Fernando Rico-Villademoros | Universidad de Granada (original) (raw)

Papers by Fernando Rico-Villademoros

COPD: Journal of Chronic Obstructive Pulmonary Disease

International Journal of Neuroscience

Aim of the study: To assess the effectiveness, overall tolerability of eslicarbazepine acetate (E... more Aim of the study: To assess the effectiveness, overall tolerability of eslicarbazepine acetate (ESL) as an initial or early monotherapy treatment of adult patients with focal epilepsy under real-world practice conditions. Materials and methods: We focused on real-world longitudinal studies that included or separately reported the results of at least one of the efficacy outcomes of interest. A DerSimonian-Laird random effects model was used with the presentation of the 95% confidence intervals of the estimate Results: 5 studies met our selection criteria and were included in the quantitative synthesis. All studies were observational and uncontrolled studies, and all but one were retrospective studies. The pooled proportion of patients who were seizure-free for the entire study period was 64.6% (95% CI, 45.7 to 79.8) at month 6 and 56.6% (95% CI, 50.2 to 62.8) at month 12. Pooled retention rates were 95.0% (95% CI, 90.3 to 97.5) at 6 months and 83.6% (95% CI, 73.9 to 90.1) at 12 months. The pooled proportion of patients who reported at least one adverse event was 27.2% (95% CI, 21.7 to 33.6), and the pooled proportion of patients who discontinued ESL due to adverse events was 8.9% (95% CI 6.2 to 12.6). Conclusions: Our results suggest that initial or early monotherapy with ESL is effective and well-tolerated for the management of adult patients with focal epilepsy in clinical practice, with results that are at least similar to those reported in the pivotal randomized clinical trial of ESL monotherapy. No new safety signals with ESL have been identified in this systematic review.

Tobacco Prevention & Cessation, 2021

INTRODUCTION This study assess the prevalence and potential determinants (attitudes, behavioral a... more INTRODUCTION This study assess the prevalence and potential determinants (attitudes, behavioral and emotional conditions) associated with waterpipe tobacco smoking (WTS) and cigarette smoking in adolescents in public compulsory secondary schools. METHODS This was a cross-sectional study conducted in October 2017 in three secondary schools from Seville, Spain, among adolescents aged 12-18 years. We administered an ad hoc questionnaire to explore the demographic and clinical characteristics of students; in addition, it included questions on consumption of tobacco (waterpipe and/or cigarette), alcohol (usual consumption and/or drunkenness) and/or cannabis, and attitudes towards waterpipe tobacco smoking. We also administered a validated version of the Strengths and Difficulties Questionnaire (SDQ), which is used to screen children and adolescents with emotional and behavioral problems. An established usage of a substance was defined as weekly or daily use. A multivariate analysis was performed using binary logistic regression methods to determine the probability of established usage. RESULTS Of the 1135 adolescents, 72.1% lived with at least one smoker; the established usage was 13.4% for waterpipe; 9.2% for cigarettes and 3.2% for dual use. Of those with established usage of waterpipe, 38.2% had established alcohol usage, 12.7% were drunk weekly or daily, and 27.4% used cannabis. Students consolidating the consumption of waterpipes were three times more likely to have established cigarette use than those not having an established usage (OR=3.7; p=0.0005). The overall SDQ score increased the likelihood of established usage of both waterpipes and cigarettes (p=0.0005). CONCLUSIONS The probability of established usage of cigarettes (multivariate analysis) is associated with increasing age (course), cohabitation with smokers, established usage of waterpipe, established use of alcohol and a borderline score in the behavioral dimension (SDQ). Addiction to waterpipes among teens is significantly associated with their behavioral and emotional difficulties.

European Neuropsychopharmacology, 2002

In the rabbit cardiac purkinje fiber model we found the following rank order for prolongation of ... more In the rabbit cardiac purkinje fiber model we found the following rank order for prolongation of the APD (lowest statistical effective concentrations in nM): risperidone (100), haloperidol (100), sertindole (300), olanzapine (1000) and clozapine (3000). EAD's were induced with risperidone (7/7), haloperidol (3/6), olanzapine (1/6) and clozapine (1/6), but not with sertindole (0/7). Conclusions: Our data indicate that the prolongation of APD and the development of proarrhythmia in rabbit cardiac purkinje fibers can not be positively correlated with the blocking effect on Ikr. This suggests that other cardiac ion channels or receptor blocking properties are opposing the effect on Ikr. For sertindole, we found a complete lack of proarrhythmic activity in rabbit cardiac purkinje fibers, supporting the presence of an important counter-regulatory mechanism(s) against arrhythmogenic events.

Archives of Sexual Behavior, 2019

The objective of this cross-sectional study was to evaluate the frequency, impact, and management... more The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate-severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation.

Un artículo científico original trata de contar la historia de una investigación. Es una historia... more Un artículo científico original trata de contar la historia de una investigación. Es una historia en cuatro capítulos, cada uno de los cuales debe proporcionar una información concreta: • Introducción: ¿cuál fue la pregunta de investi­ gación? • Material (o pacientes) y métodos: ¿cómo la es­ tudiamos? • Resultados: ¿qué encontramos? • Discusión: ¿cuáles son las implicaciones de los resultados obtenidos? El comienzo de nuestra historia, la introducción, tiene como objetivo atraer la atención del lector (¡y del editor de la revista!), algo a lo que contribuirán también el título y el resumen del artículo. Para ello es necesario ir al corazón de la investigación: cuál es la pregunta a la que pretendía dar respuesta el estudio y de dónde surgió (la razón de ser del estudio). La pregunta de investigación es el punto clave de cualquier estudio, ya que nos dice el valor que tiene esa inves­ tigación en el marco del conocimiento actual y condiciona el diseño del estudio, el segundo punto en...

Expert Opinion on Pharmacotherapy

Objectives. Depression, chronic pain and sleep disturbances frequently co-exist in FM and have sh... more Objectives. Depression, chronic pain and sleep disturbances frequently co-exist in FM and have shown to be independently related with suicidal behaviours. The present survey was performed to evaluate the prevalence of previous suicide attempts in patients with FM and its potential relationship with sociodemo-graphic and clinical characteristics of the disease. Methods. A concise survey was sent to patients of seven associations of patients with FM. In addition to the inquiry concerning the number, if any, and characteristics of suicide attempts, the survey included questions about sociodemographic and clinical data of patients as well as the revised FM impact ques-tionnaire (FIQR) and the Plutchik suicide risk scale. Results. One hundred and eighty patients answered the survey. Thirty (16.7%) of them reported one to three previous suicide attempts. Drug poisoning was the most frequently employed method for suicide attempt (70%). No relevant differences were found between suicide att...

The introduction of an original paper should attract the reader�s attention and explain why the r... more The introduction of an original paper should attract the reader�s attention and explain why the researchers undertook the study. The key elements of its structure are: the study rationale, the research question, and the study design. When discussing the study rationale, we should move from what is known about the topic to what is not known, telling the reader where the study question came from and why it was important to answer that question. The introduction may be concluded by stating the research question (sometimes presented as the study hypothesis or objectives) or by briefly describing the study design (i.e. how we answered the question). Regarding style, the introduction should be well organized and short (preferably one page), and should maintain continuity from sentence to sentence.

Expert Review of Neurotherapeutics, 2015

Fibromyalgia is characterized by chronic generalized pain accompanied by a wide range of clinical... more Fibromyalgia is characterized by chronic generalized pain accompanied by a wide range of clinical manifestations. Most clinical practice guidelines recommend multidisciplinary treatment using a combination of pharmacological and non-pharmacological therapies. The tricyclic antidepressant amitriptyline has been most thoroughly studied in fibromyalgia. Amitriptyline has been evaluated in placebo-controlled studies, and it has served as an active comparator to other therapeutic interventions in the treatment of fibromyalgia. In addition, several systematic reviews and meta-analyses have evaluated its efficacy and safety for the treatment of fibromyalgia. Data from individual studies as well as from systematic reviews indicate that low doses (10-75 mg/day) of amitriptyline are effective for the treatment of fibromyalgia and, despite the limited quality of the data, they do not seem to be associated with relevant tolerability or safety issues. Consistent with some clinical guidelines, we believe amitriptyline in low doses should be considered a first-line drug for the treatment of fibromyalgia.

Actas espanolas de psiquiatria

The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Dis... more The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Disorder of Carroll and Davidson for use in research and clinical practice in Spain for screening and assessing specific anxiety symptoms of patients with Generalized Anxiety Disorder (GAD). Observational, prospective, multisite, study comparing between patients with DSM-IV diagnosis of GAD (group A), starting or switching treatment (group A1) or stable patients (group A2), followed-up for 6 months (group A1) or 2 weeks (group A2) versus healthy control subjects (group B), assessed in a single visit. Among 223 valuable subjects the scale showed: a) adequate feasibility with a mean time of administration: 6.53 and 4.49 min (TD: 5.48 and 3.56) in groups A and B, and percentage of patients without response <5 %; b) adequate reliability (Kuder-Richardson coefficient: 0.85 and 0.79 in groups A1 and A2, and CCI coefficient: 0.89 in group A2); c) adequate validity, showing capability for discri...

The treatment of fibromyalgia involves the use of different kinds of therapeutic modalities. Amon... more The treatment of fibromyalgia involves the use of different kinds of therapeutic modalities. Among pharmacologic treatments, several antidepressants and pregabalin, an alfa2delta blocker, are the best studied drugs and have the highest degree of evidence for efficacy. Other drugs that may be used and have at least a positive randomized clinical trial include sodium oxybate, two 5-HT3 receptor antagonists and pramipexole. As it is not an inflammatory disease, NSAIDs are not useful in the long-term management of fibromyalgia, but the combination of tramadolol with paracetamol has been shown to be effective. Non-pharmacologic therapies include physical and psychological alternatives. Educating patients to understand their disease is helpful when combined with other non-pharmacologic alternatives, but has little efficacy by itself. Exercise, particularly aerobic exercise, has been shown to improve pain, depressed mood and quality of life. Cognitive-behavioral therapy has been shown to i...

Expert Opinion on Pharmacotherapy, 2015

Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different sym... more Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different symptoms such as fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress. Multidisciplinary treatment combining pharmacological and nonpharmacological therapies is advised. Publications describing randomized controlled trials and long-term extension studies evaluating drug treatment for fibromyalgia were searched in PubMed and Scopus and included in this review. Different drugs are recommended for the treatment of fibromyalgia by different published guidelines, although only three of them have been approved for this indication by the US FDA, and none have been approved by the European Medicines Agency. According to the available evidence, pregabalin, duloxetine and milnacipran should be the drugs of choice for the treatment of this disease, followed by amitriptyline and cyclobenzaprine. Other drugs with at least one positive clinical trial include some selective serotonin reuptake inhibitors, moclobemide, pirlindole, gabapentin, tramadol, tropisetron, sodium oxybate and nabilone. None of the currently available drugs are fully effective against the whole spectrum of fibromyalgia symptoms, namely pain, fatigue, sleep disturbances and depression, among the most relevant symptoms. Combination therapy is an option that needs to be more thoroughly investigated in clinical trials.

Drugs of today (Barcelona, Spain : 1998), 2014

The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The phar... more The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The pharmacological treatment of fibromyalgia is limited to a few drugs that have been demonstrated to be moderately effective in some but not all dimensions of the disease. Therefore, the search for new drugs to treat this condition is warranted. Atypical antipsychotics offered an attractive alternative because they had been shown to be active against several key symptoms of fibromyalgia. The results of open-label studies, however, appear to indicate that atypical antipsychotics are poorly tolerated in patients with fibromyalgia, and only quetiapine XR has been studied in randomized controlled trials. Quetiapine XR has demonstrated effectiveness in treating comorbid major depression, anxiety and sleep disturbance. However, in two randomized controlled trials, quetiapine XR was not differentiated from placebo and failed to demonstrate noninferiority to amitriptyline in terms of improving overall...

Clinical and experimental rheumatology

To evaluate the effectiveness and tolerability of two pool-based physical therapies, stretching a... more To evaluate the effectiveness and tolerability of two pool-based physical therapies, stretching and Ai Chi, in fibromyalgia symptomatology and sleep quality. Eighty-one patients, randomly assigned to stretching (n=39) or Ai Chi (n=42), received 18 physiotherapy sessions and were evaluated at baseline, at treatment termination, and after 4 and 12 weeks of follow-up. Main outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) and the Pittsburgh Sleep Quality Index (PSQI). Secondary outcome measures included the Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI), and the SF-12 Health Survey (SF-12). Data analysis was done with repeated measures ANOVA and effect size estimation. No differences were found between groups but significant reduction in the FIQ and the PSQI scores were observed in Ai Chi but not in stretching group, with larger effect sizes and longer effect duration on sleep measures. BDI scores decreased in stretching but not in Ai Chi ...

European Neuropsychopharmacology, 2002

P.2. Psychotic disorders and antipsychotics combines the advantages of an atypical agent with tho... more P.2. Psychotic disorders and antipsychotics combines the advantages of an atypical agent with those of longacting formulations. In this study, we assessed hospitalization rates in stable patients with schizophrenia or schizoaffective disorder during long-term treatment with long-acting risperidone. Methods: Risperidone was administered by intramuscular injection (25 mg or 50 mg, every 2 weeks). Data on hospitalizations in the previous 3 months were collected at baseline and every 3 months thereafter in a 1-year, multi-center, open-label study. Results: Of the 397 patients in the analysis, 301 (76%) were outpatients, while 96 (24%) were hospitalized at baseline. During treatment with long-acting risperidone, the need for hospitalization decreased continuously over time from 38% (150 patients) during the 3 months before study entry to 28% (111 patients) during Months 1 3, 18% (64 patients) during Months 4-6, 14% (42 patients) during Months 7-9, and 12% (33 patients) during Months 10-12. This trend was statistically significant (p <0.0001 ; longitudinal data analysis using generalized estimating equations). As a proxy measure for relapse, the 1-year re-hospitalization rate was defined as the first hospitalization for outpatients, and the first new hospitalization after discharge for inpatients at baseline. Of the inpatients, 28 were not discharged during the study period and did not contribute to the re-hospitalization analysis. The overall 1-year re-hospitalization rate was 17.6% (65 patients). In outpatients, the hospitalization rate was 15.9% (48 patients), while in inpatients the rate was 25.0% (17 patients). Conclusions: The need for hospitalization decreased continuously and significantly over 1 year of treatment with long-acting risperidone. The 1-year re-hospitalization rate associated with long-acting risperidone was low at 17.6%. Purpose: To assess the relationship between weight gain and sexual dysfunction (SD) with antipsychotics. Methods: A cross-sectional, multicenter study was carried out by 61 Spanish Psychiatrists (The EIRE Collaborative Group). Outpatients meeting DSM-IV criteria for Schizophrenia and taking a single antipychotic for at least 4 weeks were consecutively entered into the study. Evaluations comprised: demographic and clinical characteristics, CGI-severity scale, and a modified-UKU scale. Changes in weight were retrospectively assessed. Results: 636 evaluable patients (out of 669 recruited) were assessed. The average doses were those seen commonly in the clinical setting: 10.6 mg/d (HAL), 13.5 mg/d (OLAN), 360.5 mg/d (QUE) and 5.3 mg/d (RIS). The presence of weight gain and SD defined by UKU was frequent (n=326, 55.9% and n=178, 37.6%, respectively). SD was found to be statistically associated with weight changes (Chi square test: p<0.05), being more frequent among patients with higher weight gain. Specifically, 28.9% of patients showed SD among those patients with not gain (n=142), whilst 40.4%, 39.0%, 37.9% and 66.7% of patients showed SD among those patients with weight gain ~<5kgs. (n=188), >5 kgs. and ~<10 kgs. (n=82), >10 kgs. and <~15 kgs. (n=29), and >15 kgs. (n=21), respectively. SD was also found to be statistically associated with BM1 (Chi square test: p<0.05), being more frequent among patients with higher BMI. 28.7%, 41.6°/0 and 45.6% of patients showed SD among those patients with normal weight (BMI<25kg/m2) (n=171), overweight (BMI ~> 25 kg/m2 & <30 kg/m2) (n=231) and obese (BMI ~> 30 kg/m2) (n=68). P.2. Psychotic disorders and antipsychotics $283 Although uncommon, the action most frequently taken with weight gain and SD was a dose-reduction (n=32/272, 11.8%, and n=l 1/154, 7.1%, respectively). Conclusion: This preliminary analysis suggests that antipsychotic-induced weight gain is associated with an increased frequency of sexual dysfunction. On behalf of the EIRE Collaborative Group.

European Neuropsychopharmacology, 2008

The Lancet Psychiatry, 2016

COPD: Journal of Chronic Obstructive Pulmonary Disease

International Journal of Neuroscience

Aim of the study: To assess the effectiveness, overall tolerability of eslicarbazepine acetate (E... more Aim of the study: To assess the effectiveness, overall tolerability of eslicarbazepine acetate (ESL) as an initial or early monotherapy treatment of adult patients with focal epilepsy under real-world practice conditions. Materials and methods: We focused on real-world longitudinal studies that included or separately reported the results of at least one of the efficacy outcomes of interest. A DerSimonian-Laird random effects model was used with the presentation of the 95% confidence intervals of the estimate Results: 5 studies met our selection criteria and were included in the quantitative synthesis. All studies were observational and uncontrolled studies, and all but one were retrospective studies. The pooled proportion of patients who were seizure-free for the entire study period was 64.6% (95% CI, 45.7 to 79.8) at month 6 and 56.6% (95% CI, 50.2 to 62.8) at month 12. Pooled retention rates were 95.0% (95% CI, 90.3 to 97.5) at 6 months and 83.6% (95% CI, 73.9 to 90.1) at 12 months. The pooled proportion of patients who reported at least one adverse event was 27.2% (95% CI, 21.7 to 33.6), and the pooled proportion of patients who discontinued ESL due to adverse events was 8.9% (95% CI 6.2 to 12.6). Conclusions: Our results suggest that initial or early monotherapy with ESL is effective and well-tolerated for the management of adult patients with focal epilepsy in clinical practice, with results that are at least similar to those reported in the pivotal randomized clinical trial of ESL monotherapy. No new safety signals with ESL have been identified in this systematic review.

Tobacco Prevention & Cessation, 2021

INTRODUCTION This study assess the prevalence and potential determinants (attitudes, behavioral a... more INTRODUCTION This study assess the prevalence and potential determinants (attitudes, behavioral and emotional conditions) associated with waterpipe tobacco smoking (WTS) and cigarette smoking in adolescents in public compulsory secondary schools. METHODS This was a cross-sectional study conducted in October 2017 in three secondary schools from Seville, Spain, among adolescents aged 12-18 years. We administered an ad hoc questionnaire to explore the demographic and clinical characteristics of students; in addition, it included questions on consumption of tobacco (waterpipe and/or cigarette), alcohol (usual consumption and/or drunkenness) and/or cannabis, and attitudes towards waterpipe tobacco smoking. We also administered a validated version of the Strengths and Difficulties Questionnaire (SDQ), which is used to screen children and adolescents with emotional and behavioral problems. An established usage of a substance was defined as weekly or daily use. A multivariate analysis was performed using binary logistic regression methods to determine the probability of established usage. RESULTS Of the 1135 adolescents, 72.1% lived with at least one smoker; the established usage was 13.4% for waterpipe; 9.2% for cigarettes and 3.2% for dual use. Of those with established usage of waterpipe, 38.2% had established alcohol usage, 12.7% were drunk weekly or daily, and 27.4% used cannabis. Students consolidating the consumption of waterpipes were three times more likely to have established cigarette use than those not having an established usage (OR=3.7; p=0.0005). The overall SDQ score increased the likelihood of established usage of both waterpipes and cigarettes (p=0.0005). CONCLUSIONS The probability of established usage of cigarettes (multivariate analysis) is associated with increasing age (course), cohabitation with smokers, established usage of waterpipe, established use of alcohol and a borderline score in the behavioral dimension (SDQ). Addiction to waterpipes among teens is significantly associated with their behavioral and emotional difficulties.

European Neuropsychopharmacology, 2002

In the rabbit cardiac purkinje fiber model we found the following rank order for prolongation of ... more In the rabbit cardiac purkinje fiber model we found the following rank order for prolongation of the APD (lowest statistical effective concentrations in nM): risperidone (100), haloperidol (100), sertindole (300), olanzapine (1000) and clozapine (3000). EAD's were induced with risperidone (7/7), haloperidol (3/6), olanzapine (1/6) and clozapine (1/6), but not with sertindole (0/7). Conclusions: Our data indicate that the prolongation of APD and the development of proarrhythmia in rabbit cardiac purkinje fibers can not be positively correlated with the blocking effect on Ikr. This suggests that other cardiac ion channels or receptor blocking properties are opposing the effect on Ikr. For sertindole, we found a complete lack of proarrhythmic activity in rabbit cardiac purkinje fibers, supporting the presence of an important counter-regulatory mechanism(s) against arrhythmogenic events.

Archives of Sexual Behavior, 2019

The objective of this cross-sectional study was to evaluate the frequency, impact, and management... more The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate-severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation.

Un artículo científico original trata de contar la historia de una investigación. Es una historia... more Un artículo científico original trata de contar la historia de una investigación. Es una historia en cuatro capítulos, cada uno de los cuales debe proporcionar una información concreta: • Introducción: ¿cuál fue la pregunta de investi­ gación? • Material (o pacientes) y métodos: ¿cómo la es­ tudiamos? • Resultados: ¿qué encontramos? • Discusión: ¿cuáles son las implicaciones de los resultados obtenidos? El comienzo de nuestra historia, la introducción, tiene como objetivo atraer la atención del lector (¡y del editor de la revista!), algo a lo que contribuirán también el título y el resumen del artículo. Para ello es necesario ir al corazón de la investigación: cuál es la pregunta a la que pretendía dar respuesta el estudio y de dónde surgió (la razón de ser del estudio). La pregunta de investigación es el punto clave de cualquier estudio, ya que nos dice el valor que tiene esa inves­ tigación en el marco del conocimiento actual y condiciona el diseño del estudio, el segundo punto en...

Expert Opinion on Pharmacotherapy

Objectives. Depression, chronic pain and sleep disturbances frequently co-exist in FM and have sh... more Objectives. Depression, chronic pain and sleep disturbances frequently co-exist in FM and have shown to be independently related with suicidal behaviours. The present survey was performed to evaluate the prevalence of previous suicide attempts in patients with FM and its potential relationship with sociodemo-graphic and clinical characteristics of the disease. Methods. A concise survey was sent to patients of seven associations of patients with FM. In addition to the inquiry concerning the number, if any, and characteristics of suicide attempts, the survey included questions about sociodemographic and clinical data of patients as well as the revised FM impact ques-tionnaire (FIQR) and the Plutchik suicide risk scale. Results. One hundred and eighty patients answered the survey. Thirty (16.7%) of them reported one to three previous suicide attempts. Drug poisoning was the most frequently employed method for suicide attempt (70%). No relevant differences were found between suicide att...

The introduction of an original paper should attract the reader�s attention and explain why the r... more The introduction of an original paper should attract the reader�s attention and explain why the researchers undertook the study. The key elements of its structure are: the study rationale, the research question, and the study design. When discussing the study rationale, we should move from what is known about the topic to what is not known, telling the reader where the study question came from and why it was important to answer that question. The introduction may be concluded by stating the research question (sometimes presented as the study hypothesis or objectives) or by briefly describing the study design (i.e. how we answered the question). Regarding style, the introduction should be well organized and short (preferably one page), and should maintain continuity from sentence to sentence.

Expert Review of Neurotherapeutics, 2015

Fibromyalgia is characterized by chronic generalized pain accompanied by a wide range of clinical... more Fibromyalgia is characterized by chronic generalized pain accompanied by a wide range of clinical manifestations. Most clinical practice guidelines recommend multidisciplinary treatment using a combination of pharmacological and non-pharmacological therapies. The tricyclic antidepressant amitriptyline has been most thoroughly studied in fibromyalgia. Amitriptyline has been evaluated in placebo-controlled studies, and it has served as an active comparator to other therapeutic interventions in the treatment of fibromyalgia. In addition, several systematic reviews and meta-analyses have evaluated its efficacy and safety for the treatment of fibromyalgia. Data from individual studies as well as from systematic reviews indicate that low doses (10-75 mg/day) of amitriptyline are effective for the treatment of fibromyalgia and, despite the limited quality of the data, they do not seem to be associated with relevant tolerability or safety issues. Consistent with some clinical guidelines, we believe amitriptyline in low doses should be considered a first-line drug for the treatment of fibromyalgia.

Actas espanolas de psiquiatria

The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Dis... more The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Disorder of Carroll and Davidson for use in research and clinical practice in Spain for screening and assessing specific anxiety symptoms of patients with Generalized Anxiety Disorder (GAD). Observational, prospective, multisite, study comparing between patients with DSM-IV diagnosis of GAD (group A), starting or switching treatment (group A1) or stable patients (group A2), followed-up for 6 months (group A1) or 2 weeks (group A2) versus healthy control subjects (group B), assessed in a single visit. Among 223 valuable subjects the scale showed: a) adequate feasibility with a mean time of administration: 6.53 and 4.49 min (TD: 5.48 and 3.56) in groups A and B, and percentage of patients without response <5 %; b) adequate reliability (Kuder-Richardson coefficient: 0.85 and 0.79 in groups A1 and A2, and CCI coefficient: 0.89 in group A2); c) adequate validity, showing capability for discri...

The treatment of fibromyalgia involves the use of different kinds of therapeutic modalities. Amon... more The treatment of fibromyalgia involves the use of different kinds of therapeutic modalities. Among pharmacologic treatments, several antidepressants and pregabalin, an alfa2delta blocker, are the best studied drugs and have the highest degree of evidence for efficacy. Other drugs that may be used and have at least a positive randomized clinical trial include sodium oxybate, two 5-HT3 receptor antagonists and pramipexole. As it is not an inflammatory disease, NSAIDs are not useful in the long-term management of fibromyalgia, but the combination of tramadolol with paracetamol has been shown to be effective. Non-pharmacologic therapies include physical and psychological alternatives. Educating patients to understand their disease is helpful when combined with other non-pharmacologic alternatives, but has little efficacy by itself. Exercise, particularly aerobic exercise, has been shown to improve pain, depressed mood and quality of life. Cognitive-behavioral therapy has been shown to i...

Expert Opinion on Pharmacotherapy, 2015

Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different sym... more Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different symptoms such as fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress. Multidisciplinary treatment combining pharmacological and nonpharmacological therapies is advised. Publications describing randomized controlled trials and long-term extension studies evaluating drug treatment for fibromyalgia were searched in PubMed and Scopus and included in this review. Different drugs are recommended for the treatment of fibromyalgia by different published guidelines, although only three of them have been approved for this indication by the US FDA, and none have been approved by the European Medicines Agency. According to the available evidence, pregabalin, duloxetine and milnacipran should be the drugs of choice for the treatment of this disease, followed by amitriptyline and cyclobenzaprine. Other drugs with at least one positive clinical trial include some selective serotonin reuptake inhibitors, moclobemide, pirlindole, gabapentin, tramadol, tropisetron, sodium oxybate and nabilone. None of the currently available drugs are fully effective against the whole spectrum of fibromyalgia symptoms, namely pain, fatigue, sleep disturbances and depression, among the most relevant symptoms. Combination therapy is an option that needs to be more thoroughly investigated in clinical trials.

Drugs of today (Barcelona, Spain : 1998), 2014

The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The phar... more The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The pharmacological treatment of fibromyalgia is limited to a few drugs that have been demonstrated to be moderately effective in some but not all dimensions of the disease. Therefore, the search for new drugs to treat this condition is warranted. Atypical antipsychotics offered an attractive alternative because they had been shown to be active against several key symptoms of fibromyalgia. The results of open-label studies, however, appear to indicate that atypical antipsychotics are poorly tolerated in patients with fibromyalgia, and only quetiapine XR has been studied in randomized controlled trials. Quetiapine XR has demonstrated effectiveness in treating comorbid major depression, anxiety and sleep disturbance. However, in two randomized controlled trials, quetiapine XR was not differentiated from placebo and failed to demonstrate noninferiority to amitriptyline in terms of improving overall...

Clinical and experimental rheumatology

To evaluate the effectiveness and tolerability of two pool-based physical therapies, stretching a... more To evaluate the effectiveness and tolerability of two pool-based physical therapies, stretching and Ai Chi, in fibromyalgia symptomatology and sleep quality. Eighty-one patients, randomly assigned to stretching (n=39) or Ai Chi (n=42), received 18 physiotherapy sessions and were evaluated at baseline, at treatment termination, and after 4 and 12 weeks of follow-up. Main outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) and the Pittsburgh Sleep Quality Index (PSQI). Secondary outcome measures included the Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI), and the SF-12 Health Survey (SF-12). Data analysis was done with repeated measures ANOVA and effect size estimation. No differences were found between groups but significant reduction in the FIQ and the PSQI scores were observed in Ai Chi but not in stretching group, with larger effect sizes and longer effect duration on sleep measures. BDI scores decreased in stretching but not in Ai Chi ...

European Neuropsychopharmacology, 2002

P.2. Psychotic disorders and antipsychotics combines the advantages of an atypical agent with tho... more P.2. Psychotic disorders and antipsychotics combines the advantages of an atypical agent with those of longacting formulations. In this study, we assessed hospitalization rates in stable patients with schizophrenia or schizoaffective disorder during long-term treatment with long-acting risperidone. Methods: Risperidone was administered by intramuscular injection (25 mg or 50 mg, every 2 weeks). Data on hospitalizations in the previous 3 months were collected at baseline and every 3 months thereafter in a 1-year, multi-center, open-label study. Results: Of the 397 patients in the analysis, 301 (76%) were outpatients, while 96 (24%) were hospitalized at baseline. During treatment with long-acting risperidone, the need for hospitalization decreased continuously over time from 38% (150 patients) during the 3 months before study entry to 28% (111 patients) during Months 1 3, 18% (64 patients) during Months 4-6, 14% (42 patients) during Months 7-9, and 12% (33 patients) during Months 10-12. This trend was statistically significant (p <0.0001 ; longitudinal data analysis using generalized estimating equations). As a proxy measure for relapse, the 1-year re-hospitalization rate was defined as the first hospitalization for outpatients, and the first new hospitalization after discharge for inpatients at baseline. Of the inpatients, 28 were not discharged during the study period and did not contribute to the re-hospitalization analysis. The overall 1-year re-hospitalization rate was 17.6% (65 patients). In outpatients, the hospitalization rate was 15.9% (48 patients), while in inpatients the rate was 25.0% (17 patients). Conclusions: The need for hospitalization decreased continuously and significantly over 1 year of treatment with long-acting risperidone. The 1-year re-hospitalization rate associated with long-acting risperidone was low at 17.6%. Purpose: To assess the relationship between weight gain and sexual dysfunction (SD) with antipsychotics. Methods: A cross-sectional, multicenter study was carried out by 61 Spanish Psychiatrists (The EIRE Collaborative Group). Outpatients meeting DSM-IV criteria for Schizophrenia and taking a single antipychotic for at least 4 weeks were consecutively entered into the study. Evaluations comprised: demographic and clinical characteristics, CGI-severity scale, and a modified-UKU scale. Changes in weight were retrospectively assessed. Results: 636 evaluable patients (out of 669 recruited) were assessed. The average doses were those seen commonly in the clinical setting: 10.6 mg/d (HAL), 13.5 mg/d (OLAN), 360.5 mg/d (QUE) and 5.3 mg/d (RIS). The presence of weight gain and SD defined by UKU was frequent (n=326, 55.9% and n=178, 37.6%, respectively). SD was found to be statistically associated with weight changes (Chi square test: p<0.05), being more frequent among patients with higher weight gain. Specifically, 28.9% of patients showed SD among those patients with not gain (n=142), whilst 40.4%, 39.0%, 37.9% and 66.7% of patients showed SD among those patients with weight gain ~<5kgs. (n=188), >5 kgs. and ~<10 kgs. (n=82), >10 kgs. and <~15 kgs. (n=29), and >15 kgs. (n=21), respectively. SD was also found to be statistically associated with BM1 (Chi square test: p<0.05), being more frequent among patients with higher BMI. 28.7%, 41.6°/0 and 45.6% of patients showed SD among those patients with normal weight (BMI<25kg/m2) (n=171), overweight (BMI ~> 25 kg/m2 & <30 kg/m2) (n=231) and obese (BMI ~> 30 kg/m2) (n=68). P.2. Psychotic disorders and antipsychotics $283 Although uncommon, the action most frequently taken with weight gain and SD was a dose-reduction (n=32/272, 11.8%, and n=l 1/154, 7.1%, respectively). Conclusion: This preliminary analysis suggests that antipsychotic-induced weight gain is associated with an increased frequency of sexual dysfunction. On behalf of the EIRE Collaborative Group.

European Neuropsychopharmacology, 2008

The Lancet Psychiatry, 2016