Actas luso-espanolas de neurologia, psiquiatria y ciencias afines最新文献

Two cases of neuroleptic malignant syndrome presented in a psychiatry inpatient unit are commented, as well as their positive evolution.

History od separation anxiety was investigated in several psychiatryc disorders and in 150 patients with panic disorder following DSM III-R criteria. Separation anxiety was reported by 15.3% of patients with panic disorder, 3.3% of the healthy control group, 13.3% of patients with major depression, 16.7% with dystymia, 13.3% with generalized anxiety and 33.3% with social phobia (p < 0.001). Separation anxiety is thus considered a common predisposing factor of anxiety and depressive disorders. Panic disorder patients with a history of separation anxiety had an earlier age at panic onset and greater comorbidity with social phobia and agoraphobia.

Introduction: Interater agreement is a main aspect in the planning and conducting a clinical trial. The objective of this study is to show the application of assessing levels of interexaminer's agreement when multiple ratings are made on a single subject as an efficient method of evaluating the interater's reliability in planning a multicenter clinical trial.

Method: 39 psychiatrist assessed videotape of a patient with depression. The use of any reliability statistics is failed in the analysis of multiple independent ratings of a single subject since we used the methodology proposed by Cichetti et al. This method is able to identify raters whose ratings differ significantly from the average ratings and is sensitive for different levels of agreement.

Results: Interarter agreement was between good and excellent. The raters show an adequate agreement in total and items scores.

Conclusion: The design proposed permits evaluate the interater agreement in an efficient way (only in one session).

A patient with Cushing's syndrome presented psyquiatric manifestations that were diagnosed and treated before diagnosis of Cushing's syndrome. These manifestations were unspecific, unstable and they responded to etiologic treatment but they didn't to syntomatic treatment. This case demonstrates the importance to make a through search for organic factors when there are changes in physical appearance and psyquiatric features are changing through the evolution.

Background: There are many recent epidemiological studies that find that intravenous drug users' (IDU's) performance in several measures of neuropsychological function are not the same than that of the general population, whether they are seropositive to HIV-1 infection or not. Consequently, it has been stated the need to establish appropriate norms for this population. The purpose of this study is to provide normative data on a battery of neuropsychological tests from a IDU group.

Subjects and methods: This report provide normative data from a group of 116 IDU, on a battery of neuropsychological tests stratified by age group (mean = 30.9; SD = 4.5), and educational level (mean = 8; SD = 2.4). Comparisons between the means of the different groups according to age and education, and also with respect to sex are made. The analysis includes estimation of partial correlations between neuropsychological test scores and age and education.

Results: The analysis demonstrates that education is an important determinant of performance for most of these tests, while there are no differences in performance between the two age-groups. With respect to sex, females out-performed men on a measure of motor speed and coordination.

Conclusions: This report provides norms that may be of use as a reference for clinical evaluation and research in drug user populations. It also emphasizes the need to establish normative data controlling for variables like educational level, from a population with special characteristics such as IDU population.

Objectives: The objective of this study was to compare, in a naturalistic setting, the efficacy and tolerability of currently available Selective Serotonin Re-uptake Inhibitors (SSRIs) and venlafaxine in out-patients from a primary psychiatric-care center.

Material and methods: The sample was composed of 194 patients with mood disorders (major depressive disorder or dysthymic disorder according to the DSM-IV criteria) who initiated treatment either with a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram) or with venlafaxine. Baseline severity of the mood disorder was assessed using the Hamilton Depression Rating Scale and State-Trait Anxiety Inventory, and therapeutic response was measured with the Clinical Global Impression for Therapeutic Improvement. Tolerability was assessed by recording spontaneously reported adverse experiences. Patients were followed up for six months, with subjects made three o more intermediate visits.

Results: There were no significant differences in the efficacy of the antidepressants under study, but there were differences in the incidence and profiles of adverse events. Fluoxetine was associated with the lowest incidence of adverse effects in a logistical regression model. Particular events seemed to be associated with certain treatments; gastrointestinal discomfort (fluvoxamine), tremor (sertraline) and anticholinergic effects (venlafaxine).

Main studies which have shown an association between the variation in apolipoprotein genes and human neuropsychological impairement are reviewed in this work. Data from literature indicate a special relevance of apolipoprotein E (ApoE) in relation to Central Nervous System (CNS) functions, basically memory. ApoE epsilon 4 is a well documented risk factor for late-onset Alzheimer's Disease (AD). Memory changes in older adults and in AD are also associated with ApoE genotype. Furthermore, ApoE may play a role in formation or degeneration of some neural structures related to memory. In some studies a relation between ApoE's alleles and cerebral vascular disorders like ischemic, haemorrhagic, Vascular (VD) and Multi-infarct (MD) Dementias is also reported. The role of the remaining apolipoproteins in cognitive impairment is still unknown, and these molecules have been considered as risk factors associated with environmental factors in CNS pathologies, essentially the vascular ones.

Since the introduction of benzodiacepines in the medical practice their use has been generalized to numerous clinical situations. One of them is schizophrenia. In this article we analize the main settings for its use and the possible mechanisms of action, trying to draw some recomendations applicable to the psychiatric practice.

We present the use of risperidone as a potentiation strategy of the serotonergic antidepressants in four patients suffering from refractory obsessive-compulsive disorder. There were an important improvement in three patients. Adding risperidone to serotonergic antidepressants causes complex interactions between serotonergic, dopaminergic and noradrenergic systems, that could lay to the clinical improvement. These and other similar cases make necessary controlled studies. Adding risperidone to serotonergic antidepressants in patients suffering from refractory obsessive-compulsive disorder might be an effective strategy with low risk for secondary effects and without the presence of tics or psychotic symptoms.

The P300 component studies, have been generated discussion about his source, cognitive meaning and clinical applications. Since the first point of view, different structures have been proposed as a probable source of P3a or P3b in oddball and memory task and in scalp and in a intracraneal recordings. There are many papers that lucubrate about cognitive meaning of P300 and the applications of this component in the diagnostic process of psychiatric pathology. We make critic analysis and different points of view about this component.