Early Intervention in Psychosis (EIP) services have been youth-focused since their inception. Recently, NICE recommend the expansion of the age acceptability criterion to 65 years, from the previous cut-off of 35 years. The aim of this study is to compare the demographic and clinical characteristics between patients below and above 35 years of an epidemiological cohort of first-episode psychosis patients treated in the Early Intervention Service of Cantabria (ITPCan). This is an study of the 207 consecutive patients aged from 17 to 65 who were admitted to the Service of University Hospital Marqués de Valdecilla, Spain, from January 2020 to July 2024. Descriptive statistics and between groups comparisons are reported. A large proportion (51.2%) of those who presented a first episode of psychosis did so after the age of 35. The over 35s were predominantly female (65,1%), whilst the under 35s were predominantly male (58.4%) (χ2=11.495, P=0.01). No significant differences were found between the age groups in terms of the need for psychiatric care in the different facilities (emergency care, day hospital, acute unit admission or mid-stay unit admission), nor in the presentation of autolytic attempts or the requirement for mechanical restraint. DUP was significantly higher in the over 35s (u=4183.5, P=0.006), with a median of 4 months versus a median of 2 in the under 35s. As for the use of drugs, 36.6% of the under 35s regularly consume cannabis compared to 6.6% of the over 35s (χ2=15.783, P=0), while there are no differences in the consumption of tobacco or alcohol. There was a higher proportion of patients over 35 with diabetes (4.7% vs. 0%, χ2=4.407, P=0.036), hypercholesterolemia (20.8% vs. 4%; χ2=11.750, P=0.001) and a history of cardiovascular disease (7.5% vs. 1%, χ2=4.678, P=0.03), but no significant differences were observed between groups in the history of cerebrovascular disease or hypertension. In reference to diagnosis, non-affective psychosis was more frequent in both groups (73.3% in under 35s and 90.6% in over 35s), with the diagnosis of delusional disorder being more frequent in the group over 35s (18.9% vs 1%, χ2=16.127, P=0). On the other hand, the diagnosis of manic episode with psychotic symptoms was significantly higher in those under 35 years of age (22.8% vs 9.4%, χ2=6.867, P=0.009). Despite the high proportion of patients who have a late onset of psychosis, specially women, this remains an understudied group. EIP services focused on young people are gender and age inequitable. There are some clinical and demographic differences between the two age groups and EIP services should ensure that the treatments offered are tailored to the needs of both groups. None Declared

A large number of studies have suggested that longer duration of untreated psychosis (DUP) is associated with poor clinical and functioning outcomes. The aim of this study is to explore the association of duration of untreated psychosis and functional and clinical outcomes at short term (3 months) in first episode patients. This is a study of all patients admitted to the EI Service of University Hospital Marqués de Valdecilla in Spain, from January 2020 to July 2024, residents in the area (310,000 habitants), aged from 17 to 65, who experiencing a first episode of psychosis. We set the DUP cut-off point at 6 months to compare both groups, short-duration and long-duration psychosis. The response to treatment was assessed at 3 months with standardized scales: the PANSS scale was used to measure clinical response and the GAF scale to asses functional outcomes. A total of 207 first episode patients were referred to the Early intervention Service (EIS). The mean age was 37 years-old. 54% were woman (n=111). 21% were living alone. 32% were unemployed. Forty percent (n=82) have a psychiatric family history. 63% required hospital admission and forty-nine percent were involuntary. The mean GAF at the initial assessment was 34.8 (SD: 12.08). The mean duration of untreated psychosis (DUP) was 15 months (SEM ±2.63) and the median was 3 months (SD: 37.87). A total of 67 patients had DUP longer than 6 months. We did not found significant differences in sex (51.4% women in the short-DUP and 58.2% women in the long-DUP; χ2 = 0.84; p = 0.36) or age (36 years old in the short-DUP vs 37 years old in the long-DUP; p = 0.52) between groups. A greater number of people in the long-DUP group were unemployed (χ2 = 18,136, p = 0.02) compared to the short-DUP group. A&E visits were significantly higher in short-DUP group (71.8% vs 28.2%, χ2 = 8.82; p = 0.003). No significant differences were found between groups in terms of hospital admission or duration of stay. The rate of responders using the PANSS remission criteria proposed by Andreasen was 82.7% at 3 months. Non-responders were 15.9% in the short-DUP vs 20.8% in the long-DUP (p = 0.43). Non-significant differences were found. At 3 months, the rate of patients who scored more than 70 points on the EEAG scale was 71.5%. Non-significant differences were found (70% short-DUP vs 74% long-DUP; p = 0.49) between both groups. We observed that the percentage of non-responders at 3 months is higher in the group with a larger DUP. At 3 months, patients within the early intervention program showed a high level of functioning regardless of the duration of untreated psychosis. None Declared

IntroductionIn the general practice, psychiatrists widely prescribe antipsychotics for several conditions as schizophrenia, bipolar disorder and behavioral disorders among others.Aim and objectivesThe aim of this study is to describe the clinical and sociodemographic features of typical patients receiving antipsychotics and their effects after switching to long-acting treatment.MethodsA descriptive analysis of 80 outpatients collected from a mental health clinic in Santander (Spain) was performed. All patients were taking antipsychotics at baseline, both oral and intramuscular, and were switched to a different long-acting antipsychotic drug.ResultsAt baseline, 24 patients were taking oral medication and 56 intramuscular. There were 37 females and 43 males. There were no gender differences in the final treatment, but Palmitate Paliperidone (71.3%) was the most prescribed drug, followed by intramuscular risperidone (16.3%) and long-acting aripiprazole (11.3%). We found gender differences regarding cannabis (P = 0.002), alcohol (P = 0.004) and tobacco (P = 0.043) consumption, being their use more common in males. In regard to diagnosis, schizophrenia was predominant in both gender groups, whereas delusional and behavioral disorders were more frequent in females. There were no significant differences in the reason of switching, but the inefficacy was more common in males and the side effects in females. At the switching, females were significantly older than males (P = 0.003). We found significant differences before and after switching regarding the number of admissions, emergency visits and length of stay.ConclusionsAntipsychotic benefits are individual and unpredictable. When switching, some other different factors should be taking in account, not only regarding medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Patients with psychosis are treated in outpatient community clinics during most of their lifetime. Antipsychotic treatments are commonly used in regular clinical practice. However, the non-adherence is one of the main causes of relapses. Long-acting injectables (LAIs) could be a safe option to guarantee the efficacy. Aim and objectives Our purpose is to evaluate the efficacy of the switch to paliperidone palmitate from other oral or LAI antipsychotics, in terms of hospital and emergency admissions. Methods We performed a mirror-image study in an outpatient mental health clinic, comparing patients before and after paliperidone palmitate change over 43 months. Fifty-seven patients were included, most of them (n = 47) were diagnosed with psychotic disorders (82.5%) while 4 were bipolar patients (7%), and the remained patients (n = 6; 10.6%) were classified as behavioral disorders. The following variables were studied before and after the switching: number of admissions, days of stay and emergency visits. Results From those 57 patients, 44 were previously treated with other LAIs, whereas 13 were taking oral antipsychotics. The median age at switch was 49 years (SD = 12.31). The reasons for switching were: inefficacy (26.3%), non-adherence (19.3%), side effects (38.6%), and non-specified (15.8%). We found significant differences between the three main variables: number of admissions (t = 4.59; P ≤ 0.001), days of stay (t = 2.27; P = 0.027) and emergency visits (t = 3.74; P ≤ 0.001). Conclusions Paliperidone palmitate seems to be an effective treatment in order to guarantee the adherence. Our preliminary data show that paliperidone palmitate might reduce the sanitary cost in outpatients. Disclosure of interest The authors have not supplied their declaration of competing interest.

More research is needed to further our understanding of posttraumatic stress responses and comorbidity following myocardial infarction (MI), and to help us identify more clearly the personality traits which indicate that a person is more prone to developing post-MI posttraumatic stress disorder (PTSD). This study aimed to 1) investigate the comorbidity of patients who suffered from different levels of posttraumatic stress disorder following myocardial infarction (i.e. post-MI PTSD), and 2) investigate to what extent patients with different levels of post-MI PTSD differed in their personality traits. One hundred and twenty MI patients from two general practices were recruited for the study. They were asked to complete the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). They were divided into a no-PTSD group, a partial-PTSD group and a full-PTSD group, according to the scores of the PDS. One hundred and sixteen members of the general public were also recruited for comparison purposes. They were asked to complete the GHQ-28. The results showed that patients with full-PTSD reported significantly more somatic problems, anxiety, social dysfunction and depression than the other two patient groups and the control group. When age, bypass surgery, mental health problems before MI and angioplasty were controlled for, patients with full-PTSD also reported greater symptom severity of the four GHQ subscales than the other two patient groups. Patients with full-PTSD were significantly more neurotic than those with no-PTSD and partial-PTSD. Patients with full-PTSD were less agreeable than patients with no-PTSD. Regression analyses showed that personality did not moderate the relationship between PTSD and comorbidity. To conclude, following MI, those with full-PTSD tend to report more severe comorbidity than those who have not developed PTSD fully. The former can also be distinguished from the latter by virtue of their specific personality traits.

We examined changes in mood and personality characteristics in a sample of cocaine-dependent women being treated in a therapeutic community (TC). Forty-six women completed the Beck Depression Inventory (BDI), the Hamilton Anxiety Scale (HAM-A), and the Millon Clinical Multiaxial Inventory-II (MCMI-II) on admission and 12 months after discharge from the TC. On admission, the group was characterized by clinically significant scores on the BDI, HAM-A, and the MCMI-II Avoidant, Dependent, Antisocial, Passive-aggressive, Self-defeating, and Borderline scales. On follow-up, significant improvement in functioning was suggested by decreases in scale scores on the BDI, HAM-A, and MCMI-II Avoidant, Dependent, Self-Defeating, and Borderline Scales, but not for the MCMI-II Antisocial and Passive-Aggressive scales. These results suggest substantial positive effects of TC treatment on personality characteristics and functioning, but also indicate that TC treatment may not habilitate all critical personality deficits.

Objective:Nocturnal panic attacks are considered in PD patients a severe subtype of the illness. Recent studies failed at identifying more severe psychopathology in these patients. We analyzed this issue in a sample in the earlier phases of PD.Patients and method:A sample of 153 patients (107 women and 46 men) with a recent onset of a PD established with the MINI was included. Patients were free of treatment and had never received effective treatment for their disorder. Data were obtained both from the clinical interview and from specific questionnaires concerning severity (PDSS, CGI), agoraphobia (MIA), anxiety (STAI) and depression (BDI). The presence of nocturnal attacks was assessed during the clinical interview.Results:The median time of evolution of the PD was 8 months. The mean age of the sample was 30 years old. Agoraphobia was diagnosed in 66% of the cases and the mean CGI was 4.22 (moderate). More than half of the patients (52.9%) reported nocturnal panic attacks. A positive relationship was found between rate of panic attacks and nocturnal attacks (PDSS frequency: p=0.002; number of attacks in the last month: p=0.02). A positive relationship appeared with agoraphobia (PDSS agoraphobic avoidance: p=0.05; MIA alone: p=0.02). No relationship appeared regarding CGI and scales concerning psychopathology.Conclusions:Half of the patients in first stages of PD reports nocturnal panic attacks, which are related both to an increased rate of panic attacks and an increased agoraphobic avoidance. However, nocturnal attacks are not related with the whole clinical severity of PD.

In a remarkable study, Kikuchi et al. have shown that the prevalence of agoraphobia (AG) is related to long duration of panic disorder (PD) and prevalence of generalized anxiety disorder using a transverse-design study in outpatients.1 They suggest that further longitudinal studies using structured interviews are needed to determine the optimum strategies to prevent the development of AG in PD patients. In contrast, they suggest that a limitation of their study was that information given by the patients is subject to recall bias. Another possible shortcoming is the possible selection bias, given that patients with AG had a longer duration of illness and would have had more opportunity for previous psychiatric consultations. We recently organized a meeting in Santander, Spain, entitled ‘The Early Phases of Anxiety Disorders’ (Santander, Spain, 17–19 November 2005). Here, relevant European researchers in the field of anxiety disorders (mainly panic), analyzed factors related to the development of these disorders and the possibility of early intervention strategies, such as the ones recently adopted in the field of schizophrenia. The main problem in the case of PD is the difficulty of prospectively studying large cohorts of subjects, because prodromal symptoms of anxiety disorders are highly prevalent in the general population. This is not the case in psychotic disorders, where prodromal symptoms may be presented by some subjects (i.e. schizotypal patients, so on) but not by a large proportion of the population. In the case of anxiety disorders, even the study of high-risk cohorts (for instance, offspring) would be very costly, although some efforts have been made.2 With this limitation in mind, the best strategy would be to recruit patients at the first stages of the illness, after the initial consultation with the Emergency services or with general practitioners. At least this approach would give us the opportunity to analyze patient clinical features before the start of treatment and to follow them prospectively. We are conducting a study of this kind, in the Panic Disorder Unit of Cantabria (PADUC), and lately presented some data.3 In brief, panic patients recruited in the first stages of their illness were evaluated with the Mini International Neuropsychiatric Interview4 in order to determine the DSM-IV diagnosis, and only those with PD with or without agoraphobia with recent onset and who were free of any comorbid psychiatric disorder were included in the study and prospectively followed up. Median time since the first panic attack was 8 months. With more than 200 patients now included in the study, we have found that only one patient with a 1-year follow-up evaluation (out of 75 with available data at this point) developed agoraphobia and did not suffer from it at baseline. This means that nearly 99% of agoraphobics at 1-year follow up had presented agoraphobic features also at intake. In fact, some authors have suggested that the large majority of panic patients (90%) suffer from mild phobic symptoms before the onset of panic attacks.5 This contrasts with the findings reported by Kikuchi et al. because they showed that 69 out of the 170 patients (nearly 40%) with PD with AG manifested the agoraphobia more than 2 years after the onset of PD.1 We should not be surprised at some differences in the evaluation of agoraphobia because it has been shown that interrater reliability is poor among clinicians,6 and this must be especially true when cultural differences are taken into account. However, these differences reinforce the comments about the need for prospective longitudinal studies using structured interviews. This study was supported by grants from the Fondo de Investigación Sanitaria (FIS), Spanish Ministry of Health (Exp.PI020877), and from the ‘Fundación Marqués de Valdecilla’ (A/16/02).

OBJECTIVE:To explore the relations between personality traits using the Big Five model and presence of agoraphobia, clinical severity and short-term outcome in an unbiased clinical sample of never-treated panic disorder patients.METHOD:Panic disorder (PD) patients (n = 103) in the first stages of their illness were evaluated using the Neuroticism-Extraversion-Openness Five Factor Inventory of Personality (NEO-FFI) and were compared with a sample of healthy subjects. Severity was assessed by the Panic Disorder Severity Scale and the Clinical Global Impression Scales. Patients were evaluated after 8 weeks of naturalistic pharmacologic treatment with Selective Serotonin Reuptake Inhibitors.RESULTS:Panic disorder patients show more neuroticism than healthy subjects. Patients suffering from agoraphobia are more introverted than controls. Extraversion, in addition to gender and distress, during panic attacks allows to correctly classifying 72% of the cases of agoraphobia.CONCLUSION:Low scores in extraversion contribute to explain the presence of agoraphobia in panic disorder. Personality traits are neither related to clinical severity nor to short-term response to pharmacological treatment.

The complex interplay of externalizing and internalizing problems in substance use risk is not well understood. This study tested whether the relationship of conduct problems and several internalizing disorders with future substance use is redundant, incremental, or interactive in adolescents.Two semiannual waves of data from the Happiness and Health Study were used, which included 3383 adolescents (M age = 14.1 years old; 53% females) in Los Angeles who were beginning high school at baseline. Logistic regression models tested the likelihood of past six-month alcohol, tobacco, marijuana, and any substance use at follow-up conditional on baseline conduct problems, symptoms of one of several internalizing disorders (i.e., Social Phobia and Major Depressive, Generalized Anxiety, Panic, and Obsessive-Compulsive Disorder), and their interaction adjusting for baseline use and other covariates.Conduct problems were a robust and consistent risk factor of each substance use outcome at follow-up. When adjusting for the internalizing-conduct comorbidity, depressive symptoms were the only internalizing problem whose risk for alcohol, tobacco, and any substance use was incremental to conduct problems. With the exception of social phobia, antagonistic interactive relationships between each internalizing disorder and conduct problems were found when predicting any substance use; internalizing symptoms was a more robust risk factor for substance use in teens with low (vs. high) conduct problems.Although internalizing and externalizing problems both generally increase risk of substance use, a closer look reveals important nuances in these risk pathways, particularly among teens with comorbid externalizing and internalizing problems.

An acute-phase response (APR), manifested as an increase of acute-phase proteins has been shown in major depression. Panic disorder (PD) may share some aetiopathogenic mechanisms with depression, but APR has not been studied in this disorder. Forty-one panic patients in the first stages of their illness were compared with 32 healthy subjects of comparable sex, age, and body mass index. Clinical diagnosis was established with the Mini International Neuropsychiatric Interview, and severity with the Panic Disorder Severity Scale and the CGI scale. Laboratory determinations included four acute phase proteins (APPs) [albumin, gammaglobulins, fibrinogen, C-reactive-protein (CRP)] and basal cortisol level. Patients were studied after 8-wk follow-up taking selective serotonin reuptake inhibitors (SSRIs) to assess the evolution of the APPs. Gammaglobulin levels were lower, and both cortisol and CRP levels were higher in PD patients than in controls. APP did not differ between patients with or without agoraphobia. At follow-up, patients who responded to SSRIs presented a decrease in albumin levels, and a trend towards a decrease in cortisol and CRP compared with levels at intake. The conclusions of this study are that there is an APR in patients suffering from PD, and this APR tends to diminish after a successful treatment with SSRIs.

Background: The Global Assessment of Functioning (GAF) scale is a measure widely used to assess the outcome of patients with schizophrenia. However, little is known about the importance of clinical and psychosocial variables in determining its final score. The aim of this paper is to identify which factors predict GAF scores of patients with schizophrenia and their variability in 5 different European settings.Method: A representative sample of 404 patients with schizophrenia was assessed with the GAE A multiple regression analysis was performed to identify predictors of the GAF scores.Results: Clinical factors are the main determinants of GAF score. However, the analysis also showed that social and functioning factors were also significantly associated with GAF scores. Finally, the study showed the presence of intercenter differences in the factors, mainly in social functioning.Conclusions: The GAF is a useful and easy-to-apply measure of global functioning, independent of cross-cultural differences. Clinical factors are the main determinants of its score, although social functioning variables also have a lesser effect. (c) 2005 Elsevier Inc. All rights reserved.