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

Introduction: The diagnosis of attention-deficit hyperactivity disorder among adolescents and adults, when they were not diagnosed during childhood, requires retrospective evaluation of the disorder. Parents are usually the best source of information about childhood conduct, but sometimes it is impossible to get them. The Wender-Utah Rating scale was developed as an aid in the retrospective evaluation of symptoms of attention-deficit, hyperactivity e impulsivity. The objective of this study was to determine the consistency and the validity of this questionnaire in Spanish.

Method: We evaluated medical students of the Universidad Autónoma de Puebla in Mexico with the Wender-Utah Questionnaire-Spanish. Some of them were evaluated again fifteen days later. We gave them the parents Rating Scale. We calculated the internal and the test-retest consistency and also the correlation between this Questionnaire and the Parents Rating Scale.

Results: We evaluated 946 students, 400 had the test-retest procedure and 532 returned the Parents Rating Scale. The internal consistency was superior to .80. The correlation symptoms of attention deficit, hyperactivity and impulsivity. The test-retest consistency was at least .80, for the evaluation of with the Parents Rating Scale were moderate.

Conclusions: This Spanish translation of the Wender-Utah Questionnaire has adequate consistency and reproducibility so it can be used as a screening tool, also the validity of the different versions suggested can be evaluated.

The prevalence of personality disorders in penal population was studied with two instruments, the classic MMPI and the recently published IPDE, authorized by the WHO for the diagnosis of personality disorders in both, DSM-IV and ICD-10 versions. A sample of 56 prisoners from a Spanish prison was studied, mean age 22, all male, 98% of them had never requested psychiatric help. The crimes most frequently committed were related to drug traffic and drug abuse (thefts, robberies, crimes against public health). There were also cases of homicide, homicide attempt, rape and kidnapping. 91% of the studied sample presented one or more personality disorders, being the most frequent: Antisocial (79%), Paranoid (52%) and Borderline (41%). The MMPI scales most frequently obtained were: Psychopathic deviation (59%), Paranoia (46%) and Schizophrenia (41%). There was a good clinical correlation between the IPDE and the MMPI results.

We study the existence of associated psychiatric disorders in a sample of 161 alcohol dependent out-patients. 75% of them had suffered from some kind of psychiatric disorder and 66% were still suffering from the associated disorder at the moment of the evaluation. The most frequent associated disorders were affective disorders, personality disorders and other drug related disorders. Women as a whole did not have more psychiatric disorders than men, but affective and personality disorders were more frequent in women. 43.5% of the patients had suffered from a psychiatric disorder before they became alcohol dependent.

Despite obsessive-compulsive symptoms in schizophrenia have been described for over 60 years, their clinical significance and treatment still remain unclear. Described below is a schizophrenic patient with obsessional thinking and compulsive rituals who markedly reduced the obsessive-compulsive symptoms after fluoxetine was added to neuroleptic treatment.

Aims: To determine the factors associated with the maintenance of HIV-related risk behaviours in opiate patients dependent and establish whether psychopathology and more specifically personality disorders are part of them.

Design: Cross-sectional study with descriptive and analytical elements.

Setting: The inpatient Drug-Dependence Unit of the Psychiatry Department at the Hospital Clínico Universitario in Valencia, Spain.

Study sample: Study subjects (n = 110) were consecutive first admissions to the Drug-Dependence Unit.

Instruments: The following instruments were used a structured clinical history, a Questionnaire on HIV-related risk behaviours, the Symptom Checklist-90 (SCL-90), the Beck Depression Inventory (BDI), and the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II).

Results: Patients who had HIV-related risk behaviours were younger (CI95% = 0.43-3.99) and showed a younger age of first heroin and cocaine use. An association was found between a maintenance of risk behaviours and a current cocaine dependence (OR = 2.39; CI95% = 1.04-5.48), a current benzodiazepine dependence (OR = 6.81; CI95% = 2.67-17.38) and being HIV positive (OR = 2.5; CI95% = 1.10-5.67). An association was also found between HIV-related risk behaviours and the number of prior drug-related hospital admissions. The maintenance of risk behaviours was associated with the presence of personality disorders (OR = 2.63; CI95% = 1.18-5.84) and particularly with the antisocial personality disorder (OR = 3.75; CI95% = 1.61-8.75). The logistic regression analysis showed that the existence of benzodiazepine dependence, cocaine dependence, antisocial personality disorder and the number of drug-related admissions classified correctly 81.08% of patients.

Conclusions: The higher severity of patients that maintained HIV-related risk behaviours and the association found with personality disorders suggests the need of designing more efficient therapeutic strategies for a subpopulation of drug misuser that showing HIV-related risk behaviours.

The panic disorder is heterogeneous. The factorial study of the phenomenology of panic crisis suggests the existence of different subtypes: the cardio-respiratory, the vestibular, the despersonalization, the gastrointestinal and others. We review the clinical and biological data which suggest the display of these subtypes.

Introduction: Data from naturalistic studies have reported differences in the clinical use of antidepressants referring to the need for adjusting doses, treatment duration, tolerability and use of concomitant medication. These differences could be considered as an indicator of the effectiveness of antidepressants in clinical practice settings.

Objectives: It is a naturalistic, retrospective, observational study which objective is to evaluate and compare the pattern of antidepressant use (fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine) and to establish if there is a relation between the different pattern of use and the effectiveness of them.

Data and methods: A retrospective dataset of patients who initiated therapy on fluoxetine, fluvoxamine, paroxetine, sertraline, or venlafaxine with a follow-up period of 6 months was used. Information about clinical characteristics of patients and antidepressant pattern of use were collected. Pattern of antidepressant use were defined as: "initial doses", "upward dose titration", "augmentation strategy", "switching" and "early interruption of treatment". The efficacy of the therapy was assessed by the CGI-improvement.

Results: Fluoxetine was the antidepressant more associated with a statistical significance (p = 0.001) to an stable pattern of use (initial doses without upward dose titration, switching or augmentation). After controlling for other observed baseline characteristics, patients who remained on their initial antidepressant therapy, with a stable pattern of use were 1.61 times more likely than patients who had an adjustment to therapy to experience a treatment response. Patients who initiated treatment with sertraline or venlafaxine were 2.155 and 4.831 times less likely, respectively, to experience a response relative to patients who initiated therapy on fluoxetine.

Conclusions: The need to upward dose titration, switching or augmentation in the treatment could be indicated a worse therapeutic control of the symptoms. Patients treated with fluoxetine are in a stable pattern of use more likely than patients in the other antidepressants, this fact is related with better global therapeutic results.

Introduction: The bipolar disorder is an important health problem. It presents with severe sintoms, and it tends to cronify. Although lithium has a prophilactic role, it has not controlled the development of severe psychosocial complications. It is necessary to study the psychosocial aspects related to this disorder, to define the areas in which the psychosocial interventions are needed, and the types of psychosocial approaches that can be useful.

Methods: Review of the literature, through MEDLINE database in the last fifteen years, about psychosocial complications of bipolar disorder and its treatment.

Results: Many articles emphasize the important psychosocial deficits that appear in patients with bipolar disorder. These deficits concern to all social functions and persist for a long time. The patients are more vulnerable to stressing events, that can have devastating consecuences. The articles report the influence in the evolution and prognosis of this disorder, by the comorbidity of other medical and pschiatric problems. The psychotherapeutical interventions can be of interest to treat the social aspects that lithium fails to control.

Conclusions: Our approach would tend to integrate in the clinical practice both, the biomedical and psychosocial theories. This permits an integral treatment of all the factors implicated in the genesis, maintenance, and consecuences of the mental disorders.

Introduction: Families of adolescent and young adult suicide attempters are studied to analyze their role in these extremely dangerous behaviors.

Method: 72 adolescents and young adults (aged 15-24) who have made a suicide attempt and 72 normal controls matched by sex, age and marital status, are studied in a case-control design. Several aspects of each family are explored: composition, degree of stability in parental couple, type of relationships among the members, labor status of parents and medical-psychiatric and legal family history.

Results and conclusions: Only parameters analyzing parents-offspring interactions can differentiate both groups. Keep an unsatisfactory relation with any of the living parents are the family factors which place the young or adolescent subject in risk of making a suicide attempt in our surrounding.

The epidemiological data of prevalence of mental disorders according to gender differences are controversial. We analysed the prevalence among men and women via a two-stage epidemiological community study using the GHQ-28 and the SCAN on the island of Formentera (Spain). There are no sex differences in total prevalence; nevertheless some significant differences are detected when data is analysed on specific disorders. Affective disorders, sleep disorders and neurotic and somatoform disorders are more prevalent among women, whereas men have more psychoactive substance use disorders. Comorbidity with medical illness are higher in women but differences are not significant. These findings suggest the need to standardise procedures and instruments in these kinds of studies. This is because one of the bias could be the difference in the number of disorders included in the instrument design used (in our study, sleep disorders and psychoactive substance use disorders were included and personality disorders were excluded.