Las bases nerubiológicas del juego patológico

Pathological gambling (PG) was first introduced as a diagnostic category in international classifications of mental disorders in DSM-III (APA, 1980). Until recently, research examining the biological bases of PG has been relatively scarce. Nevertheless, several theories have been forworded and several lines of research have been followed that identify various neurotransmitters in the pathology: PG as un impulse control disorder and serotonin; PG, arousal and sensation seeking involving noradrenaline; PG as an addiction and dopamine. Furthermore, familial factors have been shown to influence the development of pathological gambling suggestingthe involvement of a genetic component in the disorder. Current research focuses on molecular genetics in order to identify genetic factors of susceptibility that might contribute to the etiology of the disorder.El juego patológico (JP) o ludopatía fue incluido por primera vez como una categoría diagnóstica en las clasificaciones internacionales de los trastornos mentales en 1980 , en el DSM-III de la Asociación Psiquiátrica Americana. Desde entonces se han desarrollado diversas teorías y líneas de investigación que implican diferentes neurotransmisores en su patogenia: la ludopatía como un trastorno en el control de los impulsos y la serotonina; el papel del arousal y la búsqueda de sensaciones en el juego patológico y la noradrenalina: la ludopatía como un modelo de adicción y la dopamina. Por otro lado se ha evidenciado la influencia de los factores familiares en el riesgo de desarrollar la ludopatía, lo que sugiere la existencia de un componente genético en este trastorno. Las investigaciones más recientes utilizan técnicas de genética molecular con el objetivo de identificar factores de susceptibilidad genética que pueden contribuir en la etiopatogenia del juego patológico

Trastorno bipolar en embarazo y lactancia

El trastorno bipolar (TB) es una enfermedad psiquiátrica crónica, caracterizada por fluctuaciones del humor, desde la manía hasta la depresión bipolar. Dado que suele debutar en adultos jóvenes, afecta a mujeres en edad fértil y embarazadas. El TB se asocia con mayor riesgo de efectos adversos en el embarazo, incluyendo aquellos relacionados con la medicación y posibles recaídas de la enfermedad. El objetivo de esta revisión sistemática es analizar la bibliografía reciente y de calidad sobre el tratamiento farmacológico del TB. Para ello se realizó una búsqueda sistemática en PubMed de artículos publicados entre 2012 y 2017, seleccionando aquellos de mayor calidad siguiendo los criterios de la guía PRISMA. Los psicotrópicos empleados en el TB, que incluyen principalmente litio, algunos antiepilépticos, antipsicóticos, antidepresivos y benzodiacepinas, se han asociado con efectos adversos tales como malformaciones congénitas, anomalías cardiacas, afectación del neurodesarrollo, síndrome de adaptación neonatal, abortos espontáneos y parto pretérmino, entre otros. Las recomendaciones de las Guías de Práctica Clínica (GPC) deben interpretarse con cautela, ya que tienen grados variables de evidencia y gran parte de los datos disponibles necesitan mayor investigación en futuros estudios. En conclusión, para manejar el TB durante el embarazo y lactancia, se debe utilizar el fármaco con mejor perfil de seguridad, con la mínima dosis eficaz, y en monoterapia si es posible, y es obligado monitorizar estrechamente la evolución de la mujer y de su hijo. Las GPC proporcionan un apoyo apropiado y necesario, pero siempre se debe individualizar el tratamiento.Bipolar disorder (BD) is a psychiatric chronic disease, characterized by mood fluctuations, from mania to bipolar depression. Given that it usually debuts in young adults, it affects women in childbearing age and pregnant women. BD is associated with a higher risk of adverse outcomes during pregnancy, including those related to medication and possible relapses. The objective of this systematic review is to analyse recent and high-quality bibliography about the pharmacologic treatment of BD, by the means of a systematic research in PubMed, collecting articles published between 2012 and 2017, and selecting those with the highest quality according to the standards of the PRISMA guideline. Psychotropic medication used in BD, which is mainly lithium, some antiepileptic drugs, antipsychotics, antidepressants and benzodiazepines, has been associated with adverse outcomes such us congenital malformations, cardiac anomalies, neurodevelopmental problems, neonatal adaptation syndrome, spontaneous abortion and preterm delivery, among others. Recommendations provided by Clinical Practices Guidelines (CPG) must be interpreted with caution, given that they are based on variable levels of evidence, and most part of the available data needs to be further investigated in future studies. In conclusion, regarding the management of BD during pregnancy and breastfeeding, we must choose the drug with the best security profile, using the minimum effective dose, in monotherapy if possible, and it is mandatory to monitor closely the evolution of the woman and her child. CPG provide an adequate and necessary support, but treatment must be individualized

Diagnosis of bacteraemia and growth times

Objective: The objective of this study was to predict the diagnosis of bacteraemia as a function of the time at which the automated BacT/Alert system continuously detects microorganism growth. Methods: A retrospective study of a database of 1334 patients with a positive blood culture between January 2011 and June 2013 was conducted. Together with the final blood culture results and the patient's history, growth was then analysed to assess whether it represented true bacteraemia or bacterial contamination. The earliest detection times of bacterial growth in each batch of blood cultures were analysed in a blinded fashion after classification. Results: In total, 590 batches of blood cultures corresponded to true bacteraemia and 744 to bacterial contamination. In the bacteraemia group, the median growth time was 12.72 h (interquartile range (IQR) 10.08–17.58 h). In the contaminated blood culture group, the median growth time was 20.6 h (IQR 17.04–32.16 h) (p < 0.001). Analysis of the receiver operating characteristics (ROC) curve (area under the curve 0.80, 95% confidence interval 0.771–0.826) showed that 90% of the contaminants grew after 14.7 h (sensitivity 90.5%, specificity 63.4%, positive predictive value (PPV) 65.9%, negative predictive value (NPV) 90.7%). Forty-five percent of the bacteraemia organisms grew in under 12 h (sensitivity 45.3%, specificity 95%, PPV 87.8%, NPV 68.7%). Microorganisms such as Candida sp and Bacteroides sp presented median growth times significantly longer than those of the other microorganisms. The administration of antibiotics in the week prior to bacteraemia was found to delay the growth time of microorganisms (p < 0.001). Conclusions: Knowing the time to detection of microorganism growth can help to distinguish between true bacteraemia and bacterial contamination, thus allowing more timely clinical decisions to be made, before definitive microorganism identification

New treatment guidelines for acute bipolar mania: a critical review

A number of treatment guidelines for bipolar disorder have been published and updated in the last few years. They are aimed at providing a synthesis of the best available scientific knowledge, and their application to every-day work should be helpful to clinicians. The aim of this report is to critically review recent guidelines focusing on the treatment of manic/hypomanic and mixed episodes. Guidelines are quite heterogeneous in methodology and conclusions, but they all agree that the treatment of manic/hypomanic and mixed episodes should generally be initiated with a medication such as lithium (Li), valproate (VPA) or atypical antipsychotics (AAP), including aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone as monotherapy. All guidelines agree on stopping ongoing antidepressant medication during mania. Combination therapy including Li or VPA with an AAP is suggested usually as second-line choice, sometimes as first-choice treatment for severe mania. Carbamazepine is mostly suggested as second line and not recommended in combination. Other antiepileptic drugs are not recommended for the treatment of mania, although lamotrigine may be maintained if it was prescribed previously for the prevention of depressive episodes. Main sources of discrepancies among guidelines include benefit–risk ratio issues (how much priority is given to efficacy over safety and tolerability), starting with combination versus monotherapy, and how to deal with treatments which are more experience-based than evidence-based (i.e.: electroconvulsive therapy)

Epigenetics in schizophrenia: a pilot study of global DNA methylation in different brain regions associated with higher cognitive functions

Attempts to discover genes that are involved in the pathogenesis of major psychiatric disorders have been frustrating and often fruitless. Concern is building about the need to understand the complex ways in which nature and nurture interact to produce mental illness. We analyze the epigenome in several brain regions from schizophrenic patients with severe cognitive impairment using high-resolution (450K) DNA methylation array. We identified 139 differentially methylated CpG sites included in known and novel candidate genes sequences as well as in and intergenic sequences which functions remain unknown. We found that altered DNA methylation is not restricted to a particular region, but includes others such as CpG shelves and gene bodies, indicating the presence of different DNA methylation signatures depending on the brain area analyzed. Our findings suggest that epimutations are not relatables between different tissues or even between tissues' regions, highlighting the need to adequately study brain samples to obtain reliable data concerning the epigenetics of schizophrenia

Age at first episode modulates diagnosis-related structurals brain abnormalities in patients with first-episode psychosis.

Brain volume and thickness abnormalities have been reported in first-episode psychosis (FEP). However, it is unclear if and how they are modulated by brain developmental stage (and, therefore, by age at FEP as a proxy). This is a multicenter cross-sectional case-control brain magnetic resonance imaging (MRI) study. Patients with FEP (n = 196), 65.3% males, with a wide age at FEP span (12-35 y), and healthy controls (HC) (n = 157), matched for age, sex, and handedness, were scanned at 6 sites. Gray matter volume and thickness measurements were generated for several brain regions using FreeSurfer software. The nonlinear relationship between age at scan (a proxy for age at FEP in patients) and volume and thickness measurements was explored in patients with schizophrenia spectrum disorders (SSD), affective psychoses (AFP), and HC. Earlier SSD cases (ie, FEP before 15-20 y) showed significant volume and thickness deficits in frontal lobe, volume deficits in temporal lobe, and volume enlargements in ventricular system and basal ganglia. First-episode AFP patients had smaller cingulate cortex volume and thicker temporal cortex only at early age at FEP (before 18-20 y). The AFP group also had age-constant (12-35-y age span) volume enlargements in the frontal and parietal lobe. Our study suggests that age at first episode modulates the structural brain abnormalities found in FEP patients in a nonlinear and diagnosis-dependent manner. Future MRI studies should take these results into account when interpreting samples with different ages at onset and diagnosis

A pharmacovigilance study in first episode of psychosis: Psychopharmacological interventions and safety profiles in the PEPs Project

Background: The characterization of the first episode of psychosis and how it should be treated are principal issues in actual research. Realistic, naturalistic studies are necessary to represent the entire population of first episode of psychosis attended in daily practice. Methods: Sixteen participating centers from the PEPs project recruited 335 first episode of psychosis patients, aged 7 to 35 years. This article describes and discusses the psychopharmacological interventions and safety profiles at baseline and during a 60-day pharmacovigilance period. Results: The majority of first episode of psychosis patients received a second-generation antipsychotic (96.3%), orally (95%), and in adjusted doses according to the product specifications (87.2%). A total of 24% were receiving an antipsychotic polytherapy pattern at baseline, frequently associated with lower or higher doses of antipsychotics than the recommended ones. Eight patients were taking clozapine, all in monotherapy. Males received higher doses of antipsychotic (P=.043). A total of 5.2% of the patients were being treated with long-acting injectable antipsychotics; 12.2% of the patients received anticholinergic drugs, 12.2% antidepressants, and 13.7% mood stabilizers, while almost 40% received benzodiazepines; and 35.52% reported at least one adverse drug reaction during the pharmacovigilance period, more frequently associated with higher antipsychotic doses and antipsychotic polytherapy (85.2% vs 45.5%, P<.001). Conclusions: These data indicate that the overall pharmacologic prescription for treating a first episode of psychosis in Spain follows the clinical practice guideline recommendations, and, together with security issues, support future research of determinate pharmacological strategies for the treatment of early phases of psychosis, such as the role of clozapine, long-acting injectable antipsychotics, antipsychotic combination, and the use of benzodiazepines