All these findings are negatively influencing personal satisfaction and quality of life.
ConclusionRelevance of sexual and emotional life in patients is as high as in normal population. These patients are more concerned about affection and companionship than about physical pleasure.
P-902 - Depression Caused by Primary Hyperparathyroidism With Hypercalcemia: a Case Report
- E. Vera Barrios, E. Garcia Diaz, V. Barrau Alonso, E. Diaz Mesa, A. Hernandez Diaz
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- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Multiple articles highlight the role of some organic pathologies causing depression. One common organic cause of depression is hyperparathyroidism, with hypercalcemia associated or not. The neuropsyquiatric symptoms related to primary hyperparathyroidism involved different types of presentations (anxious, affective, cognitive and psychotic). The most characteristic manifestations are depression with apathy and minus cognitive impairment.
ObjectiveDescribe a case of depression by hyperparathyroidism with hypercalcemia to remark the importance of some organic factors in some types of depression.
Suggest re-evaluating the criteria of parathyroidectomy, in which are not included depression and cognitive impairment.
Methods and resultsMale aged 71 affected by diabetes mellitus type 2, hypertension and Parkinson's disease.
In the last 2 months, the patient progressively became more apathetic, sad (with occasional crying), with hyporexia, 4 kg weight loss in the last month, and important reduction of water intake. Analysis detects hypercalcemia.
Psych evaluation shows slightly time disorientation, hypophonic language, bradilalia with increased latency of response and hypotimia.
Diagnosis of moderate depression episode is made and escitalopram 10 mg/day is prescribed.
ConclusionThis reported case is a challenge, not only in a therapeutical level, but in a diagnostic level too because several organic depression ethiologies are involved. It's interesting to observe how the decreased water-intake, caused by depression, worsened hypercalcemia, showing a continuum between both, mental and organic pathology.
We think is necessary to re-evaluate the criteria of surgical intervention for parathyroid adenoma with hypercalcemia associated to establish whether psychiatric symptoms could be one of them or not.