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

This paper reviews preclinical research which demonstrates the involvement of the opioid system in the reinforcing effects of alcohol, and the effects of naltrexone, a long-acting, nonselective opioid receptor antagonist to reduce alcohol intake. Naltrexone (50 mg/day) may prevent the return to drinking by blocking the pleasurable effects or "high" associated with alcohol drinking, and relapse rates were reduced. The most common adverse effects reported include nausea and vomiting and it does not appear to be hepatotoxic in dosages recommend. Thus, naltrexone appears to offer significant therapeutic benefits, when used with behavioural treatment for alcohol dependent patients.

Objects: Demonstrate the reliability of cerebral SPECT using 99 mTc-HMPAO.

Methods & materials: Evaluation of cerebral blood flow using SPECT in 24 patients with schizophrenia, 24 patients with bipolar disorder and 20 controls. In the study we have reliability between observers and intraobserver. In both cases kappa statistic has been applied for measuring reliability.

Results: reliability between observers represents a kappa coefficient of 0.71. Intraobserver reliability, with a medium grade concordance slightly superior, shows a medium kappa coefficient of 0.74.

Conclusions: Visual evaluation of SPECT images using 99mTc--HMPAO is a trustworthy technique to document the different patterns of regional cerebral blood flow. Reliability is determinate by the improvement, during visual analysis of reliability between observers (kappa: 0.71) and intraobservers (kappa: 0.74).

This study examined the relative efficacy of a brief-psychoeducational treatment approaches for bulimia nervosa. Our sample comprised 26 women who sought consecutively treatment at the Eating Disorders Outpatient Unit. All subjects met DSM-IV criteria for Bulimia nervosa. For the assessment were used commonly applied questionnaires in the fiel of eating disorders such as: Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI) and the Beck Depression Inventory (BDI). Outcome measures included also change in vomiting and binge-eating episodes per week. Each patient was assessed before and after a 6 weeks brief psychoeducational group therapy. At posttreatment, 30% of the patients were abstinent from binge eating-purging and 62% reduced their weekly frequency in binge eating and 56% reduced their weekly frequency in vomiting. Good-outcome (EAT scores < 30) was observed in more than 35% of our patients. The authors sought to identify factors that differentiate bulimic patients who improve while receiving treatment from those who do not.

Aim: To evaluate the impact of early retirement, quality of life and general health level of a sample of industrial workers.

Subjects: 78 early retired industrial workers were evaluated on two separate occasions, baseline and after three years.

Instruments: A sociodemographic and clinical "ad hoc" protocol and the Spanish versions ot the following scales: the Quality of Life Questionnaire (1) the GHQ-28 (2, 3) and the MMSE (4, 5), the Self-Concept Scale (6, 7) and the Depression-Anxiety Scale from Goldberg (8-10).

Results: Those retired for physical or accident purpose showed a worse self-image and greater levels of anxiety

Conclusions: Being retired for physical or accident purpose plays a significant role in the development of psychopathology.

Objective: This study evaluates the therapeutic effect of fluoxetine, a selective serotonin reuptake inhibitor, in borderline personality disorder.

Method: 46 patients with borderline personality disorder according to DSM-III-R and Diagnostic Interview for Borderlines (DIB-R) criteria, were given fluoxetine 20-60 mg for seven weeks. They were evaluated each week using Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS) and a clinical Impulsivity Scale.

Results: There were significant improvements in BPRS, HDRS, GAF and Impulsivity Scale from the first week of the treatment. These improvements continued until the seven week of treatment. The favourable outcome was not only due to the improvement in depression and impulsivity scores, but also to the decline of global psychopathology.

Conclusions: The data suggest that fluoxetine is an effective pharmacologic treatment for borderline personality disorder. These findings support the hypothesis of a 5-HT dysfunction in borderline personality disorder.

Drug dependence is common in schizophrenia. Two main models explain this association: drugs precipitate psychosis in a vulnerable subject, and drugs use to self-medicate positive and negative symptoms and neuroleptics side effects. We investigated the prevalence of psychoactive substance use and dependence in schizophrenia and its association with the subtype of schizophrenia. The sample consisted of 56 outpatients with schizophrenia according to ICD-10, between 18 and 40 years, and a control group with 56 subjects with other different disorder. They were evaluated with Addiction Severity Index (ASI) and Positive And Negative Syndrome Scale (PANSS), sociodemographical, clinical and toxicological characteristics were evaluated too. Patients were classified in subtype negative, positive or mixed according to scoring in PANSS. Schizophrenics were reevaluates at six months of development. There were higher cocaine, alcohol, cannabis and nicotine use in schizophrenics. The patients with negative subtype of schizophrenia had more clinical severity, less scoring in alcohol and drugs subscales of ASI, lower prevalence of nicotine dependence and cocaine, amphetamines, cannabis and opioids use. Drugs use were associated with a poor compliance of treatment. Therefore, cannabis and cocaine dependence, regular alcohol use and tobacco use are more prevalent in schizophrenic than control group with other mental disorders. Negative subtype had lower drug use.

Introduction: From the cognitive perspective, the inability in order to advance the future positively, it is an essential characteristic in the depression. The Anticipatory Cognitions Questionnaire (ACQ), with eight items with a proposal cognitive-anticipatory, has been developed with the objective of detecting cases of depression by means of the screening of the existence of that difficulty of bringing forward.

Material and methods: It have been carried out a multicentric study between Spain and several countries of Spanish America (Argentina, Chile, Costa Rica, Mexico and Venezuela). For it, a Spanish version of the ACQ was used, agreed between the investigators of both sides of the Atlantic Ocean. Were interviewed 291 out and in depressed patients (CIE-10), and 158 healthy controls. Evaluated them in four serial occasions (two for the controls), using the ACQ, the Hamilton's and Zung's scales for Depression, and a Global Clinical Impression.

Results: From their outputs seems to deduce that the ACQ has a good internal consistency (alpha = 0.72), elevated temporal reliability (r = 0.81, good screening capacity for depression with a cut-off equal to "7" (kappa = 0.48-0.70), and good sensitivity to change.

Conclusions: Everything it support that ACQ, in their Spanish version, it is an useful instrument for the ends that was developed.

The P-450 enzymatic complex (CYP) is one of the main enzymatic systems used by the organism to metabolize different substances, including 90% of drugs of common clinical use. Drugs can act on the CYP as substrates or as modifiers of its activity, either as inhibitors or as enzymatic inducers. Antidepressant drugs, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI), are widely metabolized by CYP. In addition, SSRI are potent inhibitors of different isoenzymes of this family. This fact allows to establish interesting differences relating the safety profile of these agents. In this review we analyze in detail, and comparatively, the effects of the different classes of antidepressants on CYP. Knowledge of these effects is of great relevance for an optimum clinical practice, allowing us to know the basis of some interactions, providing guidance for the use of correct dosage in different groups of patients and to explain some cases of unexpected toxicity or lack of therapeutic effect.