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

The authors study the construct validity of the Newcastle's Endogeneity Index (NEI). They use the correlation matrix published originally by Carney et al (1965). The results show a high reliability of the NEI (alpha = 0.77). The Factorial Analysis shows two factors, not independent, that explain a 45% of the total obtained variance; it seem to indicate a drop construct validity of the NEI. The authors discuss the validity of the endogenous/neurotic classification of the depression because of the high agreement the NEI and the clinical criterion.

A study was carried out in order to identify the main dimensions of psychiatric symptoms in primary care and to study their relationship with demographic characteristic and life events and difficulties. 233 consecutive patients without previous psychiatric contact with their doctor were assessed using the Present State Examination-9 (PSE-9) and the Life Events and Difficulties Schedule in 10 primary care offices. A factor analysis was carried out on the items of the non-psychotic part of the PSE-9. Four main dimensions (depression, non-specific symptoms, lack of confidence and self-criticism, and specific anxiety) were found explaining the 53.7% of total variance. Acute and chronic life events are associated with the depression, non-specific symptoms, and lack of confidence and self-criticism dimensions after controlling for the effect of clinical variables and demographic characteristics, and previously or currently married shows a statistical significant trend to signification in its association with the non-specific symptom dimension after controlling for the effect of clinical variables and life events.

Tardive Dyskinesia (TD) is a iatrogenic syndrome of involuntary movement that occur in association with chronic neuroleptic use. The diagnosis and ongoing assessment of TD severity is complicated by a host of methodological problems. Orofacial movements are most frequent, although other body areas, limbs, neck and trunk, may be involved. The prevalence for TD varies widely from study to study, the estimated average prevalence is a 20%. The pathophysiology of TD remains poorly understood despite the numerous theories have been proposed. One of the most consistently identified TD risk factors is age. This factor is independent of drug exposure although both are often confounded. Currently no consistency effective treatment has yet been found and the most important treatment consist of gradual neuroleptic drug-dose reduction and, where possible, complete withdrawal.

The psychiatric manifestations of hematological diseases are interesting because of their diverse presentations, complex treatment, pharmacological interactions, and frequent infectious complications. A patient with acute myeloblastic leukemia (AML) presented psychiatric manifestations of sudden onset and psychotic characteristics. The absence of organic lesions in routine neuroimaging studies suggested an added schizophreniform disorder. Further neurological study using more sensitive methods disclosed herpetic encephalitis as the origin of delirium. This case illustrates how early diagnosis, although not always possible, is important if major sequelae are to be avoided. Likewise, it is important to make a through search for organic factors in psychotic pictures that appear in the context of systemic disease.

Depression is frequent in the elderly but difficult both to diagnose and treat due to a number of distinctive features. Tianeptine is a novel antidepressant with a reverse mode of action to that of the selective serotonin reuptake inhibitors yet with proven efficacy and safety. 63 elderly patients (mean age: 68.8 years; range: 65-80 years) with depressive symptoms (major depression: 55.6%; dysthymia: 44.4%) were included in a 3-month open multicenter study with tianeptine (25 mg daily). 43 patients (68.2%) completed the study. There were no drop-outs due to side-effects. Total Montgomery and Asberg depression rating scale scores were significantly decreased (p < 0.01) on day 14, with a response rate of 76.7%. Improvements were also observed in anxiety and cognitive performance. Side-effects were seen in only 11.7% of patients, with no changes in laboratory or ancillary safety parameters. Tianeptine is thus effective and well tolerated in this category o patient.

Since the times the Hipocraticum Corpus was written, Phrenitis or Mental Confusion was described as a mental disorder related basically to fever, but also related to craneal traumatisms an others somatics ethiologies. The theorical background of the different schools was the same, the Phisis and Humors doctrine, but the results of their works were quite different. Cos school had a biographic approach, Cnido a systematic one, and Eclectics blended both with emphazis in treatment.

Objective: This study employed an alternative method for assessing serotonergic function in depression. The neuroendocrine responses to acute intravenous administration of the serotonin (5-HT) reuptake inhibitor clomipramine were assessed in patients with Major Depression with Melancholia (DMM) and matched subjects with Major Depression (DM) (without Melancholia) and Dysthimic disorder (TD).

Method: 10 patients who met DSM III-R criteria of DMM, 10 patients with DM and 10 with DD matched for age and sex received 12.5 mg of intravenously administered clomipramine. Prl, Cortisol and GH were measured during the next 135 minutes. We divided the samples using the Newcastle Scale.

Results: The DMM patients had significant blunting prolactin responses to clomipramine compared with the other patients. Most of the major depression patients without melancholia were neurotic depressions according to the Newcastle Scale. There was a negative correlation between endogeneity and prolactin response.

Conclusions: These data support the hypothesis that DMM patients have abnormal neuroendocrine responses to the intravenous administration of the 5-HT reuptake inhibitor clomipramine, and that there is an association between endogeneity and prolactin response.

Introduction: It is not clear as to the process by which the psychiatrist attracts referrals and the reasons and motivations that doctors have for referring or not. This study describes the modus operandi of referrals to the psychiatrist in the context of a university general hospital.

Method: A semi-structured interview was carried out on 50 doctors (35 male, 15 female) from the teaching hospital of the Universidade Estadual de Campinas, Brazil. Data was analyzed qualitatively, by means of content analysis, according to the psychodynamic approach.

Results: Some referrals need to be worked through in order for the doctor to overcome his resistance. Others are automatic: because something moved him deeply, the doctor directs his anguish and responsibility outside himself, without realizing the motives that lead him to do so.

Conclusion: Referral is used in a variety of ways and different things are expected of the psychiatrist, all influenced by unconscious aspects of the patient-doctor-specialist triad.

INTROD: Clinical samples gives a piece of information mediated by singular characteristics of the area (general practitioners, health services organization, needs of care feld by family or patient), but they are an important way in the study of psychosocial variables and their influence in pathways and morbidity of psychiatric disorders. MET: We obtained by SISMA survey (Information System for Mental Health in Andalucia) clinical and sociodemographic variables of a 2,016 Mental Health Center sample consulting during 40 months (attendance people = 90,368, rural area). We realized a descriptive and association study, with special attention to gender as modulating another factors related with health services use, diagnostic and clinical features. RES: ICD-10 Diagnostic groups of our sample was Affective disorders (F.3x) (36.5%, OR 1.99 for female), Neurotic disorders (F.4x) (29.75%, OR 2.01 for female) and Schizophrenia and related disorders (F.2x) (9.83%, OR 0.31 for female). The female-male ratio of our clinical sample was 1.70, incremented to 2.31 in geriatrics. Woman significantly consulted by themselves and men by their family. Married marital status was a help factor of psychopathology in women, as single status in men. Work activity and high or medium educative level was protective factors of psychopathology. CONCLUS: Clinical and sociodemographic variables we have seen, give us similar results to another spanish samples, too similar to actually accepted in Psychiatric Epidemiology. Female gender and class-linked vulnerability have an important influence as help-factors for specialized psychiatric treatment in our community.

We revise the implications that comorbidity presents from a clinical and therapeutical point of view; either in alcohol dependence or in other psychiatric disorders connected with it. From the clinical point of view, comorbidity as a whole does not produce specific consequences but each psychiatric disorder introduces peculiar characteristics in the association. Once the stability of the associated disorder has been proved, after two or three week's withdrawal, the management of comorbidity has to be based on the treatment of every single associated disorder as if they had no connection between them, within the framework of integrated programs.