https://hdl.handle.net/10481/31063 Sat, 11 Apr 2026 06:18:21 GMT 2026-04-11T06:18:21Z https://hdl.handle.net/10481/111993 Understanding Adherence to Duloxetine in Psychiatric Practice: A Cross-Sectional Evaluation of Clinicians’ Experience García-Montero, Cielo; Fraile-Martínez, Óscar; Chart Pascual, Juan Pablo; Gutiérrez Rojas, Luis; Álvarez-Mon, Miguel Ángel; Álvarez-Mon, Melchor; Ortega, Miguel Ángel Objectives: The present study aimed to explore psychiatrists’ perceptions of duloxetine in routine clinical practice, focusing on its efficacy, tolerability, and treatment adherence in major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: A structured questionnaire was administered to 97 psychiatrists from different regions of Spain. The survey covered demographic and professional data, prescription frequency, perceived clinical efficacy, tolerability, dosing patterns, and factors influencing adherence. Results: Overall, duloxetine was perceived as an effective treatment for both MDD and GAD, particularly in patients with somatic symptoms or comorbid anxiety. Tolerability was also positively rated, with nausea and fatigue identified as the adverse effects most commonly associated with reduced adherence. In addition, patient education and close follow-up were identified as the most effective strategies to improve adherence, whereas digital tools were considered promising but underused. Compared with other antidepressants, duloxetine was viewed as having a favorable balance between efficacy and tolerability, with similar or slightly higher adherence rates. Conclusions: These findings reflect a positive clinical appraisal of duloxetine among psychiatrists, highlighting its role as a versatile therapeutic option for affective and anxiety disorders, within the context of routine clinical practice in Spain, provided that appropriate adherence-support strategies are implemented. https://hdl.handle.net/10481/111993 https://hdl.handle.net/10481/111806 Prognostic Biomarkers and Precision Psychiatry: A Review of the Available Evidence Béjar Botello, Itziar María; Jiménez-Fernández, Sara; Pérez Guerrero, Gloria; Iglesias Rosado, Blanca; Gutiérrez Rojas, Luis; Herrera Imbroda, Jesús; García Romera, Inmaculada Precision psychiatry aims to overcome clinical heterogeneity by means of biomarkers that allow predicting the clinical evolution and therapeutic response in psychiatric disorders. This literature review addresses its prognostic role and its potential integration into healthcare practice. The main objective was to compile and synthesize current evidence on prognostic biomarkers in psychiatry, evaluating their usefulness in anticipating clinical evolution, therapeutic response, and risk of relapse. A strategic search was carried out on PubMed, selecting original studies that evaluated blood, genetic, epigenetic, neuroimaging, or electrophysiological biomarkers with prognostic value. We included 30 final studies that met the established inclusion and exclusion criteria and were evaluated according to standardized scales (RoB 2, NOS, AXIS). Inflammatory biomarkers showed potential as clinical modulators. Metabolomic, neuroendocrine, and neurotrophic factors reflected specific biological profiles associated with response to treatment or risk of relapse. Functional connectivity and brain morphometry were useful in the therapeutic prediction and stratification of patients. Finally, genetics and epigenetics are consolidated as tools of sensitivity and pharmacological response. Taken together, the findings reveal specific prognostic utility based on the type of biomarker and the patient’s clinical context. Despite the current methodological limitations and scarce replication of studies, prognostic biomarkers represent a step towards a more personalized psychiatry based on biological mechanisms. The future integration of multimodal models will improve clinical decision-making. https://hdl.handle.net/10481/111806 https://hdl.handle.net/10481/110415 Impact of 3-Monthly Long-Acting Injectable Paliperidone Palmitate in Schizophrenia: A Retrospective, Real-World Analysis of Population-Based Health Records in Spain. Gutiérrez Rojas, Luis; Sánchez-Alonso, Sergio; García Dorado, Marta; López Rengel, Paola M. Background: Treatment of schizophrenia requires long-term medication to prevent relapse. Treatment nonadherence may increase the risk of relapse, leading to increased hospitalizations and emergency room (ER) visits. Long-acting injectables (LAIs) such as paliperidone palmitate have improved treatment adherence and therefore symptoms. However, real-world studies comparing 3-monthly LAI formulations with other LAIs and oral antipsychotics (OAs) are scarce. Objective: The objective of this study was to investigate and evaluate the clinical effectiveness of paliperidone palmitate LAI monthly (PP1M; Xeplion®) and 3-monthly (PP3M; Trevicta®) formulations compared with the monthly LAI aripiprazole (AM; Abilify Maintena®) and OAs in Spain. Methods: This was a retrospective, observational study including 2275 adult patients with schizophrenia in a Spanish population. Data from hospital, primary care, and pharmacy dispensation electronic medical records were obtained between January 2017 and February 2018. The main outcomes included psychiatric hospitalizations and ER visit rates, days on treatment, and treatment persistence. Results: Patients receiving PP3M had a significantly lower mean hospitalization rate (0.00046 ± standard deviation [SD] 0.00181; p < 0.0001) than other treatment groups. Kaplan-Meier curves revealed that 92.0 and 88.4% of patients receiving PP3M remained hospitalization free by 12 and 18 months, respectively. All treatment groups had at least a twofold significantly higher risk of psychiatric hospitalizations compared with those receiving PP3M or OAs, and the hospitalization risk among the PP3M group was significantly lower (hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.31-0.67). The risk of ER visits was significantly lower with both PP3M and PP1M than with OAs, and lowest with PP3M (HR 0.462 [95% CI 0.29-0.62] and HR 0.833 [95% CI 0.59-0.97], respectively). Time until treatment switch with PP3M was high, with more than 86.5% of patients remaining on treatment at 18 months. Conclusions: PP3M was more effective than OAs and monthly LAIs in improving clinical outcomes for patients with schizophrenia in a real-world setting in Spain. https://hdl.handle.net/10481/110415 https://hdl.handle.net/10481/110414 Prader-Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication González Domenech, Pablo José; Gurpegui Fernández De Legaria, Manuel; González-Domenech, Carmen M.; Gómez-González, S.; Rustarazo, A.; Ruiz-Nieto, V.; Carretero Alférez, María Dolores; Gutiérrez Rojas, Luis Background: Prader-Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross-sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. Methods: Participants were recruited among all members of the Spanish Prader-Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. Results: The cohort included 177 participants (aged 6-48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only-child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. Conclusions: Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long-term application of GH therapy and the rational use of psychotropic medication. https://hdl.handle.net/10481/110414 https://hdl.handle.net/10481/110404 Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis Cruz, Sheila; Gutiérrez Rojas, Luis; González Domenech, Pablo José; Díaz Atienza, Francisco; Martínez Ortega, José María; Jiménez-Fernández, Sara The aim of this work is to investigate the effectiveness of Deep Brain Stimulation (DBS) in patients with severe Obsessive Compulsive Disorder (OCD) who are resistant to pharmacological treatments, focusing on obsessive compulsive, depressive and anxiety symptoms as well as global function. A systematic review and meta-analysis including 25 studies (without language restrictions) from between 2003 and 2020 was performed. A total of 303 patients were evaluated twice (before and after DBS). After DBS treatment OCD patients with resistance to pharmacological treatments showed a significant improvement of obsessive-compulsive symptoms (25 studies; SMD=2.39; 95% CI, 1.91 to 2.87; P<0.0001), depression (9 studies; SMD= 1.19; 95%CI, 0.84 to 1.54; P<0.0001), anxiety (5 studies; SMD=1.00; 95%CI, 0.32 to 1.69; P=0.004) and functionality (7 studies; SMD=-3.51; 95%CI, -5.00 to -2.02; P=0.005) measured by the standardized scales: Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Global Assessment of Function (GAF). Publication bias were discarded by using funnel plot. The main conclusions of this meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms. https://hdl.handle.net/10481/110404