There is increasing amount of evidence pointing toward a high prevalence of psychiatric conditions among individuals with hypermobile type of Ehlers–Danlos syndrome (JHS/hEDS). A literature review confirms a strong association between anxiety disorders and JHSh/hEDS, and there is also limited but growing evidence that JHSh/hEDS is also associated with depression, eating, and neuro‐developmental disorders as well as alcohol and tobacco misuse. The underlying mechanisms behind this association include genetic risks, autonomic nervous system dysfunction, increased exteroceptive and interoceptive mechanisms and decreased proprioception. Recent neuroimaging studies have also shown an increase response in emotion processing brain areas which could explain the high affective reactivity seen in JHS/hEDS. Management of these patients should include psychiatric and psychological approaches, not only to relieve the clinical conditions but also to improve abilities to cope through proper drug treatment, psychotherapy, and psychological rehabilitation adequately coupled with modern physiotherapy. A multidimensional approach to this “neuroconnective phenotype” should be implemented to ensure proper assessment and to guide for more specific treatments. Future lines of research should further explore the full dimension of the psychopathology associated with JHS/hEDS to define the nature of the relationship.

Background and Objectives: To develop a self-assessment screening questionnaire (SQ-CH), with image illustrated criteria to easily identify collagen anomalies and to assist Hypermobility's evaluation in a Spanish sample. Methods: One hundred ninety one participants were recruited form an anxiety outpatient unit of a general university hospital and from a primary care setting, underwent a complete and rigorous evaluation of hypermobility. First, all participants completed the self-reported measures for the screening of Hypermobility Syndrome, the 7 self-reported items in y/n format aiming to validate (SQ-CH) and the 5 item self-reporting questionnaire of Hakim and Grahame (2003). Secondly, each of the participants was individual assessed by a trained clinician on the Beighton and Hospital del Mar evaluation for the diagnosis of Joint Hypermobility Syndrome. Results: Significant correlations were found between the SQ-CH and the Beighton and Hospital del Mar scales as well as with the 5-item self-reporting questionnaire. Results on temporal stability, specificity and sensitivity of the SQ-CH were satisfactory, and the best cut-off point was set at 3 positive items (i.e. answered affirmatively). Conclusions: The developed screening questionnaire for hypermobility (SQ-CH) is, to our knowledge, the first self-assessment questionnaire to evaluate the symptoms of the joint hypermobility syndrome in a Spanish population. It has shown good validity and good reliability and is therefore ready for its use as a screening tool to assess this collagen condition in all sort of potential suffers, particularly, patients suffering from anxiety.

Introduction. The combination of antidepressants is a useful tool in the treatment of major depression, especially in cases where there is a partial response to antidepressant monotherapy. However, the use of this strategy is a matter of controversy, and its frequency of use in clinical practice is not clear. The aim of our study is to assess the use of antidepressants combination in Spain by reviewing three databases used between 1997 and 2001.Methods. Databases pertain to patients who are study subjects of major depression treatment. These databases are a result of studies performed in Spain and in which 550 psychiatrists participated. The total studied sample was comprised ofN=2,842patients, aged over 18, fitting DSM-IV criteria for Major Depressive Episode. The percentage of patients who received more than one antidepressant and the types of combinations used was described. Subsequently, a comparative study between the group which received a combination of antidepressants (N=64) and the group which received antidepressant monotherapy (N=775) was performed.Results. 27.1% of patients were on antidepressive monotherapy treatment, and 2.2% were on combination therapy. In the comparison of patients on combination therapy and monotherapy, there were significant differences only in episode duration (P=0.001). The most frequent combinations are SSRIs and tricyclic antidepressants. The active principle most widely combined is fluoxetine.Conclusions. The prevalence of use of antidepressant combination therapy is 2.2% of the global sample and 8.3% of treated patients. Other than duration of the depressive episode, no clinical characteristics exclusive to patients who received combination rather than monotherapy were found. Our study found that the most frequent combination is SSRIs + TCAs, also being the most studied.