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Introduction Postpartum depression is a common psychiatric complication after pregnancy, so it is necessary to know the depressive symptoms to be able to carry out early prevention and treatment interventions. It is a health problem with a prevalence that ranges between 10–15% according to the world literature. Behavioral and psychosocial factors favoring postpartum depression are recognized. Objectives -To emphasize multidisciplinary treatment in the combined attention to the mother-baby. -To demostrate decreased risk for baby if early use of antidepressants. -To evaluate of the impact of desvenlafaxine during breastfeeding. Methods Descriptive-study. Clinical Case. Evolution of postpartum depression. Follow-up of a patient based on coordination with the midwife attending a successful breastfeeding while treatment with desvenlafaxine. Use of Edinburgh Postnatal Depression Scale. Results -Use of Desvenlafaxine 50-100mg being compatible with breastfeeding, in adittion to depressive illness improvement *Obstetrics and psychiatry guidelines and safety considerations for lactation and antidepressants). Conclusions -Postpartum-depression could be the first episode of depression in a healthy woman. Sometimes there are unnoticed symptoms during pregnancy. -Health-care for puerperal women should be focused on both, biomedical and psychosocial issues, with a coordinated multidisciplinar team. -Due to important early treatment during the puerperium, it is recommended a close medical control of the mother´s psychological state after the birth. -If depression appears, a psychiatric follow-up is kept even after the episode remission. Besides, the role of the midwife is essential during lactation. -Some antidepressants like desvenlafaxine have demonstrated benefits over the risk of the baby´s complications without treatment. Disclosure No significant relationships.

The assessment of reproductive features (puberty, fertility and prolificacy) in female Iberian pigs indicates that exposition to intrauterine maternal malnutrition, either by deficiency or excess, is associated with juvenile obesity and a significantly earlier age of puberty onset. At adulthood, prenatal exposition to undernutrition affects reproductive outputs by diminishing prolificacy, an effect that was not found in females exposed to prenatal overnutrition. [ABSTRACT FROM PUBLISHER]

Introduction: At present in the province of Salamanca, there is no outpatient program focused on dual pathology. There is a perceived need of attention to those patients who present a serious mental disorder and a substance use disorder. Objectives: In accordance with the recommendations of the scientific evidence of recent years, we propose the creation of a specific healthcare resource within the framework of the University of Salamanca Health Complex. Methods: The dual pathology outpatient program sits (image 1) on the second level of the assistance system and follows the indications of the IV Mental Health Plan of the Regional Ministry of Health. It is intended to be a bridge between the two usual lines of assistance (image 2): mental health network and drug dependence network. It will offer a multidisciplinary and integrated approach from a biopsychosocial perspective. It will focus on diagnosis, differential diagnosis, psychopharmacological and psychotherapeutic approach, nursing care and psychometry. In addition, the dual pathology outpatient program aims to be a training area for service professionals and the basis for promoting research activity focused on dual pathology. A previous training and coordination program has been carried out with the different resources of both networks. A pilot project is proposed, building a therapeutic team consisting of a psychiatrist, two clinical psychologists, two nurses, a social worker and two social educators. Results: The first clinical results are presented. Conclusions: This new program results from the effort to improve care for patients with dual pathology. More experience in this area is necessary. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the efficacy and long-term safety of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia. Methods: Patients requiring chronic treatment for schizophrenia, not on aripiprazole monotherapy, were cross-titrated from other antipsychotic(s) to aripiprazole in an oral conversion phase (Phase 1). All patients entered an oral aripiprazole stabilization phase (Phase 2). Patients meeting stability criteria entered an ARI-OM stabilization phase (Phase 3), with coadministration of oral aripiprazole for the first 2 weeks. Patients meeting stability criteria were randomized to ARI-OM or placebo once-monthly (placebo-OM) during a 52-week, double-blind maintenance phase (Phase 4). Primary endpoint was time-to-impending relapse. Safety and tolerability were also assessed. Results: 710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo-OM=134). The study was terminated early because efficacy was demonstrated by a pre-planned interim analysis. Time-to-impending relapse was significantly delayed with ARI-OM vs. placebo-OM (p<0.0001, log-rank test). Discontinuations due to treatment-emergent adverse events (AEs) were: Phase 1, 3.8% (n=24/632); Phase 2, 3.0% (n=21/709); Phase 3, 4.9% (n=28/576); Phase 4, 7.1% (n=19/269). Most AEs were mild or moderate. Insomnia was the only AE >5% incidence in any phase. Headache, somnolence, and nausea had a peak first onset within the first 4 weeks of treatment. There were no unusual shifts in all phases in laboratory values, fasting metabolic parameters, weight, or objective scales of movement disorders. Conclusions: ARI-OM significantly delayed time-to-impending relapse compared with placebo-OM and was well tolerated as maintenance treatment in schizophrenia1. [Copyright &y& Elsevier]

Introduction Behavioural, psychological and cognitive disturbance have been associated with hypothyroidism, even it has been suggested that this symptoms may remain despite adequate replacement therapy with thyroxine. Objective To describe prevalence, sociodemographics and clinical features of patients with hypothyroidism in an acute psychiatric unit. Aims To know about the relation between hypothyroidism and psychiatric symptoms. Methods Data base collection of all patients admitted between 2010 and 2014 in the acute unit of our psychiatric hospital in Barcelona, was analyzed using SPSS program. Results In all 3.1% of the 4536 total patients had hypothyroidism. Among them, 46% were duplicate cases. Mean age was 53 ± 14.27 years. A total of 82.7% were woman. Patients having a TSH lower than 0.30 were 12%, TSH normal were 60.2%, TSH higher than 5 were 27.8%. Most frequent Levothyroxine dosage was: 75 μg (22.1%), 100 μg (19%), 25 μg (12.5%) and 125 μg (12.5%). Diagnosis more frequently associated with hypothyroidism was: Bipolar (26.5%), Schizophrenia (20%), Depression (15.1%), Unspecified psychosis (10%), Personality disorder (10%), Schizoaffective disorder (7.2%), Paranoia 4.3%. Conclusion Most of patients were stable of thyroid condition when had been admitted to our hospital. Hypothyroidism could be a relapse factor, even when treatment is adequate. Affective disorders are more frequently related with hypothyroidism (lithium has to be consider a confounding factor). [ABSTRACT FROM AUTHOR]

Introduction Several studies have suggested variations in the prevalence of schizophrenia spectrum disorders diagnosis across time. This could be due to a change in diagnostic practice motivated either for changes in DSM criteria as for local culture factors. The aim of this study is to explore the evolution of the schizophrenia spectrum disorders. We hypothesize that we would observe a transference from the schizophrenia diagnosis to psychosis not otherwise specified. Methods A retrospective review of all psychiatric discharges in acute unit in the INAD of Parc de Salut Mar of Barcelona, between 2002 and 2014 was performed, relating each discharge to its axis I psychiatric diagnostic. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis. Conclusion We have not been able to observe any transference between diagnoses across years. We observe a decrease of the proportion of schizophrenic spectrum disorders in its prevalence at discharge from 2012 to 2014. The proportion of not otherwise specified psychosis remains quite constant as a third of the schizophrenia diagnoses. [ABSTRACT FROM AUTHOR]

Personality dimensions related with drug use are novelty seeking, impulsivity and harm avoidance. Studies predicting drug of choice over personality variables are controversial. Objective To describe personality profile of drug users in relation to substance of choice. Aims To know personality dimension differences according to drug used. Methods Cloninger's TCI-R was administered to 218 patients in a dual diagnosis unit. SPSS was applied. Results Of the patients, 33.94% had personality disorder. Principal substances used were alcohol, cocaine and cannabis. Most of drug users had normal scores in each dimension. No high scores were found in reward dependence, self-directedness and cooperativeness with any drug. High scores were observed for novelty seeking in 42.9% of timulants users; for arm avoidance in a quarter of cocaine, alcohol and methadone users and for persistence in 18.2% of hypnotics users. Low scores were observed for reward dependence in 45% of heroine and hypnotics users; for persistence in 50% of methadone and 32% of cocaine users; for self-directedness in most of types of drug users and for cooperativeness in up to 50% in heroine, hypnotics, stimulants and cocaine users. Statistical significant differences were observed for cocaine use and high novelty seeking and low cooperation; for non cannabis use and high harm avoidance; for non anfetamine use and low scores in reward dependence; for opiate use and low self-directedness. Conclusions Most of patients had normal scores in the different dimensions. Presence of comorbid personality disorder led us to consider the results with caution. [ABSTRACT FROM AUTHOR]

Introduction The integrated care in dual diagnosis units involves selecting pharmacological treatment strategies for both substance use disorder and the non-addictive psychiatric disorder. It is recommended to choose drugs with a favorable balance between efficacy/tolerability, an adequate side effects profile and the minimal drug interactions. Objectives and aims To evaluate the tolerability and side effects after first administration-first dose of an extended-release injectable suspension of aripiprazole in a group of patients admitted to an acute dual diagnosis unit. Methods The study included a series of patients admitted in our unit from May to August 2015 that received the first dose of the aripiprazole preparation (400 mg). Evaluations included different scales for side effects (SAS, ESRS, UKU) and the clinical global impression scale (CGI). Results A total of 9 patients were included and evaluated (all men, mean age: 39-years-old). Diagnoses were: bipolar disorder (5/9), schizophrenia (2/9), schizoaffective disorder (1/9) and delusional disorder (1/9) with concomitant substance use disorder (6 cannabis, 2 alcohol, 1 cocaine). All of them without outpatient control and treatment at admission. The results of the clinical scales conclude that none of them had significant side effects, including extrapyramidal, with an improvement in the ICG scale. Conclusion Tolerability of extended-release injectable suspension of aripiprazole was good in all cases. In the future, new cases should be included to extend the sample and to evaluate other aspects such as the craving for substances. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the safety and tolerability of aripiprazole once-monthly (ARI-OM) initiation in patients stabilized on oral antipsychotics other than aripiprazole. Previous pivotal Phase III trials have evaluated initiating ARI-OM in patients stabilized on oral aripiprazole1. Methods: Eligible patients were treated with oral atypical antipsychotics other than aripiprazole with a history of oral aripiprazole tolerability. The study included a screening phase (30 days) and a treatment phase (28 days). Patients were stabilized per investigator's judgment for ≥14 days on risperidone, olanzapine, quetiapine, or ziprasidone, before administration of ARI-OM (400 mg). Current oral antipsychotic was co-administered with ARI-OM for 2 weeks to determine safety and tolerability of a single ARI-OM dose following treatment initiation. Safety assessments were adverse events (AEs); extrapyramidal symptoms (EPSs) using standard objective rating scales; Columbia-Suicide Severity Rating Scale; clinical laboratory measures; and weight changes. Results: 60 patients initiated ARI-OM, while continuing treatment for ≤2 weeks with oral risperidone (n=24), quetiapine (n=28), ziprasidone (n=5) or olanzapine (n=3). Treatment-emergent (TE) AEs (≥5%) were fatigue, injection-site pain, and restlessness (risperidone); insomnia, dystonia, injection-site pain, and toothache (quetiapine); and muscle spasm, tooth abscess, and toothache (ziprasidone). Prior olanzapine did not cause any AEs. Incidence of TE-EPSs were similar in all groups (< 5%). There were no unusual changes in objective EPS rating scales, suicidality, weight, laboratory values or fasting metabolic parameters across all groups. Conclusions: The AE profile of patients receiving ARI-OM concomitant with oral atypical antipsychotics other than aripiprazole was consistent with prior reports1. [Copyright &y& Elsevier]

Objective: Evaluate the effectiveness of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia. Methods: Detailed methodology has been published previously1. Briefly, the study consisted of 4 phases: oral conversion to aripiprazole (Phase 1); oral aripiprazole stabilization (Phase 2); ARI-OM stabilization (Phase 3), with co-administration of oral aripiprazole for the first 2 weeks; and an ARI-OM maintenance phase (Phase 4). Effectiveness assessments included Investigator's Assessment Questionnaire (IAQ) scores, a scale that evaluates effectiveness of current treatment vs. pre-trial medication, where a negative change in score signals improvement, and Personal and Social Performance (PSP) scale scores, where negative change in score signals worsening. Results: 710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo once-monthly [placebo- OM]=134). Mean IAQ Total scores remained stable in Phase 2 (31.3) and Phase 3 (30.6). During Phase 4, the mean change in IAQ Total score was +1.3 for ARI-OM vs. +3.8 for placebo-OM (p<0.0001). Mean changes in PSP Total scale scores showed improvement during Phase 2 (3.0) and Phase 3 (2.6). Mean change in PSP scores during Phase 4 showed greater functional stability with ARI-OM (−1.7) compared with placebo-OM (−6.2) (p=0.0002 vs. placebo-OM). Conclusions: Improvements in effectiveness, as assessed by the IAQ and PSP Total scale scores, in the Phases 2 & 3 were maintained in Phase 4 for ARI-OM compared with placebo-OM. Treatment with ARI-OM improved symptoms, overall response to treatment and functioning. [Copyright &y& Elsevier]

Objectives: To evaluate the long-term safety and efficacy of adjunctive aripiprazole (ARI) to lithium (LI) or valproate (VAL) in delaying time to relapse in bipolar I disorder. Methods: Bipolar I disorder subjects with a current manic or mixed episode received LI or VAL for at least 2weeks; inadequate responders (YMRS score ≥16 and ≤35% decrease from baseline at 2 weeks) received adjunctive ARI. Subjects maintaining mood stability (YMRS and MADRS ≤12 for 12 consecutive weeks) were randomised 1:1 to double-blind ARI (10 to 30mg/day) or placebo (PBO) plus LI or VAL. Relapse was monitored up to 52 weeks. Results: 337 subjects were randomised to continuation of mood stabiliser plus adjunctive ARI or PBO; 61.3% and 52.7%, respectively, completed the study. Adjunctive ARI significantly delayed the time to any relapse, hazard ratio=0.544 (95% CI: 0.33, 0.89, log-rank p=0.014). Overall relapse rates at 52weeks were 14.9% and 25.4% in ARI vs PBO subjects. A superior reduction in CGI-BP Mania Severity of Illness from baseline at 52 weeks was also observed (0.3 vs. 0.0, respectively, p=0.01). Adverse events generally were as expected per known drug and illness profiles with no significant difference in mean change in body weight between adjunctive PBO (0.60kg) and adjunctive ARI (1.07kg) (p=0.49Week 52, LOCF). Conclusion: Continuation of aripiprazole treatment increased time to relapse to any mood episode compared with placebo plus LI/VAL over 1 year, indicating a long-term benefit in continuing adjunctive aripiprazole to a mood stabiliser after sustained remission is achieved. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term tolerability and effectiveness of aripiprazole adjunctive to lithium or valproate in bipolar mania. Methods: Completers of a 6-week double-blind comparison of adjunctive aripiprazole versus placebo in bipolar mania partially responsive to monotherapy were followed up over 46-weeks on open-label aripiprazole plus lithium (ARI+LI) or valproate (ARI+VAL). Results: 283 (ARI+LI n=108; ARI+VAL n=175) patients entered and 146 (ARI+LI n=55; ARI+VAL n=91) completed the 46-week extension. Safety results for both combinations were consistent with the known tolerability profile of aripiprazole, lithium and valproate. No clinically significant changes in lipids or glucose were observed with either ARI+LI or ARI+VAL. Mean (SE) weight change from double-blind endpoint to Week 46 (LOCF) was 2.3 (0.6) kg with ARI+LI and 2.0 (0.4) kg with ARI+VAL. Temporal analysis of the time of first onset of adverse events showed that akathisia and insomnia tended to occur early in treatment, with few new cases in patients previously treated with aripiprazole during the 6-week study. Significant improvements from baseline in YMRS total score and MADRS total score were sustained over the 52 weeks with both ARI+LI and ARI+VAL treatment. Conclusions: Long-term aripiprazole adjunctive to lithium/valproate in bipolar mania was safe and well-tolerated. Improvements in manic and depressive symptoms observed during the first 6 weeks of treatment were maintained. [Copyright &y& Elsevier]