41 results
Antidepressants overuse in primary care: prescription trends between 2010-2019 in Catalonia
- M. S. Gonzalez, G. anmella, E. vieta, M. Primé-Tous, X. Segú, A. Mas, D. Hidalgo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S545
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Introduction
Antidepressants (AD) are one of the most prescribed pharmacological treatments in developed countries. AD efficacy is well-proven in anxiety, depressive and other mental disorders, but their use is also common in individuals without psychiatric health conditions. Indeed, recent evidence reported an increase in AD prescription over the latest years. Concern has been raised on the overuse of AD in several countries, and societal policies and national guidelines have been developed to regulate their use in the general population.
Several factor might be used to explain this increase, including the more safety profile of new AD classes (i.e. SSRI, or vortioxetine) compared to old AD, a possible overall increase in the incidence of depressive and anxiety disorders, or their inappropriate prescription in mild conditions which could be managed without pharmacological treatment as first-step option in primary care (PC).
ObjectivesExplore AD prescription patterns in relation to mental health diagnoses and identify the most relevant factors involved in PC health systems. Understanding the variables influencing AD prescription would allow designing strategies and guidelines to make appropriate use of this pharmacological group in PC. As part of the PRESTO project (www.prestoclinic.cat), here we investigated the changes in frequency and the variables associated with AD prescription in a population-representative sample of people attending PC between 2010 –2019 in Catalonia, Spain.
MethodsWe retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010-2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1,000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription.
ResultsBoth AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)= 2.83), older age (IRR = 25.43), and lower socio-economic status (IRR= 1.35) were significantly associated with increased risk of being prescribed an AD.
ConclusionsOur results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.
Disclosure of InterestM. Gonzalez: None Declared, G. anmella Grant / Research support from: received CME-related honoraria, or consulting fees from Janssen-Cilag, Lundbeck, Lundbeck/Otsuka, and Angelini, with no financial or other relationship relevant to the subject of this article, E. vieta Grant / Research support from: received research support from or served as consultant, adviser or speaker for AB-Biotics, Abbott, Abbvie, Adamed, Angelini, Biogen, Celon, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo SmithKline, Janssen, Lundbeck, Organon, Otsuka, Rovi, Sage pharmaceuticals, Sanofi-Aventis, Shire, Sunovion, Takeda, and Viatris, out of the submitted work, M. Primé-Tous: None Declared, X. Segú: None Declared, A. Mas: None Declared, D. Hidalgo Grant / Research support from: received CME-related honoraria or adviser from Abbott, Angelini, Janssen-Cilag and Ethypharm with no financial or other relationship relevant to the subject of this article.
Meta-analysis of the variability in the individual response to pharmacological treatments for mania in bipolar disorder
- G. Anmella, M. De Prisco, V. Oliva, M. Sanabra, L. Fortea, M. Ortuño, G. Fico, A. Murru, E. Vieta, D. Hidalgo-Mazzei, A. Solanes, J. Radua
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S84
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Introduction
Many studies have investigated whether there exist predictors of good response to antimanic drugs in bipolar disorder (BD). However, these factors predict response or only indicate benign illness course.
ObjectivesTo shed some light on the topic, we tested whether the response to antimanic drugs showed any variability beyond that expected by the effects of illness course and placebo.
MethodsWe included all double-blind, placebo-controlled RCTs of oral pharmacotherapies targeting adult patients with acute bipolar mania from 1991 to 2020. The primary outcome was the variance of the improvement in manic symptoms in treated individuals compared to placebo. The effect size was the log variability ratio (logVR). We performed a random-effects meta-analysis, including assessments of heterogeneity, sensitivity/cumulative/subgroup analyses, and meta-regression.
Results42 RCTs (46 comparisons) from a total of 8,438 BD patients with acute mania (53.7% male, mean age=39.3; 5,563 treatment/2,875 control groups) were included in the analysis. Individuals in active treatment groups did not show variability in the response beyond that observed in individuals under placebo (VR=1; 95% C.I.=0.97,1.03; p-value=0.97). No heterogeneity was detected between the studies (I2=0%; tau2=0%; Q=29.21; df=45; p-value=0.97). Results were similar in the leave-one-out/cumulative/subgroup analyses. Meta-regression did not show influences by age, sample size, sex, severity of manic symptoms at baseline, or clinical features (rapid cycling, mixed or psychotic features).
ConclusionsThis meta-analysis shows no evidence of differences in the individual response to treatments. These findings suggest that the average treatment effect is a reasonable assumption for the individual BD patient with acute mania. The presented article adds evidence to the equivalent results in schizophrenia-spectrum disorders, clinical high-risk state for psychosis, and major depressive disorder, not supporting classification in responders vs. non-responders. However, these findings should be balanced with results from other fields supporting such classification.
Disclosure of InterestNone Declared
Does bipolar disorder differ from other mental illnesses in terms of emotion dysregulation? A systematic review and meta-analysis
- M. De Prisco, V. Oliva, G. Fico, J. Radua, I. Grande, N. Roberto, G. Anmella, D. Hidalgo-Mazzei, M. Fornaro, A. de Bartolomeis, A. Serretti, E. Vieta, A. Murru
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S571-S572
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Introduction
Emotion regulation (ER) is the ability to assess, monitor, or modify emotional reactions to achieve a goal (Gross. Psychological inquiry 2015; 26 1-26). When ER strategies are rigidly or maladaptively applied, emotional dysregulation (ED) can occur (Thompson. Development and psychopathology 2019; 31 805-815). ED is common in people diagnosed with bipolar disorder (BD), but it can also be described in other clinical populations given its transdiagnostic nature. Numerous aspects of ED have been described in BD (De Prisco et al. Neuroscience & Biobehavioral Reviews 2022; 104914), but it is unclear whether these manifest similarly in other conditions such as major depressive disorder (MDD) or borderline personality disorder (BPD), or whether they are specific to BD.
ObjectivesThe objective of this systematic review and meta-analysis is to examine the literature comparing BD with other psychiatric disorders in terms of ED, focusing on those studies using validated clinical tools.
MethodsA systematic search from inception to April 28th, 2022, was conducted exploring the PubMed/MEDLINE,EMBASE, Scopus, and PsycINFO databases. Those studies providing quantitative data on ED in people diagnosed with BD and compared with clinical groups were eligible for inclusion. No restriction about age, sample size, or language were applied. Random effect meta-analyses were conducted, and effect sizes were calculated as standardized mean differences (SMD).
ResultsA total of 3,239 records was identified and, after duplicate removal and title/abstract evaluation, 112 were explored at the full text. Twenty-nine studies were finally included, and it was possible to perform a meta-analysis with twenty-two (145 comparisons) of them. Only studies comparing BD with MDD, and BPD provided sufficient data to perform a meta-analysis. People with BD did not differ from people with MDD in most of the comparisons considered. However, BD patients presented higher positive rumination (two comparisons: SMD=0.46; CI=0.27, 0.64; p=8.5e-07; I2=0%; and SMD=0.34; CI=0.15, 0.52; p=2.7e-04; I2=0%) and risk-taking behaviors (SMD=0.48; CI=0.27, 0.69; p=8.11e-06; I2=0%). In contrast, people with BPD displayed an overall higher degree of ED (SMD=-1.22; CI=-1.94, -0.5; p=9.1e-04; I2= 90.7) and used fewer adaptive ER strategies. Additionally, higher levels of self-blaming (SMD=-0.80; CI=-1.11, -0.50; p=2.68e-07; I2=0) and impulsive behavior (SMD=-0.76; CI=-0.89, -0.63; p=5.4e-29; I2=0) were observed.
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ConclusionsED is a trans-diagnostic construct that spans a continuum of different psychiatric disorders. Outlining the specific clinical features of one disorder versus another may help future research to increase our knowledge of these issues and develop new treatment strategies to reduce the clinical burden of these patients.
Disclosure of InterestM. De Prisco: None Declared, V. Oliva: None Declared, G. Fico Grant / Research support from: “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), Consultant of: Angelini, Janssen-Cilag and Lundbeck, J. Radua Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00394, CPII19/00009) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER) and the Instituto de Salud Carlos III, I. Grande Grant / Research support from: Spanish Ministry of Science and Innovation (MCIN) (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondos Europeos de la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR ); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022), Consultant of: ADAMED, Angelini, Casen Recordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, N. Roberto: None Declared, G. Anmella Grant / Research support from: Rio Hortega 2021 grant (CM21/00017) from the Spanish Ministry of Health financed by the Instituto de Salud Carlos III (ISCIII) and co-financed by the Fondo Social Europeo Plus (FSE+), Consultant of: Janssen-Cilag, Lundbeck, Lundbeck/Otsuka, and Angelini, D. Hidalgo-Mazzei Grant / Research support from: Juan Rodés JR18/00021 granted by the Instituto de Salud Carlos III (ISCIII), M. Fornaro: None Declared, A. de Bartolomeis Consultant of: Janssen, Lundbeck, and Otsuka and lecture fees for educational meeting from Chiesi, Lundbeck, Roche, Sunovion, Vitria, Recordati, Angelini and Takeda; he has served on advisory boards for Eli Lilly, Jansen, Lundbeck, Otsuka, Roche, and Takeda, Chiesi, Recordati, Angelini, Vitria, A. Serretti Consultant of: Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier, and Taliaz, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/00805, PI21/00787) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. Thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), Consultant of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, A. Murru Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), Consultant of: Angelini, Idorsia, Lundbeck, Pfizer, Takeda
Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout
- G. Anmella, M. Sanabra, M. Primé-tous, X. Segú, M. Cavero, R. Navinés, A. Mas, V. Olivé, L. Pujol, S. Quesada, C. Pio, M. Villegas, I. Grande, I. Morilla, A. Martínez-Aran, V. Ruiz, E. Vieta, D. Hidalgo-Mazzei
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S109-S110
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Introduction
A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout and there is a lack of resources to attend them. The COVID-19 pandemic has worsened this problem, particularly affecting healthcare workers, and digital tools have been proposed as a workaround.
ObjectivesWe present the development, feasibility and effectiveness studies of chatbot (Vickybot) aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers.
MethodsUser-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different possible clinical situations and evaluated their experience. (3) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined based on the combination of both subjective and objective user-engagement Indicators (UEIs). Effectiveness was measured using paired t-tests as the change in self-assessment scores.
Results(1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) simulated different clinical situations. 98.8% of the expected modules were recommended according to each simulation. Suicidal alerts were correctly activated and received by the research team. (2) Feasibility and effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after 2-weeks of use. No significant differences were found for anxiety [t(8) = 1.000, p = 0.347] or depressive [t(8) = 0.400, p = 0.700] symptoms, but work-related burnout was significantly reduced [t(8) = 2.874, p = 0.021] between the means of the first and second self-assessments. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement).
ConclusionsThe chatbot proved to be useful in screening the presence and severity of anxiety and depressive symptoms, in reducing work-related burnout, and in detecting suicidal risk. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising, but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required.
Disclosure of InterestNone Declared
The TIMEBASE Study: IdenTifying dIgital bioMarkers of illnEss activity in BipolAr diSordEr. Preliminary results
- G. Anmella, A. Mas, I. Pacchiarotti, T. Fernández, A. Bastidas, I. Agasi, M. Garriga, N. Verdolini, N. Arbelo, D. Nicolás, V. Ruiz, M. Valentí, A. Murru, E. Vieta, A. Solanes, F. Corponi, B. Li, D. Hidalgo-Mazzei
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S221
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Introduction
Mood episodes in bipolar disorder (BD) are still identified with subjective retrospective reports and scales. Digital biomarkers, such as actigraphy, heart rate variability, or ElectroDermal activity (EDA) have demonstrated their potential to objectively capture illness activity.
ObjectivesTo identify physiological digital signatures of illness activity during acute episodes of BD compared to euthymia and healthy controls (HC) using a novel wearable device (Empatica´s E4).
MethodsA pragmatic exploratory study. The sample will include 3 independent groups totalizing 60 individuals: 36 BD inpatients admitted due to severe acute episodes of mania (N=12), depression (N=12), and mixed features (N=12), will wear the E4-device at four timepoints: the acute phase (T0), treatment response (T1), symptoms remission (T2) and during euthymia (T3; outpatient follow-up). 12 BD euthymic outpatients and 12 HC will be asked to wear the E4-device once. Data pre-processing included average downsampling, channel time-alignment in 2D segments, 3D-array stacking of segments, and random shuffling for training/validation sets. Finally, machine learning algorithms will be applied.
ResultsA total of 10 patients and 5 HC have been recruited so far. The preliminary results follow the first differences between the physiological digital biomarkers between manic and depressive episodes. 3 fully connected layers with 32 hidden units, ectified linear activation function (ReLU) activation, 25% dropout rate, significantly differentiated a manic from a depressive episode at different timepoints (T0, T1, T2).
ConclusionsNew wearables technologies might provide objective decision-support parameters based on digital signatures of symptoms that would allow tailored treatments and early identification of symptoms.
DisclosureNo significant relationships.
PRESTOapp for health workers with mental health symptoms related to the COVID-19 pandemic
- M. Primé Tous, G. Anmella, X. Segú, M.D.R. Fernández Canseco, C. Carrino, M. Villegas, V. Vicens, J. Blanch, M. Cavero, E. Vieta, D. Hidalgo-Mazzei
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S575
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Introduction
The COVID-19 pandemic has caused a significant impact on the mental health of health workers that has brought many hospitals to launch immediate preventive mental health programs.
Objectives(1) To adapt and enhance a smartphone app (PRESTOapp) for health workers with mental health symptoms related to the COVID-19, and (2) to demonstrate its potential effectiveness in significantly reducing anxiety-depressive and PTSD symptoms in this population. We aim to incorporate Natural Language Processing (NLP)-based techniques in a chatbot user-interface that will enable a more personalized and accurate monitoring and intervention.
MethodsAn 18-months study with a 6-months preliminary phase to adapt PRESTOapp to health workers, enhance it with NLP-based techniques and chatbot user-interface, and evaluate its feasibility, and effectiveness in 12-months.
ResultsPRESTOapp has the potential to provide a prompt, personalized and integral response to the mental health demand due to the COVID-19. It will help by providing an innovative digital platform, that will allow remote monitoring of the symptoms course, provide brief psychotherapeutic interventions, and detect urgent situations. If the preliminary results of this study point to a potential effectiveness of the intervention, PRESTOapp may be easily adapted to the general population.
ConclusionsPRESTOapp may be one of the key digital platforms that may help preventing and treating potentially severe mental health consequences. Considering the unresolved problem of burnout in health workers even before the COVID-19, this project will develop the necessary technology for implementing cost-effective mental health solutions, not only during the pandemic.
DisclosureNo significant relationships.
Trans-palmitoleic acid reduces adiposity via increased lipolysis in a rodent model of diet-induced obesity
- Lidia Irasema Chávaro-Ortiz, Brenda D. Tapia, Mariel Rico-Hidalgo, Ruth Gutiérrez-Aguilar, María E. Frigolet
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- British Journal of Nutrition / Volume 127 / Issue 6 / 28 March 2022
- Published online by Cambridge University Press:
- 07 May 2021, pp. 801-809
- Print publication:
- 28 March 2022
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Obesity is defined as increased adiposity, which leads to metabolic disease. The growth of adipose tissue depends on its capacity to expand through hyperplasia or hypertrophy, in order to buffer energy surplus. Also, during the establishment of obesity, adipose tissue expansion reflects adipose lipid metabolism (lipogenesis and/or lipolysis). It is well known that dietary factors can modify lipid metabolism promoting or preventing the development of metabolic abnormalities that concur with obesity. Trans-palmitoleic acid (TP), a biomarker of dairy consumption, has been associated with reduced adiposity in clinical studies. Thus, we aimed to evaluate the effect of TP over adiposity and lipid metabolism-related genes in a rodent model of diet-induced obesity (DIO). To fulfil this aim, we fed C57BL/6 mice with a Control or a High-Fat diet, added with or without TP (3 g/kg diet), during 11 weeks. Body weight and food intake were monitored, fat pads were weighted, histology of visceral adipose tissue was analysed and lipid metabolism-related gene expression was explored by qPCR. Results show that TP consumption prevented weight gain induced by high-fat diet, reduced visceral adipose tissue weight and adipocyte size, while increasing the expression of lipolytic molecules. In conclusion, we show for the first time that TP influences adipose tissue metabolism, specifically lipolysis, resulting in decreased adiposity and reduced adipocyte size in a DIO mice model.
Interplay between productive traits, the social rank and the cow's stability in the order of entrance to the milking parlour
- E. Vargas-Bello-Pérez, J. Bastías-Ruz, P. Toro-Mujica, D.L. Teixeira, D. Enriquez-Hidalgo
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- The Journal of Agricultural Science / Volume 158 / Issue 6 / August 2020
- Published online by Cambridge University Press:
- 04 November 2020, pp. 518-526
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The aim of this study was to investigate whether social rank (SR) and stability in the order of entrance to the milking parlour are associated with production traits. The study was conducted on a dairy farm where cows (n = 215) were managed in three groups according to lactation stage (group 1: 78 cows, 0–100 days in milk (DIM); group 2: 65 cows, 101–200 DIM and group 3: 72 cows, >200 DIM). SR was calculated from observations made from agonistic behaviour performed at the water troughs and feed bunks of each pen (n = 3). The animals were classified into three levels of dominance based on at least five clear interactions, resulting in: 61 dominant, 75 intermediate and 69 subordinate cows based on SR. Stability in the order of entry was estimated as the standard deviation of the entry position. SR was weakly correlated with milk yield, urea and protein content in milk. The results showed that stable cows had higher milk production and entered the milking parlour after the non-stable animals. Stability in the order of entry to the milking parlour was not affected by SR. Overall, the use of milking facilities appears to be associated with production traits rather than SR.
Progress on the small modular stellarator SCR-1: new diagnostics and heating scenarios – ERRATUM
- F. Coto-Vílchez, V. I. Vargas, R. Solano-Piedra, M. A. Rojas-Quesada, L. A. Araya-Solano, A. A. Ramírez, M. Hernández-Cisneros, J. E. Pérez-Hidalgo, A. Köhn-Seemann, F. Cerdas, F. Vílchez-Coto, D. Jiménez, L. Campos-Duarte, E. Meneses, M. González-Vega, S. Arias
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- Journal of Plasma Physics / Volume 86 / Issue 5 / October 2020
- Published online by Cambridge University Press:
- 30 September 2020, 945860501
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Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies
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- Anjum Memon, Imogen Rogers, Sophie M. D. D. Fitzsimmons, Ben Carter, Rebecca Strawbridge, Diego Hidalgo-Mazzei, Allan H. Young
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- Journal:
- The British Journal of Psychiatry / Volume 217 / Issue 6 / December 2020
- Published online by Cambridge University Press:
- 27 July 2020, pp. 667-678
- Print publication:
- December 2020
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Background
The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population.
AimsTo synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates.
MethodThe MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375).
ResultsThe literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = −0.27, 95% CI −0.47 to −0.08; P = 0.006, I2 = 83.3%), male (pooled β = −0.26, 95% CI −0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = −0.13, 95% CI −0.24 to −0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration.
ConclusionsThis synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.
Progress on the small modular stellarator SCR-1: new diagnostics and heating scenarios
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- F. Coto-Vílchez, V. I. Vargas, R. Solano-Piedra, M. A. Rojas-Quesada, L. A. Araya-Solano, A. A. Ramírez, M. Hernández-Cisneros, J. E. Pérez-Hidalgo, A. Köhn-Seemann, F. Cerdas, F. Vílchez-Coto, D. Jiménez, L. Campos-Duarte, E. Meneses, M. González-Vega, S. Arias
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- Journal of Plasma Physics / Volume 86 / Issue 4 / August 2020
- Published online by Cambridge University Press:
- 08 July 2020, 815860401
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This work presents updates in the diagnostics systems, magnetohydrodynamics (MHD) calculations and simulations of microwave heating scenarios of the small modular Stellarator of Costa Rica 1 (SCR-1). Similarly, the design of a flexible bolometer and magnetic diagnostics (a set of Mirnov coils, Rogowski coils and two diamagnetic loops) are introduced. Furthermore, new MHD equilibrium calculations for the plasma of the SCR-1 device were performed using the VMEC code including the poloidal cross-section of the magnetic flux surfaces at different toroidal positions, profiles of the rotational transform, magnetic well, magnetic shear and total magnetic field norm. Charged particle orbits in vacuum magnetic field were computed by the magnetic field solver BS-SOLCTRA (Vargas et al. In 27th IAEA Fusion Energy Conference (FEC 2018), 2018. IAEA). A visualization framework was implemented using Paraview (Solano-Piedra et al. In 23rd IAEA Technical Meeting on the Research Using Small Fusion Devices (23rd TM RUSFD), 2017) and compared with magnetic mapping results (Coto-Vílchez et al. In 16th Latin American Workshop on Plasma Physics (LAWPP), 2017, pp. 43–46). Additionally, simulations of microwave heating scenarios were performed by the IPF-FDMC full-wave code. These simulations calculate the conversion of the ordinary waves to extraordinary waves and allow us to identify the location where the conversion takes place. Finally, the microwave heating scenarios for the $330^{\circ }$ toroidal position are presented. The microwave heating scenarios showed that the O–X–B mode conversion is around 12–14 %. It was possible to identify the spatial zone where the conversion takes place (upper hybrid frequency).
2351 – Clinical Improvement And ‘perceived Quality Of Life’ After The Partial Psychiatric Hospitalization In a General Hospital
- M. García Acuña, D. Hidalgo Mazzei, P. Barrio Giménez, Á. Torras Farrés, R. Martín-Santos
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- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1480
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The Day Hospital (DH) provides an intensive, multidisciplinary, coordinated, group and customized care for patients admitted for treatment. The therapeutic approach improve their clinical situation, their quality of life and facilitate their reintegration into everyday life. Our objective is to evaluate overall clinical improvement and perceived quality of life of patients admitted in a general hospital DH (2010–2012). Clinical diagnosis (DSM-IV-R) grouped (NSUD, SUD and DUAL), clinical variables, baseline/ high clinical situation (CGI-S), global impression of improvement (CGI-I) and related quality of life perceived (EQ5) at baseline / high were recorded. Data were analyzed using SPSS v15. 174 patients were evaluated, 58% women, mean age 47 years and schooling medium-high (76%). The average stay (DT) was 35 days. Patients came from 47%: acute hospitalization, 51%: Mental Health Center (MSC) or outpatient and 4%: other units. The reasons for admission were detoxification (34.5%), stabilization (33.3%), consolidation of detoxification (15.5%), decompensation (9.2%) and re-structuring of treatment (7.5%). The overall clinical improvement of the whole sample at the end of stay assessed by the CGI-I was: 35% = “much better” 38% = “moderately better”, 5% = “slightly better”, 21% = “no change” and only 1% “worse” (p = 0.001). An overall clinical improvement and quality of life perceived was observed in the three groups of patients. While it remains to know the persistence of these parameters in the long term, the Day Hospital proved to be an important therapeutic resource for overall clinical improvement of patients towards their incorporation into daily life.
1767 – Electroconvulsive Therapy (ect) Convulsion Time According To Diagnosis And Treatment Phase
- P. Barrio, A. Batalla, D. Hidalgo, M. García Acuña, A. Pons
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- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1032
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Introduction
ECT remains as one of the most effective and secure psychiatric treatments for a wide variety of disorders, like depression, bipolar disorder or schizophrenia. Although not fully known, several theories hypothesize about its mechanism of action. To be effective, it has to induce a generalized convulsion of at least 15 seconds.
ObjectiveTo analyze and compare convulsion times regarding diagnosis and treatment phase (acute, continuation or maintenance) to discern whether these factors influence convulsion time.
Methods1675 ECT sessions were performed on 117 patients during a year at a universitary hospital. Convulsion times were analyzed comparing them according to main diagnosis (bipolar disorder, major depressive disorder, schizophrenia, schizoaffective disorder), as well as according to treatment phase (acute, continuation, maintenance).
ResultsSchizophrenia mean convulsion time was 40,77 seconds (CI95% 39,25-42.28), for schizoaffective disorder it was 34,59 seconds (CI95% 32,74-36,44), for bipolar disorder 35,13 seconds (CI95% 33,83-36,43) and for major depressive disorder 34,90 seconds (CI95% 32,72- 37,07), with a statistical significance between groups of p < 0.001.
According to treatment phase, mean convulsion time in the acute phase was 34,94 seconds (CI95% 33,81-36,19), in the continuation phase it was 39,61 seconds (ICI95% 37,28-42,29), and in the maintenance phase it was 39,00 seconds (CI95% 37,92-40,18), with a statistical significance between groups of p < 0.001.
ConclusionsAlthough there exist statistically significant differences between groups according to diagnosis and treatment phase, they are not clinically relevant, thus concluding that neither diagnosis nor treatment phase seem to influence convulsion time to a relevant degree.
Effect of recovery period of mixture pasture on cattle behaviour, pasture biomass production and pasture nutritional value
- F. C. Pereira, L. C. P. Machado Filho, D. C. S. Kazama, R. Guimarães Júnior, L. G. R. Pereira, D. Enríquez-Hidalgo
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Pasture management that considers pasture growth dynamics remains an open question. Conceptually, such management must allow for grazing only after the recuperation of the pasture between two separate timely grazing periods when pasture reaches optimum recovery, as per the first law of Voisin’s rational grazing system. The optimum recovery period not only implies a pasture with better nutritional value and higher biomass yield but one that also reduces the production of enteric methane (CH4) to improve the grazing efficiency of cattle. Therefore, this study aimed to evaluate three different recovery periods (RP) of mixed grasses on the grazing behaviour of heifers, as well as herbage selectivity, herbage yield and nutritional value, in vitro degradability and CH4 production. Based on these criteria, three pasture RPs of 24 (RP24), 35 (RP3) and 46 (RP46) days were evaluated in six blocks using a randomized block design. At each predetermined RP, samples of the pasture were taken before the animals were allowed to graze. Right after collecting the pasture samples, heifers accessed the pasture during 4 h consecutively for grazing simulation and behavioural observations. We also measured the bite rate of each animal. The pasture growing for 24 days had the highest biomass production, best nutritional value, best efficiency of in vitro CH4 relative emission (ml) per DM degraded (g) and bite rate of the three RPs. Heifers all selected their herbage, irrespective of RP, but with different nutritional value and higher in vitro degradability. However, this did not change the production of in vitro CH4. Considering the growth conditions of the area where the study was performed, we recommend the shorter RP24 as the most suitable during the summer season. The study’s findings support the idea of management intervention to increase the quality of grazing systems.
The Real World Costs of Asenapine in Manic Episodes in the Manacor Study
- I. Forcada, I. Grande, D. Hidalgo-Mazzei, E. Nieto, C. Saez, M. Mur, E. Vieta
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Background
Asenapine is the most recent compound that hasbeen FDA- and EMA-approved for treatment of mania. Its efficacy and safety havebeen assessed in placebo-controlled trials, but little is known about itsperformance in routine clinical conditions. The MANACOR study assessed costsassociated with treatment of mania in several hospital settings acrossCatalonia, Spain. As part of the protocol, we compared cost-effectiveness ofasenapine versus other treatment options.
MethodsA combined prospective and retrospective datacollection and analysis was conducted from January 2011 to December 2013following a clinical interview and assessment of manic and depressive symptoms(YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST),sexual dysfunction (PRSexDQ) and health resource costs associated withtreatment with asenapine versus other antipsychotics.
Results152 patients from different university hospitalswere included. 53 patients received asenapine and 99 received otherantipsychotics. Considering inpatients (N=117), those treated with asenapinepresented a significantly less severe manic episode (p=0.001), less psychoticsymptoms (p=0.030) and, more comorbid personality disorder (p=0.002). Regardingoutpatients, those treated with asenapine showed significantly less severemanic episode (p=0.046), more previous mixed episodes (p= 0.013) and, moresexual dysfunction at baseline (p=0.036). No significant differences were foundin mean total costs per day.
LimitationsNon-randomized study design.
ConclusionClinicians tended to use asenapine in patientswith less severe manic symptoms but more complex clinical profile, includingmore mixed episodes in the past, concomitant personality disorder, and sexualproblems. Treatment with asenapine was not associated with higher costs when comparedto other options.
Asenapine in the Treatment of Bipolar Disorder: New Insights From the Expasen Study
- D. Hidalgo-Mazzei, A. Murru, J. Undurraga, M. Reinares, A. González-Pinto, C. De Dios, J.M. Montes, E. Vieta
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction
Bipolar disorder is characterized by relapsing and remitting mood phases, such as manic or depressive episodes as well as periods of subsyndromal symptoms. Among the treatment options for acute manic episodes, most antipsychotics have a good level of evidence of effectiveness [1]. Asenapine is a new atypical antipsychotic which showed good effectiveness and tolerability [2] along with a reasonable cost-effectiveness [3] in placebo-controlled trials. However, few studies have tested this in real-world clinical settings so far.
ObjectiveThe aim of this study was to evaluate the effectiveness and tolerability of asenapine in bipolar patients in a naturalistic clinical setting.
MethodsWe retrospectively examined the clinical records of 94 systematically followed-up adult patients who received asenapine in four selected Spanish reference centers. We assessed sociodemographic variables, tolerability as well as clinical severity through routinely used evaluation scales.
ResultsHalf of the patients reported at least one adverse effect related to the asenapine (51%), being somnolence the most frequent (30%). Although none of the side effects reported was a cause to discontinue it. Asenapine showed good levels of effectiveness with a 61% reduction of manic and 44% of the depressive symptoms. Concerning mixed states, there was reduction of 30% and 39%, for both manic and depressive symptoms respectively.
ConclusionsThough asenapine has an indication for acute manic episodes in bipolar disorder, the present study suggests that it can also have a role in treating depressive and mixed states in a real world setting. In addition, tolerability was consistent with clinical trial data.
EPA-0329 – Hypomania Check-list(hcl-32) : Reliability and Validity of the Online Version
- D. Hidalgo-Mazzei, J. Undurraga, A. Mateu, E. Vieta
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Bipolar disorder type II(BDII) has a prevalence of about 5% of the population according to different studies(1). There is evidence that the diagnosis of bipolar disorder patients may be delayed in 8 to 10 years, and this is especially relevant in BDII, where hypomania is often overlooked (2). The HCL-32 is a widely used and reliable instrument for the detection of previous hypomanic episodes and was validated in several languages, including Spanish (3). The massive use of internet and new technologies, may help to make this tool available to a greater extend of the population and could help detect even more cases. Accordingly, we evaluated the online version of the HCL-32.
Objetives:To evaluate the validity and reliability of the HCL-32 online Spanish version.
Methodology:We recruited 110 consecutive outpatients with different diagnosis, who agreed to participate and signed an informed consent. They were asked to complete a paper version(Pv)of HCL-32 in addition to an online version(Ov) sent by email within two weeks. The results were analyzed using SPSS v21.
Results:The HCL32 Pv showed a high internal consistency as well as the Ov(Cronbach's α, 0,91 and 0,90 respectively). The total score correlation between both versions was high(0,94, p<0,001) and there were no mean score significant differences. All Item-scale's correlation were significant.
Conclusion:The online Spanish version of the HCL-32 for the screening of hypomanic episodes has the same good psychometric properties as the paper version, which makes it suitable to be available to more people through Internet.
Asenapine prescribing patterns in the treatment of manic in- and outpatients: Results from the MANACOR study
- I. Grande, D. Hidalgo-Mazzei, E. Nieto, M. Mur, C. Sàez, I. Forcada, E. Vieta
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- European Psychiatry / Volume 30 / Issue 4 / June 2015
- Published online by Cambridge University Press:
- 15 April 2020, pp. 528-534
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Background:
Asenapine is the most recent compound that has been FDA- and EMA-approved for treatment of mania. Its efficacy and safety have been assessed in placebo-controlled trials, but little is known about its performance in routine clinical conditions. In this study, we compared features of patients treated with adjunctive asenapine or other adjunctive antipsychotics and the costs of the treatment.
Methods:A combined prospective and retrospective data collection and analysis was conducted from January 2011 to December 2013 following a clinical interview and assessment of manic and depressive symptoms (YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST), sexual dysfunction (PRSexDQ) and health resource costs associated with treatment with adjunctive asenapine versus other adjunctive antipsychotics.
Results:Hundred and fifty-two patients from different university hospitals were included. Fifty-three patients received adjunctive asenapine and 99 received other adjunctive antipsychotics concomitantly to mood stabilizers. Considering inpatients, those treated with adjunctive asenapine presented a significantly less severe manic episode (P = 0.001), less psychotic symptoms (P = 0.030) and more comorbid personality disorder (P = 0.002). Regarding outpatients, those treated with adjunctive asenapine showed significantly less severe manic episode (P = 0.046), more previous mixed episodes (P = 0.013) and more sexual dysfunction at baseline (P = 0.036). No significant differences were found in mean total costs per day.
Conclusion:Clinicians tended to use adjunctive asenapine in patients with less severe manic symptoms but more complex clinical profile, including more mixed episodes in the past, concomitant personality disorder, and sexual problems. Treatment with adjunctive asenapine was not associated with higher costs when compared to other options.
1361 – Online Screening And Outcome Assessment In Mental Health: Patient Satisfaction And Psychiatrists Needs
- D. Hidalgo Mazzei, A. Mateu Mullor, J. Undurraga Fourcade, E. Vieta
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E694
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Introduction
Standardized scales are a helpful and objective way to measure outcomes in clinical practice. However,previous surveys have revealed that only a small percentage of psychiatrists use them in clinical practice. Time-saving and cost-efficient tools are needed for daily clinical practice. A few successful experiences using online resources have been recently described and have been positively evaluated by patients. Still,it is an underdeveloped resource.
Objectives1. 1.Evaluate psychiatrist’s perception regarding use of scales in Spanish clinical practice facilities.
2. 2.Measure patient satisfaction using online tools.
AimsEvaluate the need and potential use of online tools in routine clinical practice.
MethodsWe conducted a survey among psychiatrists working in local clinical facilities to evaluate use of scales in daily clinical practice and their perception on the subject. We conducted a survey among patients who have used experimental online tools to evaluate their satisfaction with this method.
ResultsWe wrote an email to 54 psychiatrists asking to answer an online-survey about the subject. 47 psychiatrists answered.Among them, only 40% use them always or frequently. 47% of them felt limited resources and time to administer as a difficulty to use scales. Furthermore, 34% suggested that online implementation could be helpful. 24 patients answered the satisfaction survey. 80% of them found online scales easier and more comfortable while 63% found them faster than traditional methods.
ConclusionsScales are a useful and objective way to follow-up patients and evaluate clinical outcomes. However, psychiatrists find difficulties to use them in clinical practice, mainly by limited resources and time. Online implementation of scales is perceived as a potentially helpful and efficient tool for both psychiatrists and patients.
EPA-0330 – Ilex Paraguariensis use and Affective Symptoms: ¿is There an Association?
- D. Hidalgo-Mazzei, J. Undurraga, A. Mateu, F. Achón, D. Franco de Diana, E. Vieta, R. Martín-Santos
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Yerba mate(ilex paraguariensis(IP))is a plant widely consumed in South America as a hot(mate)or cold infusion beverage(tereré). During the last years, there was an increasing interest in its health properties supported by a growing scientific evidence. These studies showed that the IP could have hepatoprotective, hypocholesterolemic, diuretic and antioxidant properties. Furthermore it showed to be a nervous system stimulant and protectant(1). Recently, there were reports about its invitro potential to inhibit the Monoaminooxidase(MAO) which can have effects on mood state(2).
Objectives:Exploratory research to study possible associations between the use of IP and mood symptoms.
Method:An observational cross-sectional study was conducted by an online survey in paraguayan population through an invitation. The survey collected data information about sociodemographics conditions, substance use(including IP), Spielberg's State-Trait Anxiety Inventory and PHQ-9 scale for depressive symptoms. A descriptive and multiple lineal regression analysis of the data was performed.
Results:300 subjects accepted the invitation and information was obtained of about 76% of them. The sample mean age(SD) was 27(7,4), most of them females(61,6%)and with universitary studies(66,1%). The 86% of the sample consumed IP regularly and 56% daily. Only a 3,5% reported previous psychiatric history. A significant relationship was observed between the use of IP and daily alcohol(p=0,022). No relevant associations were found concerning IP use and anxiety trait-state or depressive symptoms after adjusting for the use of coffee, tea, alcohol and others sociodemographic variables.
Conclusions:No significant associations were found in the sample studied between the use of IP and state-trait anxiety or depressive symptoms. Although, given the frequency of its use, the association with alcohol consumption and its potential clinical applications, more and bigger studies might be necessary.