Browsing by Author "Nachar, Rubén"
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Item Duration of untreated psychosis and acute remission of negative symptoms in a South American first-episode psychosis cohort.(Wiley Publishing Asia Pty Ltd., 2015) González-Valderrama, Alfonso; Castañeda, Carmen Paz; Mena, Cristián; Undurraga, Juan; Mondaca, Pilar; Yáñez, Matías; Bedregal, Paula; Nachar, RubénAIM: To determine the association between duration of untreated psychosis (DUP) and symptoms remission in a hospitalized first-episode psychosis cohort. METHODS: Inpatients with a first-episode non-affective psychosis were recruited. Subjects were divided into two groups of long and short DUP using a 3-month cut-off point, and this was related to remission at 10 weeks of treatment. Multivariate analyses were performed. RESULTS: Fifty-five inpatients were included. There were no differences in remission rates of positive symptoms. Up to 76.5% of the patients with a short DUP (<3 months) achieved remission of negative symptoms versus 31.6% in the DUP ≥ 3 months group (P = 0.003). After controlling for relevant factors, patients with a shorter DUP were still three times more likely to achieve negative symptoms remission (HR: 3.04, 95% CI 1.2-7.5). CONCLUSIONS: DUP is a prognostic factor that should be considered at an early stage to identify a 'high risk' subgroup of persistent negative symptoms.Item High prevalence of metabolic alterations in Latin American patients at initial stages of psychosis(John Wiley & Sons, Inc., 2020) Iruretagoyena, Bárbara; Castañeda, Carmen; Undurraga, Juan; Nachar, Rubén; Mena, Cristian; Gallardo, Carlos; Crossley, Nicolas; Gonzalez-Valderrama, AlfonsoAim Studies conducted in the United States have highlighted a higher prevalence of metabolic alterations (MA) in Latino population and Latino psychotic patients. Metabolic risk in psychosis is known to be present from initial stages of the disease. To better characterize this population, we explored the prevalence of MA and metabolic syndrome (MS) in early psychosis patients in a Latin American country. Methods Transversal, observational study comparing the prevalence of MA and MS in patients with early psychosis from an outpatient program in Chile (n = 148) with a community representative sample from the 2009‐2010 National Health Survey (n = 568). ANOVA and regression analysis were performed obtaining odds ratio for MA and MS. Results The prevalence of MS was 44.7% in patients compared to 11.4% in the community sample (odds ratio [OR] 5.28, confidence interval [CI] 95% 3.07‐9.08; P‐value <0.001). There was no effect of gender. Subgroup analyses showed no significant association of MS with clozapine/olanzapine use, treatment duration or tobacco use. There was an association between treatment duration and hypertriglyceridemia (P = 0.024; OR 1.02, CI 95% 1.00‐1.04) and obesity (P = 0.007; OR 5.93, CI 95% 1.82‐20.22). Clozapine/olanzapine use was associated with hyperglycaemia (P = 0.007; OR 6.04, CI 95% 1.63‐22.38) and high low density lipoprotein (P = 0.033 ANOVA; OR 5.28, CI 95% 1.14‐24.37). Conclusion Latino psychotic patients have a high risk of MA and MS at initial stages of the disease which is not entirely explained by the higher risk in the whole Latino population, is irrespective of gender, and does not seem to be entirely a response to atypical antipsychotic use.Item The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases(2020-08) González-Valderrama, Alfonso; Jongsma, Hannah E.; Mena, Cristián; Castañeda, Carmen Paz; Nachar, Rubén; Undurraga, Juan; Crossley, Nicolás; Aceituno, David; Iruretagoyena, Bárbara; Gallardo, Carlos; Mondaca, Pilar; Monje, Matías; Irarrazaval, Matías; Zavala, Cynthia; Valmaggia, Lucia; Kirkbride, James B.Background. Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. Methods. We used national register data from Chile including all people, 10–65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20– F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. Results. We identified 32358 NAPD cases [12136 (39.5%) women; median age-at-first- contact: 24 years (interquartile range 18–39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7–19.1]. Multilevel Poisson regression identified a strong age–sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0–59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4–30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. Conclusion. Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of asso- ciation with population density suggests this risk may be context-dependent.Item Uso de cannabis en jóvenes hospitalizados por un primer episodio de psicosis: un estudio caso-control(2020) Castañeda, Carmen Paz; Iruretagoyena, Bárbara; Nachar, Rubén; Mancilla, Felipe; Díaz, Camila; Gallardo, Carlos; Mena, Cristián; Ramírez-Mahaluf, Juan Pablo; Undurraga, Juan; González-Valderrama, Alfonso; Crossley, Nicolás A.Background: Cannabis use among young people in Chile has increased significantly in the last years. There is a consistent link between cannabis and psychosis. Aim: To compare cannabis use in patients with a first episode of psychosis and healthy controls. Material and Methods: We included 74 patients aged 20 ± 3 years (78% males) admitted to hospital with a first episode of psychosis and a group of 60 healthy controls aged 23 ± 4 years (63% males). Cannabis consumption was assessed, including age of first time use and length of regular use. Results: Patients with psychosis reported a non-significantly higher frequency of life-time cannabis use. Patients had longer periods of regular cannabis use compared with healthy subjects (Odds ratio [OR] 2.4; 95% confi-dence intervals [CI] 1.14-5.05). Patients also used cannabis for the first time at an earlier age (16 compared with 17 years, p < 0.0). The population attributable fraction for regular cannabis use associated with hospital admissions due to psychosis was 17.7% (95% CI 1.2-45.5%). Conclusions: Cannabis use is related to psychosis in this Chilean group of patients. This relationship is stronger in patients with early exposure to the drug and longer the regular use. One of every five admissions due to psychosis is associated with cannabis consumption. These data should influence cannabis legisla-tion and the public policies currently being discussed in Chile.