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

The Landau-Kleffner syndrome consists in the association of an aphasia acquired during childhood or adolescence after a period of normal development, accompanied by epileptic fits and, sometimes, psychological disturbances. The appearance of the symptoms may not be simultaneous. The nature of this syndrome has been widely discussed and even the possibility of being a non-unitary syndrome has been considered. It may be possibly due to diverse etiologies, genetic or acquired (infectious). The relation between the aphasic, the psychologic and the convulsive symptoms has also raised controversies. A case of a female is described in which the psychological symptomatology was so severe, she had to be admitted in a psychiatric unit. The symptoms consisted in agitation during the night and severe persistent insomnia so as difficulties for relationship during day. No abnormalities were detected in a TAC nor in a RM but electroencephalographic and neuropsychological abnormalities were detected. The epileptic fits disappeared with a carbamacepine treatment but the rest of symptoms remained even more accentuated. After her admission, a treatment with valproate achieved to control her fits and the aphasic symptoms and neuropsychological deficits were compensated in the course of several months. After a year of treatment the patient's life was normalized, she resumed her studies, the EEG abnormalities disappeared so as the psychological disturbances and the behavior problems with the exception of phobic symptoms, similar to the ones of other family members. The patient has a history of epilepsy on its mother's side. The evolution and treatment response suggests that at least in some cases of the Landau-Kleffner syndrome, the etiology of the aphasia and other neuropsychological deficits and of the behavior disorders are related with some subclinical epileptic discharges and with a "functional inhibition" of some areas of the nervous system.

Evaluation of the situations related to heroin-taking, and the consequent delimitation and characterization of the patient's drug-taking pattern, should be one of the first stages in the design of an individualized treatment in the context of a cognitive-behavioural therapeutic approach. The Inventory of Drug-Taking Situations (Heroin) (IDTS[H]; Annis y Martin, 1985) was administered to a sample of 124 opiate dependent patients in order to study its reliability and factor structure. An Alpha reliability coefficient of .93 was obtained. A principal component analysis of the measure revealed a five-component solution which accounted for 50.6% of the variance. Nevertheless, a confirmatory factor analysis of the self-report showed that the original eight-factor model provides an acceptable fit to the data. Lastly, the frequency at which each of the eight original IDTS(H) subscales appeared as the highest risk situation in the profile was calculated, showing the predominance of Negative Emotional States (35%) and Social Pressure to Use (18%) as the two most important high-risk situations. Theoretical and clinical implications of the results are discussed.

Introduction: Motor left lateralization preference and lateralization inconsistencies have often been reported in schizophrenia and interpreted as an expression of a neurodevelopmental deficit in this disorder. However, the reported findings are contradictory and plagued by methodological errors.

Method: The aim of this work is to examine functional motor lateralization preferences and lateralization inconsistencies in a sample on 78 schizophrenic patients by using a reliable method and comparing them with a nonclinical sample as a control group. We also study the potential associations between lateralization and several clinical, neuropsychological and neuroimage variables.

Results: No significant differences are found between schizophrenics and the control group in functional motor preferences. Other relevant finding are: absence of correlation between crural, ocular and hand preference; an association between the severity of negative symptoms and lateralization inconsistency; and an earlier clinical onset and a smaller brain volume in right-handed schizophrenics with ocular crossed lateralization as compared with right-handed schizophrenics with consistent ocular lateralization.

Conclusion: These findings back up the hypothesis of a neurodevelopmental deficit in schizophrenia.

This study presents a clinical case about a patient suffering a manic syndrome secondary to neurocysticercosis and no responding to traditional neuroleptic treatment. We administrated the risperidone treatment, that was effective.

The authors, by means of documental research, study the possibility that the physical and psychic symptoms of Vincent van Gogh may have been due to chronic lead poisoning. The technique and materials used by Van Gogh are analysed as the cause of repeated exposure to lead as well as the possible means of penetration of the metal. Through historical-biographical analysis, the progressive symptoms of the illness are compared with those of lead poisoning. The authors conclude that the excessive and continuous use by Van Gogh of pigments which were highly toxic due to their high lead content, such as white lead (lead carbonate) and yellow chrome (lead chromium), could have penetrated his organism by digestive system (primarily) in minimal daily amounts, giving rise to a clinical condition of chronic lead poisoning. This type of poisoning coincides with the clinical symptoms Van Gogh describes in his autographed letters: initial debilitation, stomatitis with loss of teeth, recurring abdominal pains, anaemia (with a "plumbic" skin tone), neuropathy of the radial and saturnine encephalopathy including epileptic crises, progressive character changes and periods of delirium. The clinical symptoms shown by Van Gogh meet present criteria for diagnosis of Organic Mental Disorder due to cerebral lesion or somatic illness (F.06; CIE-10) (DSM-IV-R), and Organic Character Disorder (F.07; CIE-10) (DSM-IV-R).

An evaluation was made of the influence of different psychiatric co-morbidities on the symptoms of the disorder popularly known as "ataque de nervios" (nervous breakdown) among the US Hispanic population. Using a self-completed instrument designed specially for both traditional nervous breakdown and for panic symptoms, and structured or semi-structured psychiatric interviews for Axis I disorders, and evaluation was made of Hispanic subjects who sought treatment for anxiety in a clinic (n = 156). This study centered on 102 subjects who presented symptoms of "nervous breakdown" and comorbidity with panic disorder, other anxiety disorders, or affective disorder. Variations in co-morbidity with "nervous breakdown" enabled the identification of different patterns of "nervous breakdown" presenting symptoms. Individuals with "nervous breakdown" and panic disorder characteristically expressed a greater sense of asphyxiation, fear of dying, and growing fear (panic-like) during their breakdowns. Subjects with "nervous breakdown" and affective disorder had a greater sensation of anger and more tendency toward screaming and aggressive behavior such as breaking things during the breakdown (emotional anger). Finally, subjects with "nervous breakdown" and co-morbidity with another anxiety disorder had fewer "paniclike" or "emotional anger" symptoms. These findings suggest that: a) the widely used term "nervous breakdown" is a popular label for different patterns of loss of emotional control; b) the type of loss of emotional control is influenced by the associated psychiatric disorder; and c) the symptoms characteristics of the "nervous breakdown" can be useful clinical markers for associated psychiatric disorders. Future research is needed to determine whether the known Hispanic entity "ataque de nervios" is simply a popular description for different aspects of well-known psychiatric disorders, or if it reflects specific demographic, environmental, personality and/or clinical characteristics of the population.

Introduction and objectives: The temporal stability of the positive and negative symptoms in schizophrenia deserves a special interest due to its consequences in the outcome and the treatment of the disease. This study determines the temporal stability of positive/negative subtypes in schizophrenia during the acute phase.

Material and methods: This is a clinical, observational and prospective study of a dynamic cohort of patients with acute exacerbation of schizophrenia defined by DSM III-R criteria. Patients with severe and unstable organic pathology, substance dependence, mental organic disorder, mental retardation, depression, or medicamentous parkinsonism were excluded. Clinical assessment was performed with the PANSS scale. Schizophrenic subtypes were established according to inclusive and restrictive criteria of PANSS. All patients were treated with new antipsycotics and biperiden if necessary.

Results: 51 patients were assessed for 8 weeks. In the baseline, the negative subtype (63.3% and 52.5% by inclusive and restrictive system respectively) and paranoid form (45.1%) were predominant. Three types of analysis were performed to determine the temporal stability: 1. Concordance (Kappa index). The concordance of the inclusive and restrictive System, regarding to the baseline assessment, indicated that both criteria had a low temporal stability. 2. Mc Nemar Ji Square. This test showed that these changes were bi-directional except for the first visit, which was significant through the restrictive system (higher change from the negative to other subtypes). 3. Transition analysis among groups by First Order Morkov Chains analysis indicated that this change was stationary (the change was the same in all phases).

Conclusions: 1o The variable "time" has to be considered for the definition of subtypes in schizophrenia. 2o The restrictive system is more specific. It allows to identify a subgroup of patients with "Negative" schizophrenia with a high specificity and validity in clinical and epidemiological studies. 3o The use of the baseline visit as a reference (gold standard) is recommended because it exits a higher concordance among criteria and a more florid psychopathology.

In spite of the great number of studies that have proved the existence of cognitive disturbances in schizophrenic subjects, conflicting results have not allowed to glimpse a typical pattern of neuropsychological deficits in schizophrenia. On the contrary, these results have raised important controversies regarding the nature of such cognitive impairment. Thus, questions concerning the existence of generalized versus focal cognitive impairment or in relation lo the static versus progressive nature of these deficits remain unresolved. In the middle of these debates, the need for prospective research, which focuses on the neuropsychological deficits of schizophrenia and other psychotic disorders from the beginning of the illness, has been pointed out. In these lines we present the results obtained in our study in which 59 subjects, who were admitted in our hospital for presenting a first psychotic episode, were assessed. Measures of premorbid adjustment, obstetric complications and clinical symptoms were taken and correlated to measures of cognitive performance obtained by using a minibattery of neuropsychological tests at time of dismissal. Results showed, as in previous research, that neuropsychological deficits are already present in psychotic patients at the beginning of the illness. These deficits in our sample were related lo obstetric complications especially in males, and disturbances of premorbid adjustment occurred in early stages of development. These results support the neurodevelopmental hypothesis of schizophrenia.

Introduction: In Spain, suicide as a cause of death is increasing in different age groups in both sexes. The aim of the present work is to characterize the phenomenon of suicide.

Materials and methods: A retrospective descriptive epidemiological study was carried out. Data periodically published by the National Institute of Statistics (INE) on the statistical Incidence of Suicides in Spain (1906-1990) were analyzed, processed and tabulated.

Results: Suicide increases with age and this increase is more pronounced as from 40 years of age. The ratio between sexes is 3:1 in favour of men, although with a tendency to decrease. The most important causes of suicide are: physical suffering (27%), psychopathy (18%) and Daily Activities (DA) (17.5%). The method most used is hanging, which has been the case of 37% of the suicides committed in Spain during the study period (1906-1990).

Conclusions: The risk factors associated with suicide are age, male sex, and physical and mental suffering.

The present study was designed with the aim of examining the presence of psychiatric diagnosis and intellectual impairment in a sample of patients with Friedreich's ataxia. A consecutive sample of 21 patients presenting with Friedreich's Ataxia were evaluated by means of a neuropsychiatric interview. Only one patient was diagnosed as mentally retarded. Out of the 15 patients of the sample who were evaluated with be WAIS, all of them fell within a normal intellectual range. The idea that Friedreich's Ataxia produces cognitive impairment and serious psychiatric symptoms came from the earliest descriptions of the disease at the beginning of this century, which probably included many patients in their samples who had other diseases.