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PURPOSE: To analyse concordance between treatment prescribed before and after the first mental health consultation. We understand concordance in two different senses: first, as a similar amount of equivalent doses and drug type; second, as a similar treatment for each patient. METHOD: This is an analytical, descriptive, retrospective study on psychopharmacological treatment before and after first mental health consultation of 1236 patients. Drugs were classified into four groups and the equivalent dose respect to reference medication was considered in each group in order to make a comparison between primary and mental health. RESULTS: Moderate concordance was found in prescribed treatments before and after first mental health consultation (except antidepressants). The average number of benzodiazepines decreased, as did average doses prescribed at mental health consultation respect to previously prescribed treatment; average doses of antidepressants, however, increased. From the patient's perspective, dose increase was more frequent than decrease. Nevertheless, a high percentage of polymedicated patients were found, although this percentage decreased after the first mental health consultation. CONCLUSION: There exists a moderate concordance between the pharmacological treatment prescribed before and after the first mental health consultation. However, the use of benzodiazepines diminished significantly after the first consultation, mainly due to a decrease in the percentage of polymedicated patients.

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The economic recession that recently affected most European countries has led to a worsening of the mental health situation in the general population and an associated rise in outpatient psychiatric care. The aim of this study was to analyse the socio-demographic, clinical and assistential features of the demand for specialist mental health attention. A descriptive and analytical study was conducted in the period 2011-2015 (N = 1252). The principal relations among variables were analysed by an χ2 test, followed by a Z test with Bonferroni's correction. For a global perspective a Multiple Correspondence Analysis was performed. 2 The most frequent disorders were adjustment, anxiety and mood disorders, and in addition there were a large number of patients without diagnosis. The percentage of unemployed or inactive patients was high, as it was for those with a low academic level. The younger patients were more prone to have adjustment disorders, especially among the unemployed ones, while anxiety disorders were more frequent in the patients with jobs. A close association seems to exist between unemployment, low academic level and mental health problems. The high demand for mental health attention reveals a clear need to optimize the utilization of specialized care in mental health.

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PURPOSE: CYP2C8 seems to be involved in diclofenac 5-hydroxylation, while, in vitro, the 4'-hydroxylation and 3'-hydroxylation seem to be mediated mainly by CYP2C9. We have demonstrated the relevance of CYP2C9 genotypes for diclofenac 4'-hydroxylation in healthy volunteers, so that the present study was aimed at analyzing the role of both CYP2C8 and CYP2C9 genotypes on diclofenac metabolism, as well as determining the CYP2C8 allele frequencies and their relationship with CYP2C9 variants. METHODS: A group of 142 healthy white Spanish volunteers was studied. Previously, 102 of these subjects had been phenotyped with diclofenac and genotyped for CYP2C9. The CYP2C8 genotypes were determined by allele-specific PCR-RFLP methods. The urinary concentrations of diclofenac and its main metabolites were analysed using an HPLC-UV method after the administration of a single oral dose of diclofenac as described previously for part of the population studied here. RESULTS: The diclofenac/5-hydroxydiclofenac urinary concentration ratio was higher in individuals carrying a CYP2C8*3 or CYP2C8*4 allele than in those homozygous for wild-type allele CYP2C8*1 (P < 0.05). Moreover, approximately 93% of the subjects with a CYP2C8*3 allele also carried a CYP2C9*2, and 80% of the subjects that had CYP2C9*2 variant also carried a CYP2C8*3. In addition, the four CYP2C9*2/*2 individuals were CYP2C8*3/*3. CONCLUSIONS: This is the first study showing the influence of CYP2C8 genotypes on diclofenac metabolism in vivo. The linkage disequilibrium between CYP2C8*3 and CYP2C9*2 alleles was confirmed in this Spanish population.

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Los leiomiomas son tumores benignos raros que se originan desde el músculo erector de los folículos pilosos, en el escroto, en la zona genital y en los vasos sanguíneos. Se desarrollan en las zonas donde existe tejido muscular liso. Por ello, tienden a ser bastante frecuentes en los tractos gastrointestinal y genitourinario, algo menos frecuentes en la piel y raros en el tejido blando profundo. En general, los leiomiomas del tejido blando causan poca morbilidad y por ello existen pocos trabajos en la literatura concernientes a su presentación, diagnóstico y tratamiento. Presentamos el caso de un leiomioma de localización atípica (facial) que remite con tratamiento oral con doxazosina. Sólo hay descritos en la bibliografía cuatro casos a nivel mundial con este tratamiento

Leiomyomas are uncommon benign tumors that arisefrom the erector pili muscle of hair follicles, in the scrotum, in the genital zone and in the blood glasses. They develop in zones where there is smooth muscle tissue. Thus, they tend to be quite frequent in the gastrointestinal and genitourinary tracts, and somewhat less frequent in the skin and rare in the deep soft tissue. In general, soft tissue leiomyomas cause little morbidity and thus few works have been published in the literature regarding its presentation, diagnosis and treatment. We present the case of an atypical presentation site of leiomyoma, that is facial, that abated with oral treatment with doxazosine. Only four cases worldwide with this treatment have been described

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La fiebre es un motivo frecuente en las consultas de Atención Primaria que plantea un amplio diagnóstico diferencial, la mayoría de las veces debida a procesos víricos o bacterianos autolimitados y de corta duración, pero también puede ser la expresión de procesos más graves que pueden poner en peligro la vida del paciente. Un estudio protocolizado y racional desde la consulta puede ahorrar pruebas complementarias costosas, innecesarias e incluso ingresos hospitalarios. La mayoría de los protocolos consultados recomiendan la secuencia de estudios que exponemos en el protocolo recogido en la figura 1

Fever is a frequent reason for consultation in Primary Health Care that entails a wide range of differential diagnoses, most of the times due to self-limited viral or bacterial conditions of short duration. However, it may also be the expression of more serious life-threatening conditions. A protocolize and rational study made from the consultation may avoid expensive and unnecessary complementary studies and even hospital admissions. Most of the protocols consulted recommend a sequence of studies

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In the present study, we aimed to analyze the potential relevance of the polymorphism in the promoter region of the serotonin transporter (SERT or 5-HTT) gene (5-HTTLPR) and the risk of suffering major depression (MDD) in a population of patients previously genotyped for CYP2C9. Seventy white European psychiatric outpatients suffering from MDD and a group of 142 healthy volunteers (HVs) were studied. The frequency of subjects carrying the 5-HTTLPR-S allele was higher (P < 0.05) among MDD than in HV. The odds ratio associated with 5-HTTLPR-S allele was 2.03 for the MDD patients in comparison with the HV group. Previously, we found in this population that the CYP2C9*3 allele frequency was higher among this population of MDD patients than in HV. The frequency of subjects with the combination 5-HTTLPR-S and CYP2C9*3 alleles was higher (P < 0.01, odds ratio 3.47) in MDD than in HV. The present findings provide preliminary evidence about the greater risk of suffering MDD for individuals carrying both 5-HTTLPR-S and CYP2C9*3 alleles.

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CYP2D6 has been suggested to be functionally similar to the dopamine transporter. The present study was aimed at analysing the frequency of CYP2D6 alleles and genotype among schizophrenic patients compared to healthy volunteers. CYP2D6 *3, *4, *5, *6, *10 and duplicated alleles were analysed in 128 unselected schizophrenia inpatients (SP) and 142 unrelated white European Spanish healthy volunteers (HV). SP and HV with >2, 2, 1 or 0 CYP2D6 active genes were 4.7, 64.8, 28.1 and 2.3%, and 6.3, 52.1, 33.1 and 8.5%, respectively. The frequency of homozygous for CYP2D6 inactive alleles or poor metabolizers (PMs) was lower (P<0.05) in SP than in HV. Furthermore, the frequency of CYP2D6 inactive alleles was also lower in SP than in HV (16.8 vs 25.7; P<0.05), specifically the CYP2D6*6 allele was not found among patients. The present study shows a lower frequency of PMs in schizophrenic patients than in healthy volunteers supporting the hypothesis of a potential role of CYP2D6 in the vulnerability to schizophrenia.

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CYP2D6 is described as the most relevant enzyme in the metabolism of many antipsychotic drugs. Its contribution to the interindividual differences in drug response is reviewed here highlighting its role in the kinetics of antipsychotic drugs and the occurrence of drug interactions. The activity of CYP2D6 is inherited as a monogenetic trait and the CYP2D6 gene appears highly polymorphic in humans. The polymorphic alleles may lead to altered activity of the CYP enzymes causing absent, decreased (poor), or increased (ultrarapid) metabolism that in turn influence the disposition of the antipsychotic drugs. Antipsychotic drug biotransformation is mainly determined by genetic factors mediating CYP2D6 gene polymorphism, however the importance of environmental factors (dietary, smoking, diseases, etc.) is also recognized. Additionally, the potential interaction between CYP2D6 and the endogenous metabolism must be taken into consideration. The present review summarizes the relevance of physiological and environmental factors in CYP2D6 hydroxylation capacity, the inhibition of CYP2D6 activity during treatment, the use of drug/metabolite ratio as a tool to evaluate CYP2D6 hydroxylation capacity in a patient, and the relevance of CYP2D6 for drug plasma concentration and for QTc interval lengthening during treatment with antipsychotic drugs.

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In the recent years it has been increasingly recognized that pharmacogenetical factors play an important role in the drug treatment. These factors may influence the appearance of side-effects and drug interactions due to interindividual differences in the activity of metabolizing enzymes. Risperidone in humans is mainly metabolized to 9-hydroxyrisperidone by the polymorphic cytochrome enzyme P450 2D6 (CYP2D6). Plasma concentrations of risperidone and 9-hydroxyrisperidone show large interindividual variability, which may be partly related to the activity of the CYP2D6 enzyme. Around seven percent of Caucasians have a genetically inherited impaired activity of the CYP2D6 enzyme. Debrisoquine metabolic ratio (a marker of CYP2D6 activity) and the number of CYP2D6 active genes have been related to risperidone plasma concentrations among patients during steady-state conditions. A large number drugs have been described to be metabolized by CYP2D6, and it is therefore important to evaluate the clinical significance of the impaired metabolism and possible drug interactions on the enzyme. Since risperidone/9-hydroxyrisperidone ratio strongly correlates with CYP2D6 enzyme activity and the number of CYP2D6 active genes, thus it might be a useful tool in clinical practice to estimate the possible risk of drug interactions due to impaired CYP2D6 enzyme activity. CYP3A4 is the most abundant drug metabolizing enzyme in humans, and in vitro and in vivo results suggest also a role for the enzyme in risperidone metabolism. The consideration of the implication of cytochrome P450 enzymes in risperidone metabolism may help to individualize dose schemes in order to avoid interactions and potentially dangerous side-effects, such us QTc interval lengthening among patients with cardiac risk factors.

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The authors analyze the most important aspects one should bear in mind regarding medication in elderly patients. The authors study the pharmaco-kinetic and pharmaco-dynamic changes which occur with aging and how these influence variations in therapeutic responses and their most frequent adverse reactions among the elderly. The authors conclude that it is necessary to draw up individualized therapeutic plans for these patients. The authors also analyze the general recommendations made for administering and prescribing medications for the elderly. Considering that the administration of medication and the evaluation of adverse reactions are some of the most important responsibilities nurses have, the authors recommend specific programs be drawn up to evaluate the efficiency-risk binomial and to keep a close watch on adverse reactions in these patients.

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