Browsing by Author "Vieta, Eduard"
Now showing 1 - 15 of 15
Results Per Page
Sort Options
Item A 12-month prospective study on the time to hospitalization and clinical management of a cohort of bipolar type I and schizoaffective bipolar patients(Elsevier Masson SAS, 2019-09) Murru, Andrea; Verdolini, Norma; Anmella, Gerard; Pacchiarotti, Isabella; Samalin, Ludovic; Aedo, Alberto; Undurraga, Juan; Goikolea, José; Benedikt, Amann; Carvalho, Andre; Vieta, EduardBackground: Schizoaffective disorder, bipolar type (SAD) and bipolar disorder I (BD) present a large clinical overlap. In a 1-year follow-up, we aimed to evaluate days to hospitalization (DTH) and predictors of relapse in a SAD-BD cohort of patients. Methods: A 1-year, prospective, naturalistic cohort study considering DTH as primary outcome and incidence of direct and indirect measures of psychopathological compensation as secondary outcomes. Kaplan-Meyer survival analysis with Log-rank Mantel-Cox test compared BD/SAD subgroups as to DTH. After bivariate analyses, Cox regression was performed to assess covariates possibly associated with DTH in diagnostic subgroups. Results: Of 836 screened patients, 437 were finally included (SAD = 105; BD = 332). Relapse rates in the SAD sample was n = 26 (24.8%) vs. n = 41 (12.3%) in the BD sample (p = 0.002). Mean ± SD DTH were 312.16 ± 10.6 (SAD) vs. 337.62 ± 4.4 (BD) days (p = 0.002). Patients with relapses showed more frequent suicide acts, violent behaviors, and changes in pharmacological treatments (all p < 0.0005) in comparison to patients without relapse. Patients without relapses had significantly higher mean number of treatments at T0 (p = 0.010). Cox regression model relating the association between diagnosis and DTH revealed that BD had higher rates of suicide attempts (HR = 13.0, 95%CI = 4.0-42.0, p < 0.0005), whereas SAD had higher rates of violent behavior during psychotic episodes (HR = 12.0, 95%CI = .3.3-43.5, p > 0.0005). Conclusions: SAD patients relapse earlier with higher hospitalization rates and violent behavior during psychotic episodes whereas bipolar patients have more suicide attempts. Psychiatric/psychological follow-up visits may delay hospitalizations by closely monitoring symptoms of self- and hetero-aggression.Item Clinical characterization of rapid cycling bipolar disorder: Association with attention deficit hyperactivity disorder(Elsevier B.V., 2018) Aedoa, Alberto; Murrub, Andrea; Sanchez, Raúl; Grandeb, Iria; Vieta, Eduard; Undurraga, JuanBackgraund: Rapid cycling (RC) bipolar disorder (BD) is associated with more disability and worse global functioning than non-rapid cycling BD (NRC) and is understudied. This study aims to investigate clinical characteristics associated to RC in a Latin-American sample and secondarily, to generate a clinical model to test the likelihood of RC in BD. Methods: 250 BD patients were enrolled between 2007 and 2015. All patients met DSM-IV criteria for BD type I, II or NOS. The sample was dichotomized into RC and NRC subgroups, and compared in terms of sociodemographic and clinical variables by bivariate analyses. A binary logistic regression was performed to generate a model and explain variance associated with the likelihood of presenting RC. Results: Final sample included 235 patients, of which forty-four (18.7%) met RC criteria. When compared to NRC, a significantly higher proportion of RC patients were female (81.4% vs. 58.9% p = 0.006), BD type II (58.1% vs. 29.7% p = 0.002), presented more manic/hypomanic episodes (43.6 ± 35.8 vs. 12.8 ± 58.9, p = 0.001), and had less psychotic symptoms (20.9% vs. 42.2%, p = 0.010). Attention deficit hyperactivity disorder (ADHD) was a significant comorbidity in RC (23.7% vs. 8.3%, p = 0.007). No differences were found in suicidality, mixed symptoms, and seasonal pattern. After logistic regression, variables significantly associated with RC were presence of ADHD (OR 4.6 [95% CI 1.54-13.93] p = 0.006) and female gender (OR 3.55 [95% CI, 1.32-9.56] p = 0.012). Limitations: It is a cross-sectional study. Conclusions: Findings suggest that ADHD comorbidity, and female gender are risk factors for RC in BD.Publication Clinicians’ preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders around the world: a survey from the ISBD Lithium task force(2023) Hidalgo‑Mazzei, Diego; Mantingh, Tim; Pérez de Mendiola, Xavier; Samalin, Ludovic; Undurraga, Juan; Strejilevich, Sergio; Severus, Emanuel; Bauer, Michael; González-Pinto, Ana; Nolen, Willem A.; Young, Allan H.; Vieta, EduardBackground Lithium has long been considered the gold‑standard pharmacological treatment for the maintenance treatment of bipolar disorders (BD) which is supported by a wide body of evidence. Prior research has shown a steady decline in lithium prescriptions during the last two decades. We aim to identify potential factors explaining this decline across the world with an anonymous worldwide survey developed by the International Society for Bipolar Disorders (ISBD) Task Force “Role of Lithium in Bipolar Disorders” and distributed by diverse academic and professional international channels. Results A total of 886 responses were received of which 606 completed the entire questionnaire while 206 completed it partially. Respondents were from 43 different countries comprising all continents. Lithium was the most preferred treatment option for the maintenance of BD patients (59%). The most relevant clinical circumstances in which lithium was the preferred option were in patients with BD I (53%), a family history of response (18%), and a prior response during acute treatment (17%). In contrast, Lithium was not the preferred option in case of patients´ negative beliefs and/or attitudes towards lithium (13%), acute side‑effects or tolerability problems (10%) and intoxication risk (8%). Clinicians were less likely to prefer lithium as a first option in BD maintenance phase when practising in developing economy countries [X2 (1, N = 430) = 9465, p = 0.002) ] and private sectors [X2 (1, N = 434) = 8191, p = 0.004)]. Conclusions Clinicians’ preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders appear to be affected by both the patients’ beliefs and the professional contexts where clinicians provide their services. More research involving patients is needed for identifying their attitudes toward lithium and factors affecting its use, particularly in developing economies.Item e-HCL-32: a useful, valid and user friendly tool in the screening of bipolar II disorder(Elsevier Inc, 2015) Hidalgo-Mazzei, Diego; Mateu, Ainoa; Undurraga, Juan; Adriane, Rosa; Pacchiarotti, Isabella; Bonnin, Caterina del Mar; Sánchez-Moreno, José; Colom, Francesc; Vieta, EduardBACKGROUND AND OBJECTIVES: Bipolar type II (BDII) is a frequent disorder with high morbidity and mortality, characterized by depressive and hypomanic episodes. Early diagnosis can be effective in improving long-term prognosis. However, diagnosing BDII is challenging due to the difficulty in detecting past hypomanic episodes. The HCL-32 is a widely used and reliable screening instrument for the detection of past hypomanic episodes. Making this tool available to more patients could help diagnose and treat undetected cases of BDII earlier. New technologies such as the Internet have been previously used for this purpose with favorable outcomes. Accordingly, the objective of this study is to evaluate the acceptability, validity, reliability and equivalence of an online version of this questionnaire. METHODS: From May 2012 to March 2013, 52 participants attending an outpatient mental health clinic completed a paper version of the HCL-32 (HCL-32) and its online version (e-HCL-32) within two weeks. After its completion, they were asked to answer a brief satisfaction survey. RESULTS: No differences were found (HCL-32 mean total score=17.73 (SD=7.37), e-HCL-32 mean total score=18.28 (SD=7.09). T=-1.720, p=0.092, 95% CI=-1.21 to 0.09) between the results of the paper and pencil HCL-32 compared to its online version (e-HCL-32). The psychometric properties of the online version of the hypomania checklist (e-HCL-32) were good and comparable to the paper and pencil version. 80% of participants found online questionnaires to be easier to answer and more user-friendly. CONCLUSION: The results of this study support the use of an online screening tool for the detection of previous hypomanic episodes (necessary for BDII diagnosis) as it showed to have a similar validity and reliability to the traditional paper and pencil method.Publication Emotional intelligence: a comparison between patients after first episode mania and those suffering from chronic bipolar disorder type I(2023) Varo, Cristina; Amoretti, Silvia; Sparacino, Giulio; Jiménez, Esther; Solé, Brisa; Bonnin, Caterina Del Mar; Montejo, Laura; Serra, Maria; Torrent, Carla; Salagre, Estela; Benabarre, Antoni; Salgado-Pineda, Pilar; Montoro Salvatierra, Irene; Sáiz, Pilar A.; García-Portilla, María Paz; Sánchez-Gistau, Vanessa; Pomarol-Clotet, Edith; Ramos-Quiroga, Josep Antoni; Pacchiarotti, Isabella; García-Rizo, Clemente; Undurraga, Juan; Reinares, María; Martinez-Aran, Anabel; Vieta, Eduard; Verdolini, NormaBackground Deficits in emotional intelligence (EI) were detected in patients with bipolar disorder (BD), but little is known about whether these deficits are already present in patients after presenting a first episode mania (FEM). We sought (i) to compare EI in patients after a FEM, chronic BD and healthy controls (HC); (ii) to examine the effect exerted on EI by socio-demographic, clinical and neurocognitive variables in FEM patients. Methods The Emotional Intelligence Quotient (EIQ) was calculated with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Performance on MSCEIT was compared among the three groups using generalized linear models. In patients after a FEM, the influence of socio-demographic, clinical and neurocognitive variables on the EIQ was examined using a linear regression model. Results In total, 184 subjects were included (FEM n = 48, euthymic chronic BD type I n = 75, HC n = 61). BD patients performed significantly worse than HC on the EIQ [mean difference (MD) = 10.09, standard error (S.E.) = 3.14, p = 0.004] and on the understanding emotions branch (MD = 7.46, S.E. = 2.53, p = 0.010). FEM patients did not differ from HC and BD on other measures of MSCEIT. In patients after a FEM, EIQ was positively associated with female sex (β = −0.293, p = 0.034) and verbal memory performance (β = 0.374, p = 0.008). FEM patients performed worse than HC but better than BD on few neurocognitive domains. Conclusions Patients after a FEM showed preserved EI, while patients in later stages of BD presented lower EIQ, suggesting that impairments in EI might result from the burden of disease and neurocognitive decline, associated with the chronicity of the illness.Item Los costos y consumo de recursos sanitarios asociados a episodios maníacos en la práctica clínica diaria: el estudio MANACOR(SEP y SEPB. Published by Elsevier España., 2015) Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnin, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduardntroducción El Trastorno Bipolar (TB) es una enfermedad con frecuentes recaídas y remisiones que afecta a aproximadamente el 1 al 2% de la población mundial. Aún con la eficacia de los tratamientos disponibles actualmente, las recaídas son frecuentes. Por tanto, el costo y consumo de recursos asociados a cada nuevo episodio tienen un impacto importante en el sistema sanitario. El principal objetivo de este estudio fue el de estimar los costos directos y recursos sanitarios empleados durante el tratamiento de episodios maníacos en la práctica clínica diaria, teniendo en cuenta además variables clínicas. Métodos Fueron incluidos de manera consecutiva pacientes quiénes hayan presentado recientemente un episodio maníaco agudo según los criterios del DSM-IV. Se recogieron de manera retrospectiva variables sociodemográficas y durante los siguientes 6 meses se realizaron evaluaciones clínicas sistemáticas que incluían YMRS,HDRS-17,FAST and CGI-BP-M. El consumo de recursos sanitarios y los costos asociados fueron estimados a partir de los días de hospitalización, el tratamiento farmacológico, las visitas a urgencias y ambulatorias. Resultados Se incluyeron 169 pacientes de 4 hospitales universitarios de Cataluña, España. El costo directo medio de cada episodio maníaco fue de €4771. De estos, 77% (€3651) correspondía a los costos de hospitalización, 14% (€684) al tratamiento farmacológico, 8% (€386) a las visitas ambulatorias y solo 1% (€50) a visitas en urgencias. Los días de hospitalización fueron el mayor componente del costo total. Un puntaje inicial de FAST >41 predijo de forma significativa un mayor costo directo. Conclusiones Nuestros resultados demuestran el elevado costo y consumo de recursos sanitarios asociados al TB y reflejan la necesidad de diseñar más y mejores estrategias costo-efectivas en el manejo y prevención de episodios maníacos a fin de evitar ingresos hospitalarios. Un peor estado funcional basal es predictivo de mayores costos, indicando la importancia de realizar una evaluación funcional en el TB de manera sistemática.Item Making sense of DSM-5 mania with depressive features(The Royal Australian and New Zealand College of Psychiatrists, 2015) Reinares, María; Bonnin, Caterina del Mar; Hidalgo-Mazzei, Diego; Undurraga, Juan; Mur, María; Nieto, Evaristo; Sáez, Cristina; Vieta, EduardOBJECTIVE: The assessment of the depressive component during mania has become critical for the accurate diagnosis of mixed states, which were defined very narrowly in the past classification systems before Diagnostic and Statistical Manual of Mental Disorders (5th ed.). The aim of this study was to compare socio-demographic, clinical and therapeutic characteristics, as well as clinical and functional outcomes, between manic patients with and without mixed features to validate the relevance of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) mixed specifier. METHODS: This is a subanalysis of a multicentre naturalistic study MANía Aguda y COnsumo de Recursos (acute mania and health resource consumption [MANACOR]) on the burden of mania in bipolar patients from four hospitals in Catalonia (Spain). The sample consisted of 169 adult patients presenting a manic episode and systematically assessed during a 6-month period. RESULTS: A total of 27% (n = 46/169) of manic patients showed mixed features. Total number of episodes (p = 0.027), particularly depressive and mixed, was greater in manic patients with mixed features, as well as depressive onset (p = 0.018), suicide ideation (p = 0.036), rapid cycling (p = 0.035) and personality disorders (p = 0.071). In contrast, a higher percentage of pure manic subjects were inpatients (p = 0.035), started the illness with mania (p = 0.018) and showed family history of bipolar disorder (p = 0.037), congruent psychotic symptoms (p = 0.001) and cannabis use (p = 0.006). At baseline, pure manic patients received more risperidone (p = 0.028), while mixed patients received more valproate (p = 0.049) and antidepressants (p = 0.005). No differences were found in syndromic recovery at the end of the study. However, depressive change was higher in the mixed group (p = 0.010), while manic change was higher in the pure manic group (p = 0.029). At the end of follow-up, the group with mixed features showed a significant trend towards higher psychosocial dysfunction. CONCLUSION: A total of 27% of manic patients showed mixed features. Groups differed regarding clinical characteristics, course of illness, psychosocial functioning, prescribed treatment and symptom progress. Depressive symptoms in mania should be routinely assessed and considered to guide treatment.Item One-year course of illness and clinical management in a cohort of patients affected with schizoaffective and bipolar disorders.(2017) Murru, Andrea; Verdolini, Norma; Anmella, Gerard; Pacchiarotti, Isabella; Samalin, Ludovic; Undurraga, Juan; Guiso, Giovanni; Goikolea, Jose Manuel; Vieta, EduardSchizoaffective bipolar disorder (SAD) is a pleomorphic, severe, chronic condition which diagnostic definition lacks of solid and reliable diagnostic criteria in international diagnostic manuals [1]. Its clinical management often relies on indirect evidence derived from schizophrenia or bipolar disorder (BD)[2,3].Item Predictors of functional outcome after a manic episode(Elsevier B.V, 2015) Bonnin, Caterina del Mar; Reinares, María; Hidalgo-Mazzei, Diego; Undurraga, Juan; Mur, María; Sáez, Cristina; Nieto, Evaristo; Vázquez, Gustavo; Balanzá-Martínez, Vicent; Tabarés-Seisdedos, Rafael; Vieta, EduardThe identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. METHODS: We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. RESULTS: Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. LIMITATIONS: The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. CONCLUSIONS: Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.Publication Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood(2022) Verdolini, Norma; Borràs, Roger; Sparacino, Giulio; Garriga, Marina; Sagué, Maria; Madero, Santiago; Palacios, Roberto; Serra, Maria; Florencia, Maria; Salagre, Estela; Aedo, Alberto; Salgado, Pilar; Montoro, Irene; Sánchez, Vanessa; Pomarol, Edith; Ramos, Josep; Carvalho, Andre; Garcia, Clemente; Undurraga, Juan; Reinares, María; Martinez, Anabel; Bernardo, Miguel; Vieta, Eduard; Pacchiarotti, Isabella; Amoretti, SilviaObjective: This study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies. Methods: Patients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Chi-squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models. Results: The total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal-directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM. Conclusion: Early characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.Item Psychoeducation in bipolar disorder with a SIMPLe smartphone application: feasibility, acceptability and satisfaction(Elsevier, 2016) Hidalgo-Mazzei, Diego; Mateu, Ainoa; Reinares, María; Murru, Andrea; del Mar Bonnin, Caterina; Varo, Cristina; Valenti, Marc; Undurraga, Juan; Strejilevich, Sergio; Sanchez-Moreno, Jose; Vieta, Eduard; Colom, FrancescBACKGROUND: During the last fifteen years, the possibility of delivering psychoeducation programs through Internet-based platforms have been explored. Studies evaluating those programs have shown good to acceptable retention rates. In this context, we developed a smartphone application (SIMPLe) collecting information about mood symptoms and offering personalized psychoeducation messages. The main aims of this study were to evaluate the feasibility, acceptability and satisfaction of the smartphone application. METHODS: The study was conducted from March to August 2015. Participation in the study was proposed to a consecutive sample of adult patients attending an outpatient mental health clinic. Sociodemographic data, clinical and functional assessments alongside smartphone ownership and uses were collected at baseline and at 3 months' follow-up. A 5 item Likert-scale satisfaction questionnaire was also employed. RESULTS: 51 participants were initially enrolled in the study, 36 (74%) remained actively using the application after 3 months. The whole sample interacted with the application a mean of 77 days (SD=26.2). During these days they completed 88% of the daily tests. Over 86% of the participants agreed that the experience using the application was satisfactory. LIMITATIONS: The diversity of smartphones operating systems led to a moderate, although representative, sample number. Additionally, the subjective data reporting, narrow time frame of use and stability of the patients could have affected the results. CONCLUSIONS: The results confirm that this particular intervention is feasible and represent a satisfactory and acceptable instrument for the self-management of bipolar disorder as an add-on to the usual treatment but future clinical trials must still probe its efficacy.Item Risk factors for rapid cycling in bipolar disorder.(John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., 2015) Valenti, Marc; Pacchiarotti, Isabella; Undurraga, Juan; Bonnin, Caterina del Mar; Popovic, Dina; Goikolea, José; Torrent, Carla; Hidalgo-Mazzei, Diego; Colom, Francesc; Vieta, EduardThe aim of this study was to investigate the clinical factors associated with the development of rapid cycling, as well as to elucidate the role of antidepressants. METHODS: The present study (NCT01503489) is a prospective, naturalistic cohort study conducted in a sample of 289 patients diagnosed with bipolar disorder followed and treated for up to 14 years. The patients were divided into two groups on the basis of the development of a rapid cycling course (n = 48) or no development of such a course (n = 241), and compared regarding sociodemographic, clinical, and outcome variables. RESULTS: Among the 289 patients, 48 (16.6%) developed a rapid cycling course during the follow-up. Several differences were found between the two groups, but after performing Cox regression analysis, only atypical depressive symptoms (p = 0.001), age at onset (p = 0.015), and number of suicide attempts (p = 0.030) persisted as significantly associated with the development of a rapid cycling course. CONCLUSIONS: The development of rapid cycling during the course of bipolar disorder is associated with a tendency to chronicity, with a poorer outcome, and with atypical depressive symptomatology. Our study also suggests that the development of rapid cycling is associated with a higher use of antidepressants.Item Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review(Dove Press Limited, 2017) Solmi, Marco; Murru, Andrea; Pacchiarotti, Isabella; Undurraga, Juan; Veronese, Nicola; Fornaro, Michele; Stubbs, Brendon; Monaco, Francesco; Vieta, Eduard; Seeman, Mary; Correll, Christoph; Carvalho, AndréSince the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients - psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the "behavioral toxicity" conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis.Item Self-monitoring and psychoeducation in bipolar patients with a smart-phone application (SIMPLe) project: design, development and studies protocols(BioMed Central Ltd., 2015) Hidalgo-Mazzei, Diego; Mateu, Ainoa; Reinares, María; Undurraga, Juan; Bonnin, Caterina del Mar; Sánchez-Moreno, José; Vieta, Eduard; Colom, FrancescBACKGROUND: New technologies have recently been used for monitoring signs and symptoms of mental health illnesses and particularly have been tested to improve the outcomes in bipolar disorders. Web-based psychoeducational programs for bipolar disorders have also been implemented, yet to our knowledge, none of them have integrated both approaches in one single intervention. The aim of this project is to develop and validate a smartphone application to monitor symptoms and signs and empower the self-management of bipolar disorder, offering customized embedded psychoeducation contents, in order to identify early symptoms and prevent relapses and hospitalizations. METHODS/DESIGN: The project will be carried out in three complementary phases, which will include a feasibility study (first phase), a qualitative study (second phase) and a randomized controlled trial (third phase) comparing the smartphone application (SIMPLe) on top of treatment as usual with treatment as usual alone. During the first phase, feasibility and satisfaction will be assessed with the application usage log data and with an electronic survey. Focus groups will be conducted and technical improvements will be incorporated at the second phase. Finally, at the third phase, survival analysis with multivariate data analysis will be performed and relationships between socio-demographic, clinical variables and assessments scores with relapses in each group will be explored. DISCUSSION: This project could result in a highly available, user-friendly and not costly monitoring and psychoeducational intervention that could improve the outcome of people suffering from bipolar disorders in a practical and secure way.Publication Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis(2022) Sagué, Maria; Amoretti, Silvia; Garriga, Marina; Mezquida, Gisela; Williams, Evelyn; Serra, Maria; Forte, Maria; Varo, Cristina; Montejo, Laura; Palacios, Roberto; Madero, Santiago; Sparacino, Giulio; Anmella, Gerard; Fico, Giovanna; Giménez, Anna; Pons, Maria; Salgado, Pilar; Montoro, Irene; Sánchez, Vanessa; Pomarol, Edith; Ramos, Josep; Undurraga, Juan; Reinares, María; Martínez, Anabel; Pacchiarotti, Isabella; Valli, Isabel; Bernardo, Miguel; García, Clemente; Vieta, Eduard; Verdolini, NormaObstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.