The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo-controlled trials are warranted to assess how far this reflects a specific pharmacological effect.

Dual están relacionados por orden alfabético en el Anexo. IntroducciónD esde hace años ha tenido lugar un aumento significativo en la prevalencia de los diagnós-ticos psiquiátricos asociados o diagnósticos de comorbilidad. En la literatura científica se ha prestado especial atención a la asociación entre los trastornos del estado de ánimo y los trastornos de ansiedad, entre diversos diagnósticos psiquiátricos, y los trastornos relacionados con el consumo de sustancias, y entre los distintos diagnósticos del eje II, por señalar sólo algunos ejemplos de comorbilidad.En este editorial se avanza el futuro contenido de la Guía de Práctica Clínica para el Tratamiento de la Patología Dual. Entendiendo la patología dual como la coexistencia de un trastorno por uso de sustancias (TUS) psicoactivas con otros diagnósticos psiquiátricos, que más comúnmente se conoce como «diagnóstico dual o patología dual». Sin embargo, este término ha adquirido múlti-ples connotaciones, pudiendo significar en su sentido más puro que ambos diagnósticos son independientes y ocurren de forma simultánea (Lehman et al., 1989), y también que el síndrome psiquiátrico puede haber sido inducido por sustancias o que el TUS es secundario a un trastorno psiquiátrico (Sáiz Martínez et al., 2014).Existe un creciente interés por el estudio de las manifestaciones psicopatológicas coexistentes con el consumo de sustancias psicoactivas, posiblemente debido a la alta prevalencia con que aparecen en la población general y en muestras de pacientes, así como a la influencia que pueden ejercer en la evolución y el pronóstico, tanto del trastorno adictivo como del trastorno mental, y a las pocas evidencias que existen en el campo de tratamiento farmacológico y/o psicológico de esta prevalente patología (Lingford-Hughes et al., 2012). En la actualidad existe un mayor conocimiento de los efectos de las drogas en el curso de los trastornos psiquiátricos, y viceversa, a su vez la comorbilidad se ha asociado a un peor cumplimiento y resistencia al tratamiento tanto farmacológico como psicosocial, siendo recomendables los programas de tratamiento en que se integren servicios tanto para la patología mental como la toxicológica (San, 2004). Principios del tratamientoLos conocimientos sobre el tratamiento de los pacientes con patología dual están aumentando progresivamente, pero la práctica actual requiere experiencia, conocimientos y abordajes innovadores para el manejo de los complejos problemas diagnósticos y terapéuticos de estos pacientes. Sin embargo, tal como se evidencia a nivel clínico, este abordaje integrado puede ser muy eficaz en muchos pacientes con patología dual.A pesar de la frecuencia con que concurren los trastornos por uso de sustancias y otros trastornos mentales, los pacientes que presentan ambos trastornos tienden a ser

Objective: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. Design: Observational study with a 6-month follow-up. Method: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. Results: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. Conclusions: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.

The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.

Cannabis use disorder is frequent in schizophrenia patients, and it is associated with an earlier age of onset and poor schizophrenia prognosis. Serotonin 2A receptors (5‐HT2AR) have been involved in psychosis and, like Akt kinase, are known to be modulated by THC. Likewise, endocannabinoid system dysregulation has been suggested in schizophrenia. The presence of these molecules in blood makes them interesting targets, as they can be evaluated in patients by a minimally invasive technique. The aim of the present study was to evaluate 5‐HT2AR protein expression and the Akt functional status in platelet homogenates of subjects diagnosed with schizophrenia, cannabis use disorder, or both conditions, compared with age‐ and sex‐matched control subjects. Additionally, endocannabinoids and pro‐inflammatory interleukin‐6 (IL‐6) levels were also measured in the plasma of these subjects. Results showed that both platelet 5‐HT2AR and the active phospho (Ser473)Akt protein expression were significantly increased in schizophrenia subjects, whereas patients with a dual diagnosis of schizophrenia and cannabis use disorder did not show significant changes. Similarly, plasma concentrations of anandamide and other lipid mediators such as PEA and DEA, as well as the pro‐inflammatory IL‐6, were significantly increased in schizophrenia, but not in dual subjects. Results demonstrate that schizophrenia subjects show different circulating markers pattern depending on the associated diagnosis of cannabis use disorder, supporting the hypothesis that there could be different underlying mechanisms that may explain clinical differences among these groups. Moreover, they provide the first preliminary evidence of peripherally measurable molecules of interest for bigger prospective studies in these subpopulations.