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Ignacio Basurte-Villamor,1 Pablo Vega,2 Carlos Roncero,3– 5 José Martínez-Raga,6 Lara Grau-López,7– 10 Lourdes Aguilar,3– 5 Marta Torrens,11 Nestor Szerman12 1Department of Psychiatry and Behavioral Health, Clínica López Ibor, Madrid, Spain; 2Institute for Addictions, Madrid Salud, Madrid City Council, Madrid, Spain; 3Department of Psychiatry, University of Salamanca Healthcare Complex, Salamanca, Spain; 4Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain; 5Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain; 6Department of Psychiatry and Clinical Psychology, University Hospital Dr. Peset and University of Valencia, Valencia, Spain; 7Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Spain; 8Biomedical Network Research Centre on Mental Health, CIBERSAM, Barcelona, Spain; 9Group of Psychiatry, Mental Health and Addiction, Vall d’Hebron Research Institute, Barcelona, Spain; 10Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; 11Institute of Neuropsychiatry & Addictions-Hospital del Mar, Barcelona IMIM, Hospital del Mar Medical Research Institute, Barcelona University Autònoma, Barcelona, Spain; 12WADD WPA Section Dual Disorders, Mental Health and Psychiatric Institute, Gregorio Marañon University Hospital, Madrid, SpainCorrespondence: Nestor Szerman, WADD WPA Section Dual Disorders, Mental Health and Psychiatric Institute, Gregorio Marañon University Hospital, C/ Lope de Rueda 43, Madrid, 28009, Spain, Tel +34 914008690, Fax +34 915739932, Email nszermanb@gmail.comBackground: Limited studies have evaluated the effectiveness of vortioxetine in real-world settings, and none of them has involved patients with dual depression (major depressive disorder [MDD] and substance use disorder [SUD]). The objective of the study was to describe the effectiveness of vortioxetine in clinical practice and determine its effect on affective symptoms, cognitive function, quality of life, and substance use in patients with MDD and SUD.Methods: Post-authorization, retrospective, multicenter, descriptive, and observational study in 80 patients with MDD and SUD receiving a maintenance treatment with vortioxetine for six months between January 2017 and April 2021.Results: Compared with baseline, scores significantly decreased after 3 and 6 months of treatment in the Montgomery-Åsberg Depression Rating Scale total (from 28.9 to 17.7 and 12.0), and global functional impairment of the Sheehan Disability Inventory (from 26.3 to 19.1 and 16.7). The number of correct answers in the symbol digit modalities test significantly improved during vortioxetine treatment (from 40.4 to 43.8 and 48.4). Regarding the clinical global impression scale, the score for disease severity significantly decreased from 3.8 to 3.0 and 2.4. Compared with baseline, there was a significant reduction in consumption of practically all substances, especially of alcohol, cannabis, and cocaine.Conclusion: Vortioxetine was effective in clinical practice for alleviating depressive symptoms and functional impairment, and in improving cognitive and executive functions and disease severity in patients with MDD and SUD. Moreover, the treatment with vortioxetine favored a reduction in substance use and the severity of the SUDs.Keywords: vortioxetine, major depressive disorder, substance use disorder, dual disorder, major dual depressive disorder, real-world evidence

Comorbid substance use disorder (SUD) in patients with schizophrenia (dual disorder, DD) is a frequent occurrence in the psychiatric clinical practice and is positively associated with poorer outcomes. Despite a very high co-prevalence, clinical guidelines for SUD and severe mental illnesses tend to give limited consideration to co-existing disorders regarding diagnosis and management. This article is the result of a meeting held in February 2023 to discuss common challenges and best clinical practice initiatives for patients with schizophrenia and DD in different treatment settings. The authors identified issues in the clinical approach to DD in schizophrenia spectrum disorders and suggested the most suitable management based on their experience as a group of experts, identifying possible improvement areas. In conclusion, the panel recommends that individuals with DD should be cared for in a single center. Pharmacologic treatment in individuals with DD needing both control of symptoms related to schizophrenia spectrum disorders and substance withdrawal should ideally be based on using a non-sedative antipsychotic with anti- craving activity. [ABSTRACT FROM AUTHOR]

Carlos Roncero,1 Pablo Ryan,2–4 Richard Littlewood,5 Juan Macías,6 Juan Ruiz,7 Pedro Seijo,8 Raúl Felipe Palma-Álvarez,9–11 Pablo Vega12,13 1Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain; 2Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain; 3School of Medicine, Complutense University of Madrid, Madrid, Spain; 4Gregorio Marañón Health Research Institute, Madrid, Spain; 5applied strategic, London, UK; 6Department of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain; 7Provincial Center of Drug Addiction, Malaga, Spain; 8Addiction Treatment Center of Villamartín, Cádiz, Spain; 9Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; 10Psychiatry Service, Biomedical Research Networking Center for Mental Health Network, Vall Hebron University Hospital, Barcelona, Spain; 11Autonomous University of Barcelona, Barcelona, Spain; 12Spanish Society of Dual Diagnosis, Bilbao, Spain; 13Institute of Addictions, Madrid, Spain Objectives: People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population. Methods: Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence. Results: Options for improving care at engagement/screening stages include patient education programs, strong provider–patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment. Conclusion: It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy. Keywords: HCV, opioid use disorder, treatment, elimination, practical recommendations

Marc Miravitlles,1 Jesús Molina,2 José Antonio Quintano,3 Anna Campuzano,4 Joselín Pérez,4 Carlos Roncero5 On behalf of the DEPREPOC study investigators 1Department of Pneumology, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, Spain; 3Centro de Salud Lucena I, Lucena, Cordoba, Spain; 4Medical Department Grupo Ferrer, Barcelona, Spain; 5Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain Background: COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of COPD in order to guide therapy; therefore, it is important to understand the factors determining CAT scores. Methods: This is a post hoc analysis of a cross-sectional, observational study conducted in respiratory medicine departments and primary care centers in Spain with the aim of identifying the factors determining CAT scores, focusing particularly on the cognitive status measured by the Mini-Mental State Examination (MMSE) and levels of depression measured by the short Beck Depression Inventory (BDI). Results: A total of 684 COPD patients were analyzed; 84.1% were men, the mean age of patients was 68.7 years, and the mean forced expiratory volume in 1 second (%) was 55.1%. Mean CAT score was 21.8. CAT scores correlated with the MMSE score (Pearson’s coefficient r=-0.371) and the BDI (r=0.620), both p

Maria A Ramon,1–3 Cristina Esquinas,1 Miriam Barrecheguren,1 Eulogio Pleguezuelos,4,5 Jesús Molina,6 José A Quintano,7 Miguel Roman-Rodríguez,8 Karlos Naberan,9 Carl Llor,10 Carlos Roncero,11–14 Marc Miravitlles1,3 1Department of Pneumology, Vall d’Hebron University Hospital, 2Faculty of Medicine, Autonomous University of Barcelona, 3Biomedical Research Networking Center Consortium of Respiratory Diseases (CIBERES), 4Physical Medicine and Rehabilitation Department, Mataró Hospital, 5TecnoCampus, College of Health Sciences, University of Pompeu Fabra, Mataró-Maresme, Barcelona, 6Francia Health Center, Dirección Asistencial Oeste, Madrid, 7Lucena Health Center I, Lucena, Córdoba, 8Son Pisà Primary Health Care Center, Palma de Mallorca, 9Campo de Belchite Health Center, Zaragoza, 10Primary Care Centre Via Roma, 11Addiction and Dual Diagnosis Unit, Psychiatry Service, Vall d’Hebron University Hospital, 12Barcelona Public Health Agency (ASPB), Barcelona, 13Biomedical Research Networking Center Consortium of Mental Health (CIBERSAM), Madrid, 14Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain Background: Quantifying physical activity in chronic obstructive pulmonary disease (COPD) is important as physical inactivity is related to poor health outcomes. This study analyzed the relationship between patients’ self-reported daily walking time and relevant characteristics related to COPD severity.Methods: Pooled analysis was performed on data from four observational studies on which daily walking time was gathered from a personal interview. Patients were classified as physically inactive if walking time was 3, post-bronchodilator forced expiratory volume in the first second 4, and CAT score >30.Conclusion: Lower self-reported walking times are related to worse markers of disease severity in COPD. Keywords: COPD, physical activity, symptoms

Carlos Roncero,1,2 Néstor Szerman,3 Antonio Terán,4 Carlos Pino,5 José María Vázquez,6 Elena Velasco,7 Marta García-Dorado,7 Miguel Casas1,2 1Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain; 2Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain; 3Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain; 4Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain; 5Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain; 6Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain; 7Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain Background: There is a need to evaluate the professionals’ perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders.Methods: An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addic­tions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted.Results: Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient’s disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms.Conclusion: Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence. Keywords: dual diagnosis, professionals’ perception, noncompliance, decompensation, relapse

Carlos Roncero,1 Ana Isabel Campuzano,2 Jose Antonio Quintano,3 Jesús Molina,4 Joselín Pérez,2 Marc Miravitlles51Addiction and Dual Diagnosis Unit, Psychiatry Department, Vall d’Hebron Hospital-ASPB. Ciber de Salud Mental (CIBERSAM) and Department of Psychiatry and Legal Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain; 2Medical Department, Grupo Ferrer, Barcelona, Spain; 3Primary Care Center Lucena I, Lucena, Cordoba, Spain; 4Primary Care Center Francia, Dirección Asistencial Oeste, Madrid, Spain; 5Department of Pneumology, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, SpainPurpose: We investigated the association between cognitive impairment and chronic obstructive pulmonary disease (COPD), taking into account demographic and clinical variables evaluated during routine practice.Patients and methods: We performed a post hoc analysis of a cross-sectional study that included subjects with stable COPD. Sociodemographic and clinical information was recorded using the Body mass index, airflow Obstruction, Dyspnea and Exacerbations index and the Charlson comorbidity index. Cognitive performance was studied by the mini-mental state examination, with a score less than 27 indicating clinical impairment. Depressive symptoms, physical activity, and quality of life (EuroQoL-5 dimensions and COPD Assessment Test) were also evaluated.Results: The analysis included 940 subjects. The prevalence of cognitive impairment was 39.4%. Multivariate logistic regression models revealed that cognitive impairment was associated with educational level (odds ratio [OR] =0.096, 95% confidence interval [CI] =0.011–0.447) and poorer quality of life measured by the EuroQoL-5 dimensions social tariff (OR =0.967, 95% CI =0.950–0.983). When questionnaires were not included in the analysis, cognitive impairment was associated with educational level (OR =0.063, 95% CI =0.010–0.934), number of exacerbations (OR =11.070, 95% CI =1.450–84.534), Body mass index, airflow Obstruction, Dyspnea and Exacerbations index score (OR =1.261, 95% CI =1.049–1.515), and the Charlson comorbidity index (OR =1.412, 95% CI =1.118–1.783).Conclusion: Cognitive impairment is common in COPD and is associated with low educational level, higher disease severity, and increased comorbidity. This could have therapeutic implications for this population.Keywords: chronic obstructive pulmonary disease, cognitive function, mini-mental state examination, depression, quality of life, comorbidity

In Saccharomyces cerevisiae cytokinesis is efficiently achieved when a concerted series of events take place at the neck region, leading to septum formation. Here it is shown that Bni4p plays a crucial role in this process. [DELTA]bni4 mutants contain normal amounts of chitin and show normal chitin synthase III (CSIII) activity, but are partially resistant to Calcofluor White (CFW), probably due to the striking pattern of chitin distribution. CFW vital staining shows that chitin is synthesized in daughter cells and that it is also asymmetrically deposited at the mother-side of the neck in large-budded ceils. This specific pattern coincides with that of Chs4p and Chs3p proteins. Alternatively, staining of unbudded cultures confirmed that Bni4p directs early chitin ring assembly, but is no longer required for the chitin deposition that occurs late in the cell cycle at cytokinesis. Consequently, this work provides a strategy to genetically discriminate between the absence of chitin synthesis ([DELTA]chs3 mutant) and failure in chitin ring assembly ([DELTA]bni4 mutants). The characterization of double mutants affected in chitin synthesis and primary septum (PS) assembly ([DELTA]myo1 and [DELTA]chs2) provides evidence for the cooperation of Bni4p in PS formation besides its role in chitin ring assembly. In addition, it is shown that the chitin ring, but not the late deposition of chitin, cooperates in the correct assembly of the actomyosin ring and the PS when the biological function of the septins is compromised. We conclude that Bni4p is not only required for the assembly of the chitin ring, but is also involved in septum architecture and the maintenance of neck integrity.

Results demonstrate that the antifungal activity of calcofluor is dependent on chitin and partially on the high-osmolarity glycerol response (HOG) pathway. Data also indicate that HOG functions under noninducing conditions and maintains cell wall architecture.

OBJECTIVE: T his s tudy’s m ain objective is to carry out a systematic review of the onset of psychotic symptoms after opioid withdrawal. The opiate dependence correlated to psychiatric symptoms has been well described. MATERIALS AND METHODS: Following the PRISMA methodology. The consecutive search strategy was applied: (morphine OR buprenorphine OR oxycodone OR tramadol OR fentanyl OR remifentanil OR opioids OR heroin OR methadone) AND (Psychosis OR psychotic symptoms OR schizophrenia). RESULTS: 1 2 c ase r eports, 3 s eries o f c ases, 2 clinical studies, and 2 reviews were found. It seems that the time association is present in all of them; symptoms appear days after the interruption of the opioid. Most of the articles reported are case reports that describe symptoms that appear after the suspension of the opioid substance; in most cases, the reintroduction of the opioid had therapeutic effects and provoked a remission of these symptoms. These preliminary findings indicate that opiates could have an antipsychotic effect; however, the literature is scarce. It is critical to consider, if needed, in opioid-dependent patients who start with psychosis after the opioid withdrawal the possible replacement or reintroduction of opioids to prevent further deterioration in the patient’s mental status. CONCLUSIONS: This study encompasses a comprehensive description of the literature concerning the possible not well-studied outcome of opioid withdrawal. There are some reports of temporal association between withdrawal and psychotic symptoms that improved after the reintroduction of the opioid; it could be taken into consideration in the clinical practice. [ABSTRACT FROM AUTHOR]