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

Use of BMT (bone marrow transplatation) has rapidly grown in the last few years. It extends to a variety of neoplastic illnesses and hematological malignancies. This procedure includes implicit appearance of many and important stressors, both physical and psychological, due to the illness and to chemotherapy treatments, among which the appearance and severe colateral effects during the stay in hospital has a special relevance. The need to consider the influency of predictive variables like, prior experiences, optimistic vs. pesimistic expectancies and the strategies of coping used in the adaptation through the treatment, are a central point in the study of the fluctuations of the different psychological responses and their interrelation with the physiology symtomatology which are present during the different phases of the process of BMT.

Introduction: Postpartum Depression is a psychiatric syndrome with a prevalence of 10-15%. The studies show that depressive mothers have a "negative" relation with their children.

Method: 205 primiparous women are analyzed, of them, we take a group of "cases" (23 depressive mothers) and a "control" group (37 women without psychiatric symptoms). Childrearing in the first postpartum year is analyzed.

Results: 13.5% of the studied women have a Postpartum Depression within the first six postpartum months. There aren't sociodemographics differences between both groups. Childrearing of depressive mothers is lower in affect and care than control mothers.

Conclusions: Childrearing of depressive mothers in postpartum period is lower in Affect and Care than non depressive mothers in the same period.

Introduction: The different occurrence of Suicide depending on the rural/urban environment, as well as the interaction of this variable with others such as sex and age has given rise to a large quantity of investigations over the world. It was necessary to carry out in Spain an updated study of these characteristics.

Objective and methods: Our purpose is to work with the raw data referred to suicide in the two last Spanish Census years. 4,619 records of suicide are requested and obtained from the Spanish National Statistics Institute registered in the years 1981 and 1991. Adjusted rates by rural/urban environment, sex and age are established and compared to each other.

Results and conclusions: Suicide rate in Spain is always higher in the cities that in the country, no matter be sex or the age group. However, there appears to be no continuous relationship between Suicide and the environment variable, since the large cities seem to confer a certain prevention. On the other hand, the feminine urban suicidal behaviour is becoming quantitatively more and more similar to those of men.

A total of 439 schizophrenic patients according to ICD-10 criteria was included in an open label postmarketing surveillance study to evaluate the efficiency of resperidone as maintenance treatment of the schizophrenic acute exacerbation. The efficiency of risperidone was assessed according the number of patients who responded to treatment, the duration of the hospitalization period an the decrease in the total score as well as in the different clusters of the Brief Psychiatric Rating Scale (BPRS) during the study period. A patient was considered as responder to treatment when a decrease of, at least, a 20% was achieved in the total BPRS score while being treated in monotherapy with risperidone. Safety was evaluated by the UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline and weeks 1, 2, 6 and 12. Forty patients (9.1%) were excluded from the statistical analysis due to protocol violation. Eighty one patients (20.3%) dropped out due to lost for follow-up (n = 25; 6.3%), new hospitalization (n = 23; 5.8%), inefficacy (n = 12; 3%), side effects (n = 7; 1.8%) and others (n = 14; 3.5%). Risperidone was used at doses between 1.5 and 19 mg daily (mean dosage: 7.66 +/- 3.07 mg daily). The duration of the hospitalization when dosages of risperidone of less than 6 mg daily were used was 32.1 days. However, when higher dosages were used, the number of days in-hospital decreased (26.6 days at dosages between 6 and 9 mg daily and 25.3 days when dosages higher than 9 mg daily were used). There was a significant reduction, versus baseline, in the BPRS mean total scores as well as in it's different clusters. (positive symptoms, negative symptoms, anxiety/depression) from week one onwards. At week 1, 66.9% of the patients had an improvement (20% versus baseline in their BPRS total score. At the end of the study period, 93.2% of the patients had an improvement (20% in their BPRS total score. There was a significant reduction in the total UKU subscale for neurological side effects scores (p < 0.005) from week 1 onwards, as well as for the total score of the following symptoms: rigidity, hypokinesia, hyperkinesia tremor and akatysia.

Introduction: It has been studied the possible confusion in the diagnosis of bipolar disorder when there are no clear mania symptoms and other psychiatric disorders, due to his clinic similarity. The diagnosis received from a group of patients admitted in a Psychiatric Unit of a General Hospital by manic episode were studied.

Methods and material: 84 admitted patients have been followed up along an average of 32 months. By means logistic regression, there were found the factors that explained the change in the diagnosis along the evolution.

Results: 87% of the patients after the follow up kept the diagnosis of bipolar disorder. However, 63.1% had received other diagnosis. Two factors predicted to receive other diagnosis: depressive clinic and not having stable couple.

Conclusion: Bipolar disorder presents a proper stability once diagnosis have been made. It may be confused with psychotic sight, unipolar depression and B cluster personality disorders. It is checked that patients which start with manic psychosis phases are the ones that present biggest diagnosis stability.

Previous studies have revealed that serotonin reuptake inhibitors are effective for the treatment of obsessive compulsive disorder (OCD) in children and adolescents. The clinical efficacy of sertraline (STL) for eight adolescents with OCD is examined. The patients are between 12 and 17 years old, being 3 of them female and 6 male. The severity is measured with OC-NIMH Scale and self-report Leyton-20 questionnaire. Administration of STL was begun at 50-200 mg/day, with maintenance dose of 50-150 mg/day. Seven patients responded adequately to STL for more than six months; a girl, aged 16, require discontinuation of STL because of untoward effects. The improvement starts before the 8th week of treatment. Six months later improvement scores with OC-NIMH and Leyton-20 rated near the 50%. In the seven patients with STL either have no untoward effects or mild effect. Favorable results are observed either in adolescents who received STL and cognitive therapy or those with STL as main treatment without any structure psychotherapy. After 6-21 months with STL, improvement has continue of has been increased.

One of the main difficulties we find in psychopharmacologic treatment of schizophrenia is medication compliance. Following Kissling, only 40-50% of patients adequately follow prescription directions. This phenomenon becomes one of the major factors of the high relapse rates in schizophrenia. Several studies have been made in recent oriented to improve medication compliance through psychoeducational groups involving patients and their closest relatives. Our results confirm the hypothesis. Statistically significant differences (p < 0.0001) are found between readmission rates in control group (2.32%) and in group of patients participating in psychoeducational groups (0.30%). Significant differences are also found when considering separately first episode patients (1.61% controls vs. 0.04% cases, p < 0.0001) and patients with previous history (3.05% controls vs. 0.61% cases, p < 0.0001).

The recognition and differentiation of conversion and factitious disorders could be difficult when they coexist with physical problems and their psychopathology is not evident. We present two illustrative cases of patients who share the existence of neurological disorders and present a similar psychiatric semiology, which is phenomenologically different related with their physical deficits. The psychopathological assessment was made by means of a standardized instrument for diagnosis (SCAN) and suitable paraclinical techniques for each case. The test MMPI (Minnesota Multiphasic Personality Inventory) was used in both cases, and an exploration with Thiopental was carried out in one of them. The pertinent differential diagnosis, the advantages of coordinated interdisciplinary interventions in order to elucidate these mental disorders, and the convenience of using appropriated psychometric instruments and exploratory methods are expounded in the present paper.

The relationship between tobacco consumption and psychiatric disorders is a widely discussed topic that is generating a considerable yet controversial bibliography, that can be approached from different points of view. The authors make a revision and critical evaluation about smoking prevalence on psychiatric population, in the different psychiatric disorders and discussing the theories implicated.