The European Journal of Psychiatry

Profile of male adolescents with conduct disorder on intellectual efficacy, cognitive flexibility, cognitive coping, impulsivity and alexithymia: A comparison with high-risk controls

Background and Objectives: To specify which of the documented cognitive and emotional deficits characterize adolescents with conduct disorder (CD) compared with high-risk controls. Methods: High-risk adolescent males with and without CD were compared on intellectual efficiency, cognitive flexibility, impulsivity, alexithymia, and cognitive coping strategies. Substance use was controlled for in analyses. Results: Both groups showed normal intellectual efficiency and cognitive flexibility, as well as heightened alexithymia and behavioral impulsivity. Youths with CD evidenced more self-defeating and black-and-white thinking under stress, and more acting-out under negative affect, than those without CD. Conclusions: Deficits specific to CD resided in facets of emotional functioning and cognitive coping that might be targeted by a coping skills intervention.

Improving territorial accessibility of mental health services: The case of Spain

Background and Objectives: Citizens choose their health care services not only depending on their needs, but also on where they are located. The location of the services is especially important in the case of mental health due to the specific features of mental disorders. This article provides an analysis of temporal access by road to outpatient mental health centres in Andalusia (Spain) with a view to improving accessibility for the greatest volume of population possible. Methods: Firstly, accessibility by road to the outpatient mental health centres was calculated in terms of time by establishing journey times using the ArcGIS Geographical Information System´s (GIS) Network Analyst module. These journey times by road enabled travel times to be established for these sections, temporal accessibility areas to be plotted from each of the outpatient mental health centres and the number of people included in each accessibility area to be calculated. Results: The accessibility analysis enabled the sitting of the centres to be evaluated for 2006, a comparison to be made with 2011 (with six new facilities having been set up since 2006) and new locations for the siting of these six new facilities to be proposed. Conclusions: This study has enabled the optimum territorial locations to be proposed for the six mental health centres created between 2006 and 2011 that would allow travel times to be reduced for the greatest numbers of people possible. It can be stated on the basis of this study that, if territorial criteria had been taken into account, 97,720 inhabitants would have seen their travel times to their nearest mental health centres reduced using the same resources.

Psychotropic drug use in patients with various chronic somatic diseases

Background and Objectives: To reveal insight into prevalence and incidence of psychotropic drug use in patients with various chronic somatic diseases and into time differences between incidence of the somatic disease and start of psychotropic drug use. Methods: A cohort study was performed using the Agis Health Database from 2002 to 2005. Patients with one or more of nine frequently occurring chronic somatic diseases were selected (N = 140,983). The non-exposed group (N = 417,486) was composed of patients without any of these nine diseases. For the somatic disease prescribed drugs were used as a proxy-indicator. Prevalences and incidences of psychotropic drug use were calculated as well as mean time between the incidence of the somatic disease and release date of the psychotropic drug. Results: Prevalence of antidepressant drugs and benzodiazepines was increased among patients with somatic diseases, with odds ratios of respectively 1.83 (95%CI 1.80-1.87) and 2.31 (95%CI 2.27-2.35). In the first year after incidence of the somatic disease, mean duration in time to start of psychotropic drug use was significantly shorter compared to patients without somatic disease. Conclusions: Physicians should be aware of the high prevalence and earlier onset of psychotropic drug use in all patients with chronic somatic diseases.

Ziprasidone versus Olanzapine in the weight gain associated with the treatment of schizophrenia: A six-month double-blind randomized parallel group study

Background and Objectives: Previous data from safety analysis indicate that olanzapine can result in substantial weight gain, while no change has been observed with ziprasidone. Obesity may be a threat to health and cause subjects to discontinue their antipsychotic medication. To further evaluate the differential effects of ziprasidone and olanzapine on weight gain, a study was carried out having body weight as the primary efficacy endpoint. Methods: A six-month randomized, double-blind, parallel study was carried out in male and female subjects aged 18-70 years with a primary diagnosis of schizophrenia (DSM-IV-TR) and a clinical condition requiring treatment initiation with a new antipsychotic, ziprasidone or olanzapine 1:1, to assess treatment-related weight changes. Fifty patients were included. Efficacy outcomes were assessed at baseline and at weeks 1, 4, 12, 18 and 24. The primary efficacy endpoint was the percent change from baseline in body weight at week 24. Safety was also assessed. Results: At week 24, there was a significantly greater increase in body weight (7.5%, p <0.0001) in patients treated with olanzapine than in those treated with ziprasidone and the number of subjects who had a weight gain > 7% was significantly higher in the olanzapine compared to the ziprasidone group (n = 11 [47.8%]) vs n = 3 [11.1%]; OR = 6.246, p-value = 0.0150). PANNS-N significantly decreased in both groups. Most AEs were moderate or mild in both groups. Conclusions: Olanzapine increases body weight significantly over ziprasidone at week 24. However, treatment with either ziprasidone or olanzapine improved PANSS positive, negative and general psychopathology scores and was well tolerated.

Olanzapine as an add-on treatment in migraine status: A randomized double-blind, placebo-controlled, pilot study

Background and Objectives: The authors assessed the effectiveness of olanzapine as an adjunctive treatment in migraine status. Methods: Randomized, double-blind, placebo-controlled study. Subjects consecutively admitted to a day program of tertiary referral (97 % women; age: 35.8 ± 11.8 yrs.) were assigned to olanzapine (n = 14, 5-10 mg/day) or placebo (n = 17), added to the standard neurological treatment during 4 days. Primary measures were the change in pain and the return to regular daily activities. Secondary and safety measures were the magnitude of sedation, constipation and glucose level changes. Results: No significant differences were observed in the overall analysis of the primary measures. However, change in pain significantly correlated with age in the olanzapine group (p = 0.03). In the > 40 year-old group, olanzapine (n = 5) displayed a significantly higher reduction in pain than placebo (n = 4) at days 1 (p = 0.048) and 3 (p = 0.045). No significant differences were observed in the change of serum glucose levels. Conclusions: Olanzapine was well tolerated and sedation was welcomed by most subjects. The positive effect in subjects aged > 40 years awaits replication.

Cycloid psychoses: Leonhard´s descriptions revisited

Background and Objectives: Cycloid psychoses are characterized by polymorphic symptomatology with intraphasic bipolarity, a remitting and recurrent course and favourable prognosis. Perris and Brockington (P&B) described the first set of operational criteria that were partly incorporated in ICD-10. The present study investigates psychopathological profiles according to the P&B criteria and the original descriptions by Leonhard, both against the background of the criteria from the prevailing international classification systems. Methods: Eighty patients with psychotic disorders were recruited and assessed with various psychometric instruments at baseline and after six weeks of antipsychotic treatment in order to investigate the presence of cycloid psychoses according to Leonhard (LCP) and the effect of treatment with antipsychotics. The overlap between LCP and DSM-IV Brief Psychotic Disorder (BPD), ICD Acute Polymorphic Psychotic Disorder (APP) and P&B criteria was calculated. Results: Using P&B criteria and a symptom checklist adapted from the original descriptions by Leonhard, 14 and 12 cases of cycloid psychosis were identified respectively reflecting a prevalence of 15-18%. Small though significant concordance rates were found between LCP and both DSM-BPD and ICD-APP. Concordance between LCP and P&B criteria was also significant, but modest. Conclusions: This study demonstrates that LCP can be identified in a substantial number of patients with psychotic disorders. Cycloid psychoses are not adequately covered in current classification systems and criteria. Since they are demonstrated to have a specific psychopathological profile, relapsing course and favourable prognosis, it is advocated to include these psychoses in daily differential diagnostic procedures.