Actualment, el cannabis es la substancia il·legal que mes consumeixen els adolescents espanyols, la que comencen a consumir a una edat mes primerenca, la que mes peticions de tractament motiva en aquest grup d'edat, la mes mencionada a urgencies infanto-juvenils i la que mes consequencies academiques, legals i d'ajust psicosocial genera (OESD, 2008). Els models motivacionals de l'us de substancies suggereixen que la conducta esta generada per diferents raons, l'estudi de les quals es important per ajudar a entendre el context i les circumstancies del comportament addictiu. Per l'estudi dels motius de consum de cannabis, Simons i col·laboradors (1998) van desenvolupar el Marihuana Motives Measure (MMM). L'analisi factorial exploratori del MMM suportava la presencia de cinc subescales: Enhancement, Coping, Conformity, Social i Expansion. Aquests motius han demostrat ser uns predictors significatius dels problemes relacionats amb el consum de cannabis. Identificar i millorar la comprensio dels motius de consum i la seva relacio amb l'us i la dependencia es un aspecte de gran importancia per al desenvolupament d'intervencions, tant preventives, com terapeutiques. Donada la manca d'instruments validats en poblacio clinica adolescent espanyola per estudiar els motius de consum i la poca investigacio realitzada en aquest sentit al nostre context i a nivell internacional, els objectius de l'estudi son estudiar les propietats psicometriques del MMM en una mostra d'adolescents amb trastorn per us de cannabis, analitzar les associacions dels motius amb variables cliniques relacionades amb el consum i amb el rendiment academic d'aquest pacients i estudiar la relacio entre els diferents motius de consum i els principals trastorn mentals. Els resultats obtinguts en l'analisi factorial realitzat en aquest treball confirmen una estructura similar a la versio original (Simons i cols. 1998). L'estudi de les propietats psicometriques de la versio espanyola del MMM indiquen un index de fiabilitat i validesa satisfactoris. A mes, els motius de consum han mostrat ser utils a l'hora d'estudiar la relacio tant del consum i les consequencies academiques associades com del consum i la comorbiditat que presenten aquests pacients. El MMM es una eina fiable i valida que ens permetra entre d'altres, obrir linies futures de recerca pel disseny d'intervencions mes efectives dirigides als adolescents consumidors de cannabis.

In order to better understand individual vulnerabilities to bipolar I disorder, this study evaluates individual differences in Behavioral Activation and Inhibition Systems as possible markers of bipolar I disorder. BAS and BIS functioning was evaluated in 39 bipolar I euthymic patients and in 38 controls. Patients showed higher scores on the BAS scale; differences were not detected on the BIS scale. Eighteen months post-initial assessment, patients were re-grouped according to the presence and type of new episodes. Patients relapsing with a depressive episode showed lower scores on the BAS scale than patients suffering from a manic/hypomanic episode, and a tendency to score lower than patients still asymptomatic. Reported higher BAS functioning would reinforce the hypothesis of a trait vulnerability to present approach behaviors during euthymia associated with bipolar I disorder, not necessarily related to the proximity of a manic/hypomanic episode, and interestingly not detected when approaching a depressive episode, circumstance in which BAS functioning would be similar to controls. Results did not reveal a weaker BIS in patients, hypothesized to account for BAS instability in bipolar I disorder.

Objective A post-hoc analysis of the data from a randomised clinical trial involving prescription of antipsychotic treatment to never treated first-onset psychotic patients was used to compare the weight change after 6-week olanzapine treatment (standard tablets vs. orally disintegrating formulation).Method In the subgroup of 38 patients randomised to olanzapine, standard olanzapine tablets were non-randomly and consecutively prescribed to the first 19 patients, with the orally disintegrating formulation being prescribed to the following 19 patients.Results After 6-week treatment with olanzapine, a significant higher increase in weight was noted in those patients on standard tablets (mean weight increase 6.3 +/- 1.9 Kg) as compared to those on orally disintegrating olanzapine (mean weight increase 3.3 +/- 3.2 Kg (F = 7.7; p = 0.009). BMI increase was also significantly higher in the olanzapine tablet group (mean increase of 2.1 Kg/m as compared with 1.1 Kg/m(2) in the orally disintegrating group) (F = 4.7; p = 0.036). Substantial weight gain (SWG) (>= 7% increase from baseline weight) was noted in 84.2% (n = 16) of the olanzapine tablet patients and in 31.6% (n = 6) of the orally disintegrating olanzapine patients, with the olanzapine tablet group showing a significant increase in the mean percentage of weight gain (F = 4.0; p = 0.014).Conclusions Partial sublingual absorption occurring with orally disintegrating olanzapine may bypass gastrointestinal metabolisation and hence lead to differences in metabolite versus parent compound ratios. However, the need arises to replicate the present study with a longer follow-up. Copyright (c) 2007 John Wiley & Sons, Ltd.

Background: We conducted a naturalistic, multicenter, 24-hour, nonrandomized, observational study describing for the first time the effectiveness and safety of intramuscular (IM) olanzapine to control agitation and aggression in "real world" patients with psychosis. The data thus obtained was compared with that reported from randomized double-blind clinical trials.Method: 92 patients attending psychiatric emergency settings were enrolled. The study subjects were 44 male and 48 female patients with a mean age of 36.5 12 years and DSM-IV-TR diagnoses of schizophrenia (48.9%), psychotic disorder not specified (23.9%) or bipolar disorder (27.2%). 10 mg IM olanzapine was administered to all patients. An optional second injection was permitted >= 2 hours later in line with hospital policy. Evaluations (PANSS-EC and CGI-S) were performed at baseline and 2 and 24 hours following the IM injection.Results: Two hours after IM olanzapine was administered, a mean decrease of -9.6 in the PANSS-EC from a baseline score of 26.5 was recorded. At the 24-hour endpoint a statistically and clinically significant reduction in the PANSS-EC scores (11.6 +/- 5.3) was observed as compared with values at study entry (26.5 +/- 5.9) and at 2 hours endpoint (16.9 +/- 9.3), which represent a mean decrease of -14.9 and -5.3, respectively.Conclusion: The present naturalistic study provides naturalistic data on the effectiveness of IM olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar mania that is in line the data obtained in randomized double-blind clinical trials. (c) 2006 Elsevier Masson SAS. All rights reserved.

AddictionVolume 101, Issue 11 p. 1670-1671 MONOGRÁFICO CANNABIS. REVISTA ESPAÑOLA DE DROGODEPENDENCIAS LUIS SAN, LUIS SAN Psychiatry Department, Hospital San Rafael, Barcelona, SpainSearch for more papers by this author LUIS SAN, LUIS SAN Psychiatry Department, Hospital San Rafael, Barcelona, SpainSearch for more papers by this author First published: 10 October 2006 https://doi.org/10.1111/j.1360-0443.2006.01675.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume101, Issue11November 2006Pages 1670-1671 RelatedInformation

Agitation is commonly seen in acute schizophrenic patients and core symptoms include a wide range of symptom. It requires rapid and effective treatment approaches in order to protect patient and caregiver from potential injury. Clinician's decision of pharmacological treatment should be individualized to the needs and circumstances of the patient. Benzodiazepines, typical antipsychotics, and combinations of typical antipsychotics and benzodiazepines have been widely used as treatment options. Atypical antipsychotics have clear advantages over the typical drugs as they generally show a much better safety and tolerability profile, particularly to EPS and related side effects, however clinical perception regarding efficacy in treating acutely agitated psychotic patient is controversial. New intramuscular atypical antipsychotic formulations offer evidence of being at least as effective as typical antipsychotics in controlling agitation. Therefore, they should be considered as first line therapy in agitated schizophrenic patients.

Polydipsia is a frequent clinical entity in psychiatric patients, especially in those with a psychotic disorder. Acute episodes of polydipsia can produce important metabolic alterations and even coma and death. Psychogenic polydipsia is a underestimated diagnosis, due to multiple causal factors and an etiology that has not been clearly established. We present the case of a patient with psychiatric background who was seen due to a clinical situation of severe acute renal failure by high rhabdomyolysis that needed hemodialysis, due to acute polydipsia. We also review some of the epidemiological and clinical factors and etiopathogeny of the polydipsia. It is considered necessary to keep in mind the in mind the diagnosis of polydipsia in any psychiatric patient showing acute symptoms of confusion.

Highlights•We describe four patients of repeated catatonia following lorazepam taper.•All the reported cases were either adolescents or young adults.•Developmental anomalies appear to be linked to recurrent catatonic presentations.AbstractThe evidence base for long term lorazepam treatment in catatonia is limited. Here, we describe four patients with differing primary diagnosis, all of whom had catatonic relapses whenever lorazepam was tapered following acute response. The common threads in the cases are highlighted and contextualized with global literature which may facilitate identification of such patients in clinical practice.

A single case of a patient suffering from a first psychotic episode and the differential diagnoses between affective and psychosis is performed throughout the combined use of peripheral serotonergic markers and clinical psychopathological scales during a 6-months follow-up. The results suggest the need of performing further studies combining biological and clinical markers of psychiatric disorders.

The hippocampus plays a critical role in verbal and spatial memory, thus any pathological damage to this formation may lead to cognitive impairment. It is suggested that right and left hippocampi are affected differentially in healthy or pathologic aging. The purpose of this study was to test the hypothesis that verbal episodic memory performance is associated with left hippocampal volume (HV) while spatial memory is associated with right HV. 115 non-demented adults over age 70 were drawn from the Einstein Aging Study. Verbal memory was measured using the free recall score from the Free and Cued Selective Reminding Test – immediate recall (FCSRT-IR), logical memory immediate and delayed subtests (LM-I and LM-II) from the Wechsler Memory Scale-Revised (WMS-R). Spatial Memory was measured using a computerized dot memory paradigm that has been validated for use in older adults. All participants underwent 3 T MRI with subsequent automatized measurement of the volume of each hippocampus. The sample had a mean age of 78.7 years (SD=5.0); 57% were women, and 52% were white. Participants had a mean of 14.3 years (SD=3.5) of education. In regression models, two tests of verbal memory (FCSRT-IR free recall and LM-II) were positively associated with left HV, but not with right HV. Performance on the spatial memory task was associated with right HV, but not left HV. Our findings support the hypothesis that the left hippocampus plays a critical role in episodic verbal memory, while right hippocampus might be more important for spatial memory processing among non-demented older adults.

Cannabis has been commonly regarded as an innocuous drug, and has been used for centuries due to its multiple therapeutic effects (analgesic, anticonvulsant, sedative, antidepressant, etc.). However, growing evidence in recent years highlights the risk of adverse effects secondary to dependence and withdrawal syndrome. We report a case of severe cannabis dependence, that led to a variety of psychopathological, cognitive and somatic symptoms. This is compared with the bibliography and we analyze the influence of a possible underlying psychiatric disease. The adverse effects include affective and eating disorders, and the possibility of seizure induction. A novel therapeutic strategy in cannabis dependence is reported. Key words: Cannabis. Mania. Bulimic behaviors.

The 5-HT2A receptor binding parameters using [3H]ketanserine and its intracellular signal inositol 1,4,5 trisphosphate (IP3) concentrations were determined in platelets from schizophrenic patients so as to assess differences with respect to a control group and to a standardized antipsychotic drug treatment. Seventy-five antipsychotic-free patients with a DSM-IV diagnosis of paranoid schizophrenia were included in the study. Blood samples were collected before the onset of antipsychotic treatment (baseline values) and after 3 weeks of treatment. Antipsychotic-free schizophrenic patients showed significantly increased basal 5-HT2A densities in comparison to the control group, together with a significantly increase (23%) in the 5-HT2A binding density in those patients treated with risperidone. These changes could be attributed to an up-regulation of 5-HT2A receptors caused by previous treatment with antipsychotic drugs, which is consistent with the chronic effect of 5-HT2A antagonists to up-regulate the number of binding sites. With regard to second messenger IP3 concentrations, basal concentrations in schizophrenic patients were not significantly different from control values, nor was there any significant difference between basal vs. posttreatment values. These results are possibly related to failure of second messenger systems of ‘translating’ extracellular messages generated presynaptically into effective neurotransmitter signals in schizophrenic patients.

INTRODUCTION:Recent studies have confirmed the usefulness of the therapeutical combination of two antidepressants from different pharmacological families in patients with single drug therapy resistant depression.METHODS:In this prospective 6 weeks open-labeled study, efficacy of combination strategy was evaluated. This included the addition of reboxetine to 34 outpatients with DSM-IV major depressive disorder, who had not responded previously, or who partially responded to conventional treatment in single drug therapy with serotonin selective reuptake inhibitors (SSRI). Data were analyzed on a intent-to-treat basis.RESULTS:Mean decrease in the 21 item Hamilton depression rating scale (HDRS) score was 49.4% (from 26.9 to 13.6; p<0.0001) and in the clinical global impressions scale (CGI) was 40.4% (from 4.6 to 2.7; p < 0.0001). At the end of the treatment, 47.1% of the patients we re considered in remission (HDRS < or = 10), 55.9% evaluated as responders (HDRS < or = 50%) and 58.8% considered as having improvement (CGI<4). No serious side effects were observed during combination therapy, the most frequent being nervousness and the urinary hesitancy (5.9%).CONCLUSIONS:The results of this study suggest that addition of reboxetine to SSRI may be an effective and well-tolerated strategy in treatment-resistant patients who have failed to adequately respond to single drug therapy with SSRI.

Cholecystokinin (CCK) and its receptor CCK-2R have been shown to promote emotional responsivity and behavioral sensitization to psychostimulants in the rat. An animal model has been developed based on locomotor response to a novel inescapable environment. Animals exhibiting consistent differences in locomotor response to novelty have been termed as high and low responder rats (HR and LR, respectively). This paradigm is deemed to model sensation-seeking, a personality trait closely associated with substance abuse. The present study provides genetic and pharmacological evidence that the CCK-ergic system modulates this behavior. Distinctive patterns of CCK-related gene expression in HR and LR animals occurred beyond the mesolimbic pathways. CCK gene expression was higher in hippocampus, amygdala, and prefrontal cortex, but lower in the ventral tegmental area of HR relative to LR rats. Levels of CCK-2R mRNA were more elevated in LR animals in some areas of the forebrain such as the prefrontal cortex, nucleus accumbens, and hippocampus. Additionally, CCK-2R blockade with the antagonist LY225.910 (0.5 mg/kg) removed phenotype differences in sustained exploration of novel stimuli (i.e., a novel-object) in HR and LR rats exposed to an enriched open-field test series. Finally, CCK-2R blockade also altered M2 and 5-HT7 receptor gene expression in the mediodorsal thalamus (a strategic structure for corticothalamic trafficking) in a phenotype-dependent manner. Taken together, the findings reported here suggest that distinct CCK-ergic function may contribute to promoting individual differences in novelty-seeking behavior.

Background: The Calgary Depression Scale for Schizophrenia (CDSS) is a valid tool to assess depression in schizophrenics and has been translated, adapted, and validated to be used in different non-English languages. Therefore, it may be predicted that a Spanish version of this scale will be also a valid instrument to assess symptoms of depression in patients with schizophrenia. Objective: We determined the validity of the Spanish version of the Calgary scale (CDSS-S). Methods: Outpatients and inpatients (n=93) diagnosed as having schizophrenia by DSM-IV criteria confirmed by SCID-IV interview were included. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-17 and HDRS-21 items), Montgomery-Åsberg Depression Rating Scale (MADRS), Extrapyramidal Symptoms Rating Scale (ESRS), and Barnes Acathisia Rating Scale were administered by a first rater, whereas the CDSS-S was assessed by a second independent rater. Results: The internal consistency (Cronbach's alpha 0.83) and the interrater reliability (>0.73 intraclass correlation coefficient [ICC] for single items and 0.92 for total score) were good. The test–retest reliability was high (ICC of 0.89). The scale showed a good construct validity with statistically significant correlations with HDRS-17, HDRS-21, MADRS, and G6 item (depression) of PANSS. The CDSS showed no correlation with the positive subscale of PANSS and a weak correlation with the negative subscale, general psychopathology subscale, and total score of PANSS. A cut point of five showed 94.7% sensitivity, 86.5% specificity, and 70% and 98% positive and negative predictive values, respectively. Conclusions: The Spanish version of CDSS is a valid instrument to assess depressive episodes for stabilized and acute patients with schizophrenia.

Background: To investigate the usefulness of the combination therapy with two antidepressants from different pharmacological families in treatment-resistant depressive patients. Methods: In this prospective 6 weeks open-label study, we assessed the effectiveness of the addition of reboxetine to 61 depressive patients that had previously not responded, or had done so only in a partial way, to conventional treatment, in monotherapy, with selective serotonin reuptake inhibitors (SSRIs), venlafaxine or mirtazapine. Data were analyzed on an intent-to-treat basis, using the last-observation-carried-forward (LOCF) method. Results: Mean decrease on the 21-item Hamilton Depression Rating Scale (HDRS) score was 48.9% and on the Clinical Global Impressions Scale (CGI), 38.9%. At the end of the treatment, 62.3% of the patients were evaluated as improvement (CGI<4), 54.1% as responders (HDRS≤50%) and 45.9% in remission (HDRS≤10). No serious side effects were observed during combination therapy, being more frequent increased sweating (8.2%) and dry mouth (6.6%). Conclusions: These findings suggest that the strategy of combination with reboxetine may be an effective and well-tolerated tool in treatment-resistant patients who have failed to adequately respond to monotherapy with SSRIs, venlafaxine or mirtazapine.