Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 25 num. 4 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<B>Comorbidity patterns in dual diagnosis across seven European sites</B>]]> Background and Objectives: Psychiatric inpatients with substance use disorders are a significant public health concern due to grave consequences including increased risk of self harm, homicide as well as poor clinical outcome. The present study aims to examine and compare patterns of comorbidity (i.e. concurrent substance use disorders and severe mental illness) among psychiatric inpatients across seven European sites. Methods: 352 patients were included consecutively from psychiatric inpatients units at 7 European sites and interviewed with the Mini- International Neuropsychiatric Interview and the European version of the Addiction Severity Index questionnaires. For analysis the psychiatric diagnostic groups were organized into broader categories. Results: Concurrent alcohol use disorder and mood disorder was found to be the most prevalent comorbidity pattern (30.8%) across Europe. Alcohol or drug use disorder combined with mood disorder was most prevalent among females and in the older age group whereas mixed substance use and psychosis was more frequent among males and younger participants. Finally, differences in comorbidity patterns were found at different European sites. Conclusions: The prevalence of different comorbidity patterns varied across European clinical settings. Significant differences between comorbidity subgroups were found with regard to age and gender. <![CDATA[<B>In vivo type II T-helper cells shift in schizophrenia compared to sex- and age-matched healthy controls</B>]]> Background and Objectives: Over-production of the type II T-helper cells (Th2-shfit) has been suggested as a candidate mechanism for the etiology in at least one subgroup of schizophrenia. Hitherto, empirical evidence is derived mostly from in vitro cytokine production. Due to frequently undetectable serum levels of the major Th2 cytokine Interleukin-4 (IL-4), direct evidence, measured as a ratio between Th1/Th2 (type I/type II T-helper cells) characteristic cytokines, is rare. This study aimed at examining whether a serum Th2-shift occurs in schizophrenia. Th2-shift was defined as markedly decreased serum IFN-&gamma;/IL-4 and/or IFN-&gamma;/IL-10 and/or IL-2/IL-4 ratios, compared with healthy subjects. Methods: Totally 74 subjects were recruited: 37 drug-free subjects with schizophrenia according to ICD-10 and DSM-IV as well as 37 age- and sex-matched healthy controls. Cytometric Bead Array, which enables a simultaneous measurement of 6 cytokines with the same volume of test sample, was used to assess serum Th1/Th2 ratios and cytokine levels. Non-parametric Mann-Whitney U test was utilized to detect the diversities in serum Th1/Th2 ratios and cytokine levels between both diagnostic groups. Results: Subjects with schizophrenia showed significantly reduced serum IFN-&gamma;/IL-4 and IFN-&gamma;/IL-10 ratios if compared to healthy controls. If both sexes analyzed separately, males with schizophrenia had significantly reduced serum IFN-&gamma;/IL-10 ratios, while female patients showed markedly decreased serum IFN-&gamma;/IL-4 ratios. Conclusions: A clear Th2-shift was observed in schizophrenia. Males and females with schizophrenia seemed to have different profiles of Th2-shift. Th1/Th2 ratios appeared to play different roles in the pathology of males and females with schizophrenia. <![CDATA[<B>Prevalence of burnout in a sample of Brazilian teachers</B>]]> Background and Objectives: Burnout is a psychological response to chronic work-related stress of an interpersonal and emotional nature. Brazilian law have already contemplated burnout syndrome as a mental and behavioural disorder related to work. The aim of this study was to identify the prevalence of burnout in a sample of Brazilian teachers. Methods: The sample was composed of 714 teachers from 8 schools in Porto Alegre and its metropolitan area (Brazil). The levels of burnout were evaluated by the Spanish Burnout Inventory, educational version (SBI-Ed). In addition, Psychosomatic disorders were estimated by the UNIPSICO subscale. Results: The percentage of participants who indicated high levels of burnout was 12 % (Profile 1), and 5.6% fell into Profile 2 because they were affected by strong feelings of guilt. Moreover, participants with high scores on the SBI dimensions (low on Enthusiasm toward the job) scored significantly higher on psychosomatic disorders than participants with low scores. Conclusions: Based on psychometric considerations, participants who fit Profile 2 of burnout could be considered burnout cases according to Brazilian legislation. However, using a clinical interview to make the diagnosis is recommended. <![CDATA[<B>Screening for metabolic syndrome in long-term psychiatric illness</B>: <B>Audit of patients receiving depot antipsychotic medication at a psychiatry clinic</B>]]> Background and Objectives: Metabolic syndrome (visceral obesity, dyslipidaemia, hyperglycaemia, hypertension) is a substantial public health problem, especially amongst individuals receiving antipsychotic medication. Methods: We studied routine screening practices for metabolic syndrome amongst psychiatry outpatients receiving injected depot anti-psychotic medication at a clinic in Dublin, Ireland. Results: Our initial audit (n = 64) demonstrated variable levels of documentation of criteria for metabolic syndrome in outpatient files; e.g. weight was recorded in 1.6% of files, serum high density lipoprotein in 12.5%. As our intervention, we introduced a screening check-list comprising risk factors and criteria for metabolic syndrome, based on the definition of the International Diabetes Federation. Re-audit (n = 54) demonstrated significantly improved levels of documentation; e.g. weight was recorded in 61.1% of files. Notwithstanding these improvements, only 11 (20.4%) of 54 patient files examined in the re-audit, contained sufficient information to determine whether or not the patient fulfilled criteria for metabolic syndrome; of these, 3 patients (27.3%) fulfilled criteria for metabolic syndrome. There was, however, significant additional morbidity in relation to individual criteria (waist circumference, serum triglyceride level, systolic blood pressure and serum fasting glucose). Conclusions: We recommend enhanced attention be paid to metabolic morbidity in this patient group. <![CDATA[<B>Bipolar Disorder Comorbidity in Anxiety Disorders</B>: <B>Relationship to demographic profile, symptom severity, and functional impairment</B>]]> Background and Objectives: High rates of comorbidity between anxiety disorders and bipolar disorder (BD) have been reported. Studies on the impact of BD comorbidity in individuals with a principal anxiety disorder have been limited. Methods: Individuals (N = 186) seeking anxiety disorder treatment completed questionnaires and a diagnostic interview. Anxious individuals with comorbid BD were compared to anxious individuals with comorbid depression, and individuals with an anxiety disorder only. Results: Anxious individuals with BD were more likely to report being single, separated or divorced, and to present with greater substance abuse and comorbidity than individuals with an anxiety disorder only. Anxious individuals with BD also presented with lower household income than anxious individuals with depression, and individuals with anxiety only. Anxious individuals with either comorbid BD or comorbid depression reported greater functional impairment and more severe symptoms than individuals with anxiety only. Conclusions: Overall, the presence of comorbid BD was associated with demographic and clinical factors that have been previously shown to adversely affect treatment outcome in people with anxiety disorders.