The European Journal of Psychiatry

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

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

Dual diagnosis in the psychiatric emergency room in Spain

Background and Objectives: Dual diagnosis is associated with increased emergency department service use. During recent years, increased emphasis has been given to monitor the decision to hospitalise the most sever patients. Many rating scales have developed based on patient-related factors. To assess the level of severity of dual diagnosis patients measured by the Severity Psychiatric Illness (SPI) Scale and to evaluate it as a tool for predicting discharge in emergency psychiatric practice. Methods: Data on 1,227 consecutive admissions visited in a psychiatric emergency room of a general teaching hospital during a period of six months were collected. A routine computerised protocol was completed which included socio-demographic, clinical and social factors and the SPI scale. Results: 206 admissions (17%) had dual diagnosis disorder, 106 (9%) had substance abuse disorder (SUD), and 906 (74%) had non-substance abuse disorder (NSUD). Differences among groups were found in clinical characteristics, discharge decision, readmissions, previous psychiatric history, reason for referral, DSM-IV diagnosis and illicit drug use. Dual diagnosed patients had the highest scores of severity. Logistic regression analyses revealed the independent contribution of different SPI'items. The model showed a good fit and indicated excellent calibration in the sample studied, predicting 87.6% of discharge decisions. Conclusions: Dual diagnosed patients at the emergency psychiatric room presented the highest levels of severity both in clinical and social problems. While the SPI was a good tool for assessing severity of illness in our patients, only some dimensions predicted discharge decision.

Influence of age at onset on social functioning in outpatients with schizophrenia

Background and Objectives: There are different factors that have been found to predict disability in schizophrenia. The aim of our study is to evaluate the influence of age at onset on social functioning in schizophrenia in a large sample of schizophrenic outpatients controlling for gender. Methods: Two hundred and thirty-one subjects with schizophrenia (DSM-IV criteria) were randomly selected from a register that included all patients under treatment in five mental health care centers (MHCC) in Spain. Patients were evaluated with a sociodemographic and clinical questionnaire, and the Spanish version of the Living Skills Profile (LSP). Pearson's analyses were performed between age at onset and LSP, and an ANOVA analysis to compare three groups of age at onset (early, middle and late). Gender was introduced as a covariable. Results: Mean age at onset of the total sample was 23 (sd 7.35), with women having a later age at onset than men (women 24.6 (sd 9.1) ; men 22.2 (sd 5.9) (p<0.05)). The relation between age at onset and social functioning was only significant in the not interpersonal social behavior subscale (p<0.01). Early age at onset was positively related to social contact-communication (p<0.05), not interpersonal social behavior (p<0.05) and total LSP score (p<0.05). When including gender as a covariable, a significant relationship between age at onset and social functioning was found in most of the LSP subscales. Conclusions: Early onset of illness negatively influences psychosocial functioning, especially in the areas of communication, not interpersonal social behaviour and self-care. Female gender positively influences most aspects of social functioning.

Psychosomatic medicine: A new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine

Background and Objectives: In the past, Psychosomatic Medicine (PM) has had ambiguous connotations, and there have been many other names for this specialized fields, including Consultation-Liaison Psychiatry. The objective of this report is to briefly review the background, the history and current status of PM, which recently was recognized in the U.S. a psychiatric subspecialty. Methods: Historical review and review of the literature. Results: PM has a rich history. Psychoanalysts and psychophysiologists pioneered the study of mind-body interactions, and crucial events in the development include the funding of PM units in several U.S. teaching hospitals by the Rockefeller Foundation, and the training grants and a research development program funded by the National Institute of Mental Health. By the 1980s, all psychiatry residency programs were requiered to provide substancial clinical experience in the field, and as of 2005 there were 32 fellowship programs in the Academy of Psychosomatic Medicine's (APM) directory. In 2001, The Academy of Psychosomatic Medicine (APM) applied for the recognition of PM as a subspecialty of psychiatry, and formal approval was granted by the American Board of Medical Specialties (ABMS) in March 2003. The foundation of PM is a specialized body of scientific knowledge regarding psychiatric aspects of medical illness. This has been articulated in contemporary textbooks, journals and regular scientificic meetings of national and international societies A cadre of scholars and researchers has emerged, and important contributions have occurred. A major goal of the PM field is to improve the psychiatric care of patients with complex medical conditions. There are a number of obstacles and challenges ahead in pursuing optimal integration of PM services into existing service delivery systems of care, but anticipated expansion of accredited fellowship programs in PM will hopefully help address this shortfall. In the past 20 years an international PM network has developed with increasing scientific exchanges, and the US paradigm is regarded as important for the development of PM as a subspecialty internationally. Conclusion: Formal recognition as a subspecialty in the U.S. has and will strengthen PM and will enhance its growth internationally.

Do dissociative disorders exist in Northern Ireland?: Blind psychiatric - structured interview assessments of 20 complex psychiatric patients

Background and objectives: Dissociative disorders remain relatively controversial diagnoses in British psychiatry. The aim of the current paper was to assess Northern Irish psychiatric patients with complex clinical presentations for dissociative disorders. Method: Twenty patients meeting operationally defined criteria for psychiatric complexity were blindly assessed by a psychiatrist in a diagnostic interview followed by a clinical psychologist in a structured interview. Results: Thirteen of the 20 participants were positive for at least one dissociative disorder. Those with a dissociative disorder had a range of co-morbid problems and all reported histories of childhood trauma and neglect. Conclusion: The psychiatric symptom profiles of dissociative disorders in Northern Ireland are similar to those reported in the literature. Complex psychiatric presentations offer a potential diagnostic clue for such conditions.

Psychooncology: the state of its development in 2006

Background and Objectives: Psychooncology research and practice has grown exponentially in recent years. We review the evidence-based accomplishments of psychooncology in key areas that inform clinical practice. Methods: We reviewed the following computerized databases: PubMed, Embase, Cochrane, Ovid Medline and Psychinfo for studies on predetermined areas of interest representing the continuum of current psychooncology, focusing on meta-analyses and controlled studies. Results: Cancer related psychological distress occurs in one third of patients. Psychological factors are of importance in cancer prevention such as the relationship of smoking to depression. The association between personality styles and cancer vulnerability is not strong, but social support is a well-established prognostic factor. Existential distress may manifest as demoralization; meaning and dignity-based therapies have been designed to assuage existential angst in the cancer setting. Psychotherapy is efficacious in ameliorating cancer related distress, anxiety and depression, with newer models focusing on meaning and adaptive coping. Although there is not a strong evidence-base for the impact of psychooncology on survival, psychological factors clearly impact on adherence to cancer treatment. Most survivors do well overall, but concerns relate to the long term impact of specific treatments or special populations including children. Neurocognitive effects of chemotherapy have recently been associated with carriers of Alzheimer precursor genes. Doctor-patient communication is of increasing clinical interest alongside concern that physician burnout is increasing. Conclusions: Evidence-based research informs psychooncology's clinical practice and service provision in 2006.