Purificación López’s research while affiliated with Centro de Investigación Biomédica en Red de Salud Mental and other places

Purpose Bipolar disorder (BD) is a mental illness involving mood disorder, characterized by alternating normal mood, manic and depressive symptom. People with BD are associated with an unhealthy lifestyle. Assessment of cardiorespiratory fitness (CRF) indicates the overall health and can be directly measured and assessed by the cardiopulmonary exercise test and peak oxygen uptake (VO2peak), respectively. The CRF in the BD population may be altered due to sex, age, depression symptoms, and inactivity. The aim of this study was to analyze possible correlations of CRF with clinical symptoms and body composition variables. Methods Participants (n = 53, 44.9 ± 13.2 yr old) with BD were assessed with (1) body mass index and fat body mass (FBM) percentage; (2) upright bicycle ergometer using an incremental ramp protocol to get the VO2peak; and (3) symptoms of the disease [Hamilton Depression Rating Scale (HRSD) and Clinical Global Impressions Scale (CGI-S)]. Correlation analyses were performed among clinical symptoms, BMI, and VO2peak. Results The studied population showed overweight based on BMI (29.4±6.8 kg/m2), and obesity taking into account the fat mass percentage (33.6±10.6 %). According to Kaminsky et al., participants were classified in the 40th percentile with a low physical condition (VO2peak =25.8±8.4 mL·kg-1·min-1). Spearman's rho correlation coefficients demonstrated an inverse relationship between VO2peak (mL·kg−1·min−1) and HRSD (B=-0.286; P = 0.040); VO2peak (mL·kg−1·min−1) and CGI-S (B=-0.277; P = 0.047); and VO2peak (mL·kg−1·min−1) and FBM (B=-0.606; P < 0.001). Conclusions In population with BD a significantly higher CRF was detected in those with lower clinical symptoms, as well as lower FBM. Exercise interventions for improving CRF should be promoted in this population to better control clinical symptoms.

The main objective of the present study was to investigate the association between several epigenetic clocks, covering different aspects of aging, with schizophrenia relapse evaluated over a 3-year follow-up period in a cohort of ninety-one first-episode schizophrenia patients. Genome-wide DNA methylation was profiled and four epigenetic clocks, including epigenetic clocks of chronological age, mortality and telomere length were calculated. Patients that relapsed during the follow-up showed epigenetic acceleration of the telomere length clock (p = 0.030). Shorter telomere length was associated with cognitive performance (working memory, r = 0.31 p = 0.015; verbal fluency, r = 0.28 p = 0.028), but no direct effect of cognitive function or symptom severity on relapse was detected. The results of the present study suggest that epigenetic age acceleration could be involved in the clinical course of schizophrenia and could be a useful marker of relapse when measured in remission stages.

Suicide is a major health issue worldwide involving nearly 800.000 deaths per year (WHO, 2017) and is the principal cause of external death in the Basque Country resulting in 180 casualties in year 2016 (Eustat, 2017). Preventive interventions have shown efficacy at reducing suicidal behaviour up to a 25-30%, hence they are one of the priorities of public health policies according to Mental Health Strategy of the Basque Country (2010) and local research is being promoted by the Health Department of Basque Government. As history of prior suicide attempts is one of the highest risk factor for committed suicide, the main objective of this project is to evaluate the efficacy of a telemedice-based intervention at reducing future suicide attempts by a 12-month telephone follow-up after a recent attempt. This integrated-care research project involves the collaboration of 4 centres of the Basque Public Health System – Osakidetza: OSI Araba (Coordinator), OSI Barrualde, Gipuzkoa Public Mental Health Network and Consejo Sanitario (CS). Following a multidisciplinary approach, the different mental health professionals of these centres, including psyquiatrists, psychologists and nurses, coordinate across different assistance levels, i.e., Psychiatry Service, Primary Care (CS) and, in necessary cases, Emergency Service and Social Services. Prospective and non-randomized study will be conducted in Araba University Hospital, Outpatient Public MH Network of Gipuzkoa and Hospital Galdakao, in which 260 patients with a recent suicide attempt will have a 12-month telephone follow-up (5 calls: week 1, month 1, month 3, month 6, month 12) carried out by trained nurses of the patient counselling service of CS. As a control group, another 260 patients will receive Treatment as Usual (TAU). Simultaneously, a cost study will be carried out during 12 months after first suicide attempt, calculating both direct (health services, pharmacotherapy and counselling programme costs) and indirect costs (associated work leaves and costs). Additionally, this project endeavours to shed light on the neurobiology of suicidal behaviour by exploring the relation between suicide attempts and inflammation parameters. A longitudinal sub-study will be carried out by OSI Araba, in which 20 patients treated with telemedicine, 20 patients with TAU and 20 healthy subjects will undergone a blood-sample extraction for analysis of peripheral inflammatory markers and a clinical assessment. The objective of this sub-study is to analyse the possible influence of telemedicine on the reduction of inflammatory levels and the relation of these biological parameters with clinical outcomes.

Poor adherence is a major problem in patients with manic episodes that impairs functionality and has unknown effects on oxidative stress. The objective of this study was to analyze the relationship between adherence to medication, severity of symptoms and oxidative stress in a sample of patients with a first episode of mania. A longitudinal, 6-month study was performed in 60 patients, who were classified as adherent and non-adherent to medication (mainly antipsychotics). Blood levels of oxidative stress parameters and expression of the antioxidant nuclear transcription factor NRF2 in mononuclear cells of peripheral blood were assessed at baseline and at the end of follow-up. In addition, clinical symptoms and functioning were evaluated. Linear multivariate regression was used to determine the relationship between adherence, oxidative stress, and clinical symptoms. Finally, 44 patients completed follow-up. The results of this study showed that at 6-month follow-up, adherence was significantly associated with better functioning and reduced clinical symptoms. Additionally, more severe symptoms were associated with increased levels of oxidative stress and antioxidant parameters. At study completion, non-adherents exhibited greater levels of antioxidants than adherent patients. In conclusion, poor adherence to medication is associated with a poorer prognosis in the medium term and causes increased antioxidant response.

Introduction: Benzodiazepines and Z drugs (BZD/Z drugs) are commonly used for the treatment of insomnia and anxiety in older adults for long periods of time. Given the physiological and metabolic characteristics of this group of patients, they are more prone to the adverse effects of these drugs which include falls. The recommendations for use of BZD/Z drugs include the need to adjust the dose and select those with a short half-life, to avoid adverse events, which as well as potentially affecting patient outcome, increase healthcare costs. In this study, we have evaluated the hospital-related costs associated with falls in older adults who use BZD/Z drugs at doses higher than recommended for this age group. Methods: We conducted a cross-sectional observational study assessing the BZD/Z drug prescriptions of older adults attending the emergency department after a fall. Cost analysis was performed for cases in which the prescriptions exceeded the maximum recommended dose for this age group. Results: A total of 40.6% of the prescriptions recorded were higher than the defined daily dose in older adults (DDDolderadults). Of the 57 patients who used BZD/Z drugs at higher-than-recommended doses, 53 experienced trauma and 33 required hospitalisation. The costs associated with emergency department services, tests performed and hospitalisation amounted to €1850/patient. Conclusions: Appropriate dosage of BZD/Z drugs in older adults could reduce both patient suffering and costs for the health system.

Objective Despite cautions by professional associations, benzodiazepines (BZD) and Z hypnotics (BZD/Z) are widely prescribed to older adults who are particularly susceptible to insomnia and anxiety, but who are also more sensitive to drugs adverse events. In this study, we assessed the prescription of BZD/Z drugs in a sample of older adults (≥65) who presented for emergency care after a fall. Methods We collected the type, number and dose of BZD/Z drugs prescribed and explored gender differences in the prescription. Results BZD/Z drugs were prescribed to 43.6% of the sample (n = 654) and more frequently to women; 78.4% of prescriptions were for BZD/Z drugs with a short half-life. The majority of patients (83.5%) were prescribed only one type of BZD/Z, but 16.5% had been prescribed multiple BZD/Z drugs, with no gender difference. Doses higher than those recommended for older adults were prescribed to 58% of patients, being the doses significantly higher for men compared to women (70.0% vs 53.1%). Conclusions Over 40% of older adults presenting for emergency care after a fall had previously been prescribed BZD/Z drugs. Some important gender differences in the prescription of BZD/Z drugs were seen, especially prescription above the recommended dose and of drugs with a long-half life.