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

Unlabelled: Some evidence suggests that temperament and personality traits could influence the development and severity of eating disorders. This study was designed to study these aspects.

Methods: 72 patients with DSM-IV eating disorders including 25 anorexia nervosa restricting type, 17 with anorexia nervosa binge eating-purging type and 30 with bulimia nervosa were studied and compared with thirty healthy controls. Personality disorders and temperament were studied with the Eysenck's EPQ, Cloninger's TCI and SCID-II. Impulsive and clinical features were studied with specific rating scales.

Results: 61.8% of patients had at least one personality disorder. Avoidant personality disorder was the most commonly diagnosed in anorexia restricting type (25%). Borderline personality disorder was the most frequent in bulimia nervosa and in the binge eating-purging type of anorexia nervosa. Dimensionally, the group of eating disorders presented high scores in neuroticism and low scores in self-directedness. Higher harm avoidance was found in bulimic patients and higher persistence was associated with anorectic patients. Bulimic patients were significantly more impulsive than anorectic and controls.

Conclusions: Temperament and personality traits differ in anorectic and bulimic patients. Bulimic symptoms are linked to impulsive temperament traits and to impulsive personality features. Anorectic symptoms are linked to persistent temperament traits and anxious personality features.

Despite heterogeneous phenotype, lack of pathognomonic symptoms and great variability of symptoms during the course of the illness, functional neuroimaging studies have showed specific patterns of activation associated to particular schizophrenic symptoms or symptom dimensions. Negative symptoms have been associated to hypofrontality; auditory hallucinations seem to be related to abnormalities in brain regions involved in language and, reality distortion dimension has been associated to left temporal lobe impairments.

Unlabelled: The existence of panic disorder (PD) in old population is a source of debate.

Objectives: This study is aimed at studying the sociodemographic and clinical characteristics of panic disorder in patients over 60 years of age seen in two outpatient psychiatric clinics.

Method: All consecutive cases of PD (DSM-III-R) who contacted with two outpatient clinics in a three-year period were assessed by the same team. Those patients aged 60 or more at the time of interview were grouped and compared with a young and adult group. PASS and Marks-Matthews' Phobia Scale were administered to the sample.

Results: Fifty-three (15.6%) out of 341 PD patients were over 60 years of age. Elderly patients reported less frequency and severity of symptoms, less comorbidity with social phobia (p < 0.01) and alcoholism disorders (p < 0.01) and more with dysthymia (p < 0.05). The elderly patients with PD reported fewer family histories of alcoholism (p < 0.05), depression (p < 0.05) and PD (p < 0.05).

Conclusions: The rate of PD patients over 60 years of age who get in touch with outpatient psychiatric clinics is variable but not uncommon. Some clinical characteristics of PD in the elderly such as medical comorbidity and less symptom severity may enhance misdiagnosis in clinical settings.

Alimentary restraint, cognitive variable related to eating behavior and obesity, is reportedly a valuable predictor for the development of therapeutic strategies. This paper addresses the relationship between maternal restraint and several psychological variables in their daughters (alexithymia, neuroticism, extraversion). From the study of 35 mother-daughter dyads it can be concluded that daughters of highly restrained mothers tend to present high scores in the Restraint scale of the Three Factor Eating Questionnaire of Stunkard and Messick, translated into Spanish and validated as Cuestionario de Conducta Alimentaria. Daughters of highle restrained mothers present also higher scores in the Neuroticism scale of the revised version of the Eysenck Personality Questionnaire. Daughters of mothers with low Restraint scores are in average higher than those of their mothers, although lower than those belonging to daughters of highle restrained mothers. Previous observations on the positive correlation between Disinhibition and Hunger of the Three Factor Eating Questionnaire are confirmed. These results add an additional risk factor for obesity (mothers with high Restraint) and contribute to delineate a set of psychometric indicators which might be useful in the diagnosis and prognosis of eating and body weight disorders.

Schizophrenia, a psychiatric disease that is highly prevalent among the general population, has polymorphic clinical manifestations at onset and during its evolution. The most frequent manifestations are an abrupt onset with positive symptoms, perception and thought disorders, which were included by Kurt Schneider in the first range symptoms. However, on other occasions the onset is insidious and the so-called negative symptoms are present, resulting in clinical manifestations that are similar to the state of absence and a less favorable patient prognosis. Since the last century when Kraepelin defined early dementia, various authors have tried to explain the nature of this disease, resulting in Bleauler's definition of the fundamental symptoms. A clinical case of hebephrenic schizophrenia is presented in which disorders in thought, affect and volition predominated. We discuss the psychopathological views of less well-known, but not for that reason less important, authors, such as Guirod and Dice, and the similarities and differences between their views and current classifications.

The concept of autism as a fundamental symptom of schizophrenia has been lacking of psychiatric eminence in the course of time, just because of its absence of univocal sense, and its extraordinary richness, hardly to be apprehended by deterministic procedures. However, the experience which it refers to, is still present in the daily clinical practice. In its attempt of apprehend this reference, the psychopathology has developed several concepts, as diverse and unspecific as "Praecoxfeeling", "self disorders", or "contact disturbances". In this paper, we start from "Intersubjectivity" as the viewpoint from which we try to comprehend the immediate experience of the Other as a whole. Finally, our purpose would be to offer an interpretation of autism that could serve as a comprehensive substrate for many of the manifestations of the schizophrenic condition.

Selective serotonin reuptake inhibitors (SSRI) have demonstrated to be effective, well tolerated and relatively safe drugs in cases of overdosage. However, and related to the potentiation of the serotonergic transmission elicited by them, these drugs have been associated by some authors with the possibility of causing vascular complications. Serotonin is a vasoactive substance with complex actions on vessel wall as a result of its interaction with specific receptors existing at this level. We present the case of an adolescent girl who suffered a cerebral infarction after consuming a toxic dose of paroxetine and two other products, one of them containing caffedrine and theodrenaline, and the other one a phlebotonic agent. In connection with the possible pathophysiological mecanism the implied products as well as the serotonergic vascular receptors are briefly reviewed. Finally, a reference is made to Calls syndrome as a possible entity related to the unfortunate event suffered by the patient. As a conclusion risks of the combined pharmacotherapy, especially in cases of overdosage and in child and adolescent populations, are underlined.

A common idea is the that the patients with affective and anxiety disorders recover in a partial way their memories in function of their state. This particular fact can influence the remembrance of the upbringing so that the memory is facilitated for facts congruent with their current affects. The authors apply a questionnaire of upbringing (PBI) to a group of anxious and depressive patients at the beginning of the treatment and when the improvement has taken place. There are not variations for the punctuations in the scale of upbringing, which is invariant with the changes of the humour.

Despite its high frequency and its severe financial, social and personal complications, compulsive buying is rarely described in the psychiatric literature. We reviewed all the published papers on this syndrome to describe its clinical features, epidemiology and response to drug or psychological treatment. Psychiatric comorbidity is also reviewed and nosologic implications are analyzed.

This article presents information regarding the anatomic and physiological basis of hypnotic type trances and dissociation. Conjugated upward deviation of the eyes, as well as the so-called "rolling of the eyes" (explained in the text), which are present during trances, are suitable entry points for the study of the anatomic substrate underlying these experiences. The thalamus, posterior commissure, pretectal zone, and Cajal and Darschewitsch nuclei are the anatomic zones related with the upward gaze, "eye rolling" and trance type changes of consciousness. Independently of these facts, at least three different types of trance behavior can be differentiated: the form that we call passive is present in physiological sleep, and consists of the eyes turning upwards spontaneously. In the form called active, the trance is linked clearly to the upward stare and ocular rotation. Finally, a form that we call intermediate in this study accompanies personality changes in multiple personality disorder and some cases of psychogenic flight. This study attempts to demonstrate that the conjugated upward deviation of the eyes can be, in the absence of another disorder, a first-order indicator of disorder of consciousness of the type found in dissociative disorders.