Co-occurrence of substance use disorders and other mental disorders in people undergoing specific treatment for any of them in Spain

The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high but is, in fact, unknown in Spain; and it is approached from different healthcare networks. The objective of the present study was to know the prevalence of this co-occurrence, both in specific addiction treatment networks and in mental health networks, in Spain. An observational, multicenter cross study, with a randomized sample, of patients under treatment for SUD or OMD in different Autonomous Communities of Spain was carried out (N=1,783). A specific ad hoc online questionnaire collecting sociodemographic variables, substance use and diagnoses of SUD and OMD was completed.The data obtained in the survey show a significant concurrence of SUD and OMD diagnoses (in more than 60% of the patients). A high prevalence of OMD was found in those patients receiving treatment for their SUD (71%), and also of diagnoses of any SUD (68.9%) and active substance use (50%, except tobacco) in people receiving treatment for diagnoses of OMD. Also were found significant relationships between addiction to certain substances and specific mental disorders: personality disorders with all SUDs; psychotic disorders with cannabis use disorder, but not cocaine use disorder; affective disorders with cocaine use disorder, and anxiety disorders with cannabis use disorder. This study provides preliminary information about the high coexistence in routine clinical practice of addictive disorders and other mental disorders in different treatment settings in Spain.

Long-Acting Injectable Second-Generation Antipsychotics in Seriously Ill Patients with Schizophrenia: Doses, Plasma Levels, and Treatment Outcomes

This research studies the dose-plasma level (PL) relationship of second-generation antipsychotics, together with the treatment outcomes achieved, in seriously ill people with schizophrenia. An observational, prospective, one-year follow-up study was carried out with patients (N = 68) with severe schizophrenia treated with paliperidone three-month (PP3M) or aripiprazole one-month (ARIM). Participants were divided into standard-dose or high-dose groups. PLs were divided into "standard PL" and "high PL" (above the therapeutic reference range, TRR) groups. The dose/PL relationship, and severity, hospitalizations, tolerability, compliance, and their relationship with doses and PLs were evaluated. There was no clear linear relationship between ARIM or PP3M doses and the PLs achieved. In half of the subjects, standard doses reached PLs above the TRR. The improvements in clinical outcomes (decrease in clinical severity and relapses) were related to high PLs, without worse treatment tolerability or adherence. All participants remained in the study, regardless of dose or PL. Clinical severity and hospitalizations decreased significantly more in those patients with high PLs. Considering the non-linear dose-PL relationship of ARIM and PP3M in people with severe schizophrenia, PLs above the TRR are linked to better treatment outcomes, without worse tolerability. The need in a notable number of cases for high doses to reach those effective PLs is highlighted.

Plasmatic Levels and Response to Variable Doses of Monthly Aripiprazole and Three-Month Paliperidone in Patients with Severe Schizophrenia. Treatment Adherence, Effectiveness, Tolerability, and Safety

Introduction

There is a need when optimizing antipsychotic treatment to know the plasmatic levels (PLs) achieved with the different doses and their relationship with effectiveness and toxicity, especially in patients with poor clinical progress. This study investigates the dose-PL-response relationship of monthly aripiprazole (AOM) and three-month paliperidone (PP3M).

Methods

Observational, 52-week prospective study of patients with severe schizophrenia (CGI-S ≥ 5) treated with PP3M or AOM for at least one year before their inclusion in the study (N=68). Dose-PL relationship was determined. Subjects were included in standard-dose and high-dose (above labeled) and standard/therapeutic range-PLs and high-PLs (above range) groups. Treatment adherence, effectiveness (hospitalizations, severity), tolerability and safety were assessed. PLs and clinical response were evaluated.

Results

No clear linear relationship was found between doses and PLs. In a considerable number of cases, standard doses achieved PLs above the therapeutic range. A significant clinical improvement was related to high PLs, without less safety, tolerability, or treatment compliance being involved. Clinical severity decreased more frequently in patients who received high doses and reached high PLs. Hospital admissions decreased significantly in those patients with high PLs.

Conclusion

Taking into account the absence of a linear relationship between doses and PLs, the effectiveness in people with severe schizophrenia of AOM and PP3M depends on reaching high PLs, achieved with high doses, but also with standard doses in some cases, without leading to worse treatment tolerability, safety, or adherence.

The mental health nurse as case manager of a patient with severe schizophrenia

Community-based programmes for people with severe mental illness (SMI), with a case management methodology, have shown high treatment adherence and a decrease in psychiatric hospitalizations. There is a need for continuity of care through a good therapeutic relationship, maintained throughout the care process until reaching clinical stabilization. The proposed case shows the treatment of a woman with a diagnosis of schizophrenia who began treatment in a mental health centre and was later referred to a case managed SMI programme. A nursing assessment was carried out from the beginning and a care plan was made based on the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Interventions Classification) taxonomy. The outcomes over the years are remarkable, achieving among other objectives not only clinical stabilization but also a normal life.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

OBJECTIVES

To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).

METHODS

Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (N = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.

RESULTS

The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (P < .0001), as well the involuntary admissions (P < .001). Being on long-acting injectable antipsychotic medication was related with these results (P < .0001).

CONCLUSIONS

Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Adherence, Tolerability and Effective Doses of Aripiprazole Once-monthly in the Long-term Treatment of Patients with Severe Schizophrenia

BACKGROUND

The evaluation of long-term effectiveness and tolerability of Aripiprazole Once-monthly (AOM) is yet scarce, and severely ill patients have not been specifically studied.

OBJECTIVE

The aim of the study was to explore the long-term adherence, effectiveness and tolerability of AOM in the treatment of patients with severe (Clinical Global Impression-Severity, CGI-S ≥ 5) schizophrenia, and whether high-dose therapy may benefit patients inadequately controlled on standard doses.

METHOD

Six-year mirror-image study, with 36-month prospective follow-up, was conducted on patients with severe schizophrenia who underwent treatment with AOM (n = 60). Assessment included the CGI-S, the WHO Disability Assessment Schedule (WHO-DAS), the Medication Adherence Report Scale (MARS), laboratory tests, and weight and adverse effects reported. Reasons for treatment discontinuation, hospital admissions and psychiatric medications in the previous three years and during the follow-up were recorded.

RESULTS

The average dose was found to be 780 (120) mg/28 days. Tolerability was good, with few side effects or biological parameters alterations reported. There were three discharges due to adverse effects, two due to lack of effectiveness and one treatment abandoning. Weight and prolactin levels were found to be decreased. CGI-S and WHO-DAS decreased (p < 0.001), and MARS increased (p < 0.001). There were less treatment abandoning, hospital admissions (p < 0.0001) and concomitant medication (p<0.01) than during the previous 36 months.

CONCLUSION

Treatment adherence and tolerability of AOM were found to be remarkable, even in those patients on high doses. AOM showed effectiveness in patients with severe schizophrenia, who recorded less hospitalizations and clinical severity and disability, although a considerable percentage of them needed higher doses than labeled.

Oral Versus Long-Acting Injectable Antipsychotic Treatment for People With Severe Schizophrenia: A 5-Year Follow-up of Effectiveness

ABSTRACT

The objective here is to compare the effectiveness of long-acting injectable antipsychotics (LAI-APs) and oral ones (OAPs) in patients with severe (Global Clinical Impression-Severity ≥ 5) schizophrenia (N = 688). A 5-year follow-up study has been conducted in patients undergoing standard treatment in mental health units (MHUs) or on a severe mental illness program (SMIP). A total of 8.7% of the patients on the SMIP discontinued treatment, whereas 43.6% did so in MHUs (p < 0.0001). In both cases, treatment retention was significantly higher in patients on LAI-APs (p < 0.001). Also, hospital admissions were in both cases fewer among those on LAI-APs (p < 0.001). There was a significant link between suicide attempts and OAP treatment (p < 0.01). Given the relationship between the use of LAI-APs versus oral treatments in achieving higher adherence and less relapses and suicide attempts, the use of second-generation antipsychotics LAIs should be considered more suitable for people with severe schizophrenia.

Paliperidone Palmitate Every Three Months (PP3M) 2-Year Treatment Compliance, Effectiveness and Satisfaction Compared with Paliperidone Palmitate-Monthly (PP1M) in People with Severe Schizophrenia

Paliperidone palmitate every three months (PP3M) is expected to facilitate patient's treatment compliance and satisfaction. The objective here was to compare PP3M treatment compliance and satisfaction, effectiveness and tolerability, with paliperidone palmitate-monthly (PP1M) in patients with severe schizophrenia. A 24-month prospective, open-label study of patients with severe schizophrenia treated with PP3M after at least 2 years of stabilization with PP1M (n = 84) was carried out. Treatment satisfaction was assessed with the Treatment Satisfaction Questionnaire for Medication (TSQM) and with a Visual Analogue Scale (VAS). Effectiveness was measured with psychiatric hospital admissions and the Clinical Global Impression-Severity (CGI-S) scale. Tolerability assessments included laboratory tests, weight and adverse effects. Reasons for treatment discontinuation were recorded. CGI-S significantly improved after 24 months. Three patients changed back to PP1M due to adverse effects, and four were hospitalized. There were neither abandoning nor significant changes in weight or biological parameters, and lower incidence of side effects, with PP3M treatment. TSQM and VAS scales increased. No differences were found related to doses. Apart from somewhat improvement in treatment adherence, effectiveness, and tolerability, patients with severe schizophrenia lengthy treated with PP1M showed more satisfaction with PP3M, even those who needed high doses to get clinical stabilization.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

OBJECTIVES

To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case- managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).

METHOD

Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (n=344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.

RESULTS

The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (p<0,0001), as well the involuntary admissions (p<0,001). Being on long-acting injectable antipsychotic medication was related with these results (p<0,0001).

CONCLUSIONS

Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Patients with severe schizophrenia. functioning improvement after 7-year of comprehensive treatment

Introduction

To reach not only clinical but also rehabilitation (especially to improve psychosocial functioning) goals in people with schizophrenia is a need.

Objective

To know the retention in treatment and functional outcomes of patients with severe schizophrenia enrolled in a specific and comprehensive programme for 7 years.

Method

A 7-year prospective, observational study of patients with severe schizophrenia (CGI-S of 5 or over) undergoing comprehensive programme (n = 200). Assessment included at the beginning and after 3, 6, 12, 24, 36 and 84 months: the CGI-S, the Camberwell Assessment of Needs (CAN) and the WHO-DAS. Time in treatment, reasons for discharge, laboratory tests, weight, medications, adverse effects and hospital admissions in the previous six years and during the follow-up were registered.

Results

CGI at baseline was 5.9 (0.7). After seven years, 44% of patients continued under treatment (CGI = 4.3 (0.8); P < 0.01); 36% were medical discharged (CGI = 3.4 (1.5); P < 0.001); WHO-DAS decreased in the four areas (P < 0.005) and also CAN (P < 0.01); 8% were voluntary discharges. Ten patients dead; three of them committed suicide (1.5%). Hospital admission decreased significantly (P < 0.001), and also antipsychotic combinations and antiparkinsonian medications. Fifty-five percent of all of them were treated with atypical long-acting antipsychotics, with good tolerability and few side effects (among them, only 4% were voluntary discharges).

Conclusion

Retention of patients with schizophrenia with severe symptoms and impairment in a specific and comprehensive programme was really high. Such good treatment adherence helped to get remarkable clinical and functional improvement. Long-acting medication seemed to be useful in improving treatment adherence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effect of Game Management on Wild Red-Legged Partridge Abundance

The reduction of game and fish populations has increased investment in management practices. Hunting and fishing managers use several tools to maximize harvest. Managers need to know the impact their management has on wild populations. This issue is especially important to improve management efficacy and biodiversity conservation. We used questionnaires and field bird surveys in 48 hunting estates to assess whether red-legged partridge Alectoris rufa young/adult ratio and summer abundance were related to the intensity of management (provision of supplementary food and water, predator control and releases of farm-bred partridges), harvest intensity or habitat in Central Spain. We hypothesized that partridge abundance would be higher where management practices were applied more intensively. Variation in young/adult ratio among estates was best explained by habitat, year and some management practices. Density of feeders and water points had a positive relationship with this ratio, while the density of partridges released and magpies controlled were negatively related to it. The variables with greatest relative importance were feeders, releases and year. Variations in post-breeding red-legged partridge abundance among estates were best explained by habitat, year, the same management variables that influenced young/adult ratio, and harvest intensity. Harvest intensity was negatively related to partridge abundance. The other management variables had the same type of relationship with abundance as with young/adult ratio, except magpie control. Variables with greatest relative importance were habitat, feeders, water points, releases and harvest intensity. Our study suggests that management had an overall important effect on post-breeding partridge abundance. However, this effect varied among tools, as some had the desired effect (increase in partridge abundance), whereas others did not or even had a negative relationship (such as release of farm-reared birds) and can be thus considered inefficient or even detrimental. We advise reconsidering their use from both ecological and economical points of view.

Market value of restocking and landscape in red-legged partridge hunting: a study based on advertisements

Context In Spain, the release of farm-reared partridges to hunt is increasingly used, despite being thought to affect sustainability of wild stocks and to reduce the need of natural habitats for game. Aims To explore the market value as a possible incentive for current management, we evaluated within a segment of the red-legged partridge hunting market whether the use of farm-reared birds (as opposed to wild stock) or the naturalisation of landscapes are affecting the hunt market price. Methods We considered estates that sell individual hunting days and contacted buyers through advertisements. We gathered all advertisements for the 2010 season in four top hunting magazines and two websites, and conducted a telephone survey to record price and associated characteristics of hunts. We looked for relationships between price and the characteristics of sold hunts, using general linear models. Key results Hunts varied largely in price, but neither restocking nor naturalisation of the landscape explained price variation, at least within our sample of estates. The absence of price difference between wild or released partridges could be reflecting the current difficulty to distinguish both kinds of products in the market. Conclusions Market forces alone might not be promoting the public interest of the sustainable use of wild stocks versus industrial hunting based on farm-reared birds. Implications If promoting conservation and sustainable use of wild stocks is considered a major goal of official institutions in charge of biodiversity conservation and game management, they should promote reliable ways of identifying estates selling wild or restocked partridges, and they should also evaluate benefits and costs associated with hunting farm-reared birds relative to wild birds, so as to help internalise these costs and benefits if necessary. A study of the determinants of hunter demands would also help explain variation in supply and market prices.

Harvest of Red-Legged Partridge in Central Spain

A basic rule to attain sustainable use of harvested resources is to adjust take to availability. Populations of red-legged partridges in Spain have decreased in recent decades, and releases of farm-bred partridges to improve short-term availability are increasingly common. We used questionnaires and bird surveys to assess whether harvest was related to availability of wild partridges or intensity of farm-bred partridge releases. We studied 50 hunting estates, including 6 administratively labeled as intensive (with few numerical and temporal restrictions to releases). In addition, we considered hunting pressure (number of hunters × hunting days/km²) and habitat as explanatory variables in the analyses. In intensive estates, annual harvest was exclusively related to release intensity, indicating that in these estates hunting is detached from natural resources and approaches an industrial activity based on external inputs. In non-intensive estates, harvest was affected by wild stock availability, walked-up shooting pressure, and habitat (greater harvest in estates with more Mediterranean shrubland). In these estates, releases did not increase annual harvest, and can be considered an inefficient practice. Additionally, the relationship between abundance estimates and harvest disappeared in estates with low partridge abundance estimates, suggesting possibilities for overharvesting in a large proportion of estates. Increasing the abundance of wild red-legged partridge through techniques like habitat management, and improving the adjustment of harvest to availability, may be a good strategy to increase long-term harvest in non-intensive estates. Additionally, Government and managers must create ways to segregate and label the estates where only wild red-legged partridges are managed from those where releases are used, to reduce ecological costs of management decisions. © 2012 The Wildlife Society.