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

Objective: In this work with the SPECT we tried to define the most possible the disfuntions that could exist in a group of patients with severe recurrent depression.

Material and method: The sample is compound for fifteen patients (2 men and 13 woman) diagnosed of recurrent depression according CIE-10 with equal distribution between melancholic depressions and depressions with psychotic symptoms congruents and not congruents with the state of mood. The mean age of the group is of 55.4 years. All the patients have been studied with de SPECT (Tc-HMPAO) during the first week of hospitalization. The severity of the depressive syndrome was studied with the questionnaire for depression of Beck and the state of anxiety was studied with the questionnaire of anxiety of Spielberger. All the patients were severes depressives and anxious according to the questionnaires.

Results: We appreciated disfunction, hypocaptation, in frontoorbital zones, well bilateral (mainly in recurrent depressions with psychotic symptoms) or only in the left frontal side (areas of Brodmann 10 and 11) mainly in recurrent melancholies. We also found that in almost all the patients existed hypocaptation in the left angular circunvolution (areas of Brodmann 37 and 39). In the recurrent melancholies the localization of the hypocaptation is fundamentally posterior parietotemporal in the left side.

Conclusions: In the recurrent serious depressions the hypocaptation is located to prefrontal level with tendency to bilateral being and/or posterior parietotemporal left side, that in the melancholies the localization of the hypocaptation is fundamentally posterior parietotemporal in the left side and it could imply that when the severity clinic gets complicated with psychotic symptoms the hypocaptation is located in a bigger number of places (prefrontal and left posterior parietotemporal) in relation to what it happens in the melancholic depressions. It seems to exist relationship between depressive and anxious severity and localization of the hypocaptation.

Event related Potentials, which seem to be an objective parameter reflecting cognitive functions, have been examined in depression. To evaluate the influence of visual and auditory stimuli on the P300 latency we studied 42 patients with major depression and 21 normal subjects. The experimental tasks applied were first a series of 300 auditory stimuli [255 (85%) were tones of 1000 Hz, and considered the frequent stimulus, whereas 45 (15%) were tones of 2000 Hz and referred to as the rare stimulus and second a series of 300 visual stimuli 255 (85%) were black circles on a white background, and considered the frequent stimulus, 9 cm diameter, 200 ms duration whereas 45 (15%) were back squares on a white background and referred to as the rare stimulus, 9 cm diameter, 200 ms duration] in the center of a computer screen. The results shown an increase of P300 latency in depressive patients during auditory and visual tasks. Non differences were found in reaction time to visual or auditory stimuli. These results are consistent with an impairment in brain function in depressive patients that is associated with cortical hypoactivity and deficits in perceptive, auditory or visual, functions.

Recognition confabulation was studied in 16 schizoprhenic patients and 16 normal controls. Half of the schizophrenics presented recognition confabulation, while the remaining 8 and 16 controls did not. This type of confabulation was associated to attentional deficiency, difficulties in perceptual follow-up and perceptive changes. These test satisfactorily discriminated confabulating schizoprhenics and both ill and healthy non-confabulating subjects. The possible mechanisms underlying this type of confabulation are discussed, in relation to the deficiences observed.

Clinical observation: A 67-year-old female patient operated of a severe aortic esthenosis with extracorporeal circulation during cardiac surgery, developed psychiatric disturbances with excitement and delirium, being necessary internamtient in a psychiatric ward, a month later. The evolution was right after neuroleptic treatment and nowdays she's assimptomatic. We review what is wrote about posteparative cognitive dysfunction (POCD), being this a tardive presentation case. We analize the definition, prevalence, etiology, pathofisiology, treatment and prevention since it is a reversible surgery complication but if it isn't early diagnosed and treated, its morbidity and mortality can be high.

Introduction: In this paper, a collective of Psychiatry Residents from Valencia surveys the degree of achievement and satisfaction with the Spanish programme.

Method: Every resident received an enquiry and a letter with instructions to fill it. Colleagues who did not answer back, were contacted and sent a new enquiry.

Results: We received a total of 142 enquiries from 52 institutions (80% of the total). The results are distributed in supervision, theoretical training, research, rotatories, assistential pressure, staff-resident ratio, training out of the programme and satisfaction.

Conclusions: This work show that the programme is not being carried out properly. There are still some deficiencies in many rotatories, even though they have been improved. In spite of it, the level of satisfaction with the residence is acceptable.

Background: Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. The comsumption pattern associated with psychiatric complications is unknown.

Method: Thirty-six case reports about psychiatric complications due to ecstasy and published from 1985 to 1997 were studied.

Results: The disorders with higher prevalence were psychosis (n = 21), panic attacks (n = 12) and depressive symptoms (n = 3). Seventy two per cent were substance abusers. Urinary drugs screening were present in 28%, only in two subjects might detect amphetamine. Men had higher MDMA doses compsumption and higher prevalence of background psychiatric disorders than women. Subjects with psychotic symptomatology had more psychiatric background, higher doses of MDMA comsumption and for a long time than individuals with depressive or panic attacks symptomatology.

Conclusions: The review of the case reports of psychiatric complications related to ecstasy use do not allow to conclude that ecstasy use was the main responsible factor for psychiatric symptoms. They could be related to an individual vulnerability and or to lasting of comsumption.

Introduction: The schizophrenia is considered an heterogeneous disorder which phenomenological differences could to point to etiopathogenic differences. Negative symptoms are associated with poor treatment response. In the last year different operative criteria of the "refractory treatment" concept has been developed. The association between negative schizophrenic symptoms and neuroleptic treatment response is studied.

Method: An open cross-sectioned design is made. 50 schizophrenics (DSM III-R criteria) inpatients are divided into 2 groups: one of 25 treatment-refractory schizophrenics (defined as Kane criteria, modified), and a second group of 25 treatments-responders schizophrenics. Negative symptoms are evaluated by the SANS into the five days before the hospital discharge.

Results: The two groups showed differences in the number of hospital income and total length of stay (p < 0.01). There were no differences in the subscales: "alogia", "affective flattening" and "attention impairments", although differences were found in "anhedonia-asociality" and "avolition-apathy" subscales (p < 0.05).

Discussion: Association between negative symptoms-poor outcome is issued. Possible relation between "anhedonia-asociality" and "avolition-apathy" added to social dimension with refractoriness to treatment is suggested.

Schizophrenia is a heterogeneous clinical syndrome and this variability may reflect differences in etiology and pathophysiology. Such heterogeneity could be responsible for the difficulties in research when all patients with schizophrenia are included in the same group. Subgroups of more clinical homogeneity are more likely to be homogeneous for the presumed pathophysiology of interest. Primary, enduring negative symptoms have been proposed to designate the deficit syndrome. The data obtained in the recent years and summarized in this review show that negative symptoms broadly defined are less effective for subgrouping schizophrenia and that the deficit syndrome is a different domain within schizophrenia.

The pharmacological treatment of serious mental disorders in the pregnancy, supposes a clinical dare by the possible repercussions on the fetus and the pregnancy: theratogenesis, perinatal syndrome or postnative sequels in the development. The electroconvulsive therapy (ECT) as much takes implicit a minimum risk for the mother as for the fetus and therefore, it must be located in the highest positions of the therapeutic decision trees. In the present article, are reviewed the consequences of the pharmacological treatment and the ECT in the serious mental disorders during the pregnancy. Is referenced to all of the pharmacological groups and with respect to the ECT: their indications, counterindications, complications and technical procedures advisables. Finally is reviewed the guide line for each syndromical group of psychiatric diseases.