Spanish Journal of Psychiatry and Mental Health最新文献

Background: Suicide is a leading cause of mortality worldwide, with approximately 27% of deaths by suicide occurring in individuals older than 70 years. Suicide attempts in older adults are more likely to be fatal and are typically more premeditated than impulsive. The objective of this study was to identify key sociodemographic and clinical characteristics of older adults who recently attempted suicide.

Material and methods: The total sample included 1336 adult patients, categorized into 3 groups (young, middle-aged, and elderly group), who had attended the emergency room with a suicide attempt. An analysis was performed using Chi-square tests and ANOVA for risk factors, to study the relationships among suicidal ideation, behavior, psychiatric symptoms, impulsivity and childhood trauma. Similarly, to compare inter-group risk factors and suicidal behavior, multigroup path analysis was used.

Results: The older group stood out in lower levels of suicidal ideation, self-harm, trauma and impulsivity. Similarly, they showed higher levels of hypermentalization, greater medical damage after the suicide attempt and fewer psychiatric diagnoses, than the patients from the other age groups.

Conclusions: Although older people have fewer clinical symptoms and risk factors, their attempts are more severe. Preventing suicide in older people is complex, being a very vulnerable period, where there are unique risk factors, making it necessary to develop new effective interventions to prevent suicide in this neglected population.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common, complex, multifactorial neurodevelopmental disorder. In this study, conducted by experts in the management of ADHD in adults, a set of recommendations have been developed based on a review of the available evidence, with the aim of improving the clinical care of these patients.

Materials and methods: This study was conducted in full compliance with the consensus methodology developed by the RAND Corporation/University of California Los Angeles (RAND/UCLA). The 29 proposed statements were evaluated using a 2-round iterative Delphi process. Of the 18 invited panellists, 15 completed both rounds (83.3% response rate).

Results: After 2 rounds of voting, the expert panel reached consensus, either in agreement or disagreement, on 93.1% of the statements (a total of 27 of the 29 proposed). These included proposals on important topics in the management of ADHD in adults, such as barriers to detection and diagnosis, unmet treatment needs, treatment objectives, the treat-to-target approach, and response and remission criteria.

Conclusions: This study has sought to reinforce the importance of a structured and multidisciplinary approach in the management of ADHD in adulthood, focused on the patient and their needs. The recommendations presented here aim not only to mitigate the adverse outcomes associated with untreated ADHD, but also to facilitate a substantial improvement in the quality of life of individuals living with this disorder.

Introduction: Hyperprolactinaemia and sexual dysfunction are common adverse effects of antipsychotic drugs, particularly with dopamine D2 receptor antagonists. Long-acting injectables such as paliperidone palmitate (PP) and risperidone ISM may differ in their endocrine safety profiles, especially across sexes. We aimed to compare prolactin levels and clinically significant sexual dysfunction in patients treated with risperidone ISM vs monthly PP.

Methods: We conducted a cross-sectional study including 59 patients with psychotic disorders (27 on risperidone ISM, 32 on PP). Clinically significant hyperprolactinaemia was defined as prolactin levels above sex-specific thresholds along with hypogonadism and/or sexual dysfunction. The Arizona Sexual Experience Scale was used to assess sexual function. Hormonal assays included prolactin, testosterone, and oestradiol. Prolactin values were log-transformed for regression models. Multiple linear regression assessed predictors of prolactin, including treatment, sex, age, dose, co-treatment with aripiprazole or other antipsychotics, and sex-by-treatment interaction. An exploratory logistic regression examined predictors of clinically significant hyperprolactinemia (with either hypogonadism or sexual dysfunction).

Results: Women on PP showed significantly higher prolactin levels vs those on risperidone ISM (interaction between female sex and PP; p=0.002). Aripiprazole co-treatment was associated with lower prolactin levels (p=0.020). Clinically significant hyperprolactinaemia was present in 55.6% of the risperidone ISM group vs 68.8% of the PP group. The exploratory logistic regression model revealed no significant predictors of clinically significant hyperprolactinaemia.

Conclusion: Risperidone ISM may be associated with a more favourable prolactin profile in women vs PP. Findings support the relevance of sex and adjunctive strategies in managing antipsychotic-induced endocrine side effects.