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

This article constitutes the first of a series directed to review fundamental disorders in clinical psychogeriatrics. This sort of publication is intended to retrieve clinical practice as the cornerstone for research and teaching in psychiatry. Besides, and particularly in geriatry, we try to expand the strategy of liaison work with primary physicians. In this case, a nosological review of the so called "delusion of negations" is presented. The Jules Cotard's original concept of subtype of delusional melancholia is contrasted to the view of numerous authors in this century who have described it as a form of non-specific delusional syndrome.

The evolution of two twin patients diagnosed of catatonic schizophrenia is studied, through their clinical history, and the incidence of affective factors on the evolution of their clinical chart is evaluated. With regard to the results, the diagnosis of schizoaffective disorder is postulated.

In the introduction the authors highlight the clinical theoretical and practical importance of affection disorders, especially depressive ones, during childhood and adolescence, their relationships of continuity and the limitations of psychopharmacological studies with antidepressants and other medicines. The authors review the bibliography consulted about the use of antidepressants in depressive disorders during adolescence following this order: authors and years, medicine used, type of population, number of cases, proportion of males and females, age ranges, dose in mg/kg/day, ranges of plasmatic concentrations, most frequent secondary and unwanted side effects, time of duration of the study, comorbidity, existence of a previous washing stage, as well as placebo and global results. The studies with triciclical antidepressants (TAD) are classified into open ones and controlled ones. Among the open ones, they review the studies by Dugas et al (1980), Geller et al (1985), Ryan et al (1986), Strober et al (1990), and Ambrosini et al (1994). Among the controlled ones, they review the studies by Kramer and Feiguine (1981), Geller et al (1990), Boulos et al (1991), and Kutcher et al (1994). In the third part, the studies of enhancement of TAD with lithium by Ryan et al (1988 a and b) and Strober et al (1992) are analysed. In the fourth part, the studies of enhancement of TAD with the IMAO by Ryan et al (1988-1990) are evaluated. In the fifth part, the ten studies with ISRS (fluvoxamine, fluoxetine, paroxetine and sertraline) on the treatment of depression during adolescence are also discussed. In the final comments there is a summary of the clinical perspective of this kind of psychopharmacological therapy. Four tables and 73 bibliographical references are included.

Objectives: The aim of this study is to determine the predictive value on rehospitalization of sociodemographic variables, positive/negative symptoms and thought disorders. The results are part of research project founded by the Basque Health Department.

Methods: A 18 month follow-up study of a cohort of 60 patients with acute exacerbation of schizophrenia was carried out. The assessment was performed with DSM III-R diagnostic criteria, PANSS and CGI rating scales, and SCID-P semistructured interview. All patients received antipsychotic treatment. The sociodemographic and disease data, the dimensional score of the PANSS subscales, the score of CGI scale, the items 2, 12, 13 and 14 of the PANSS as indicators of formal thought disorders; and the items 1, 5, 6, 17 and 23 of the PANSS as content thought disorders were established as predictors. The predictive value was determined by the Cox regression test (Lee 1992).

Results: We did not find predictive value either in the PANSS scores or in the 9 thought disorders evaluated (Wald and RR tests were not significative). Nevertheless, considering the values of standard error obtained in the Cox regression we were not in a position to assure that they did not have an incidence in the hospitalizations. The CGI was the only scale that showed prognostic value (Wald test = 1.9945; RR = 1.7499). Our results indicated that the lower number of previous hospitalizations (Wald test = 1.1437; RR = 1.1437) and the high level of studies (Wald test = 2.4258; RR = 1.8052) diminished the risk of rehospitalization.

Conclusions: 1 o The predictive value on rehospitalization for the positive/negative symptoms and thought disorders was not confirmed. 2 o CGI is the only scale with predictive value. That fact makes us consider the importance of what German psychiatrists called "smelling the schizophrenia" or "The smell of schizophrenia". 3 o Our results indicate that the lower number of previous hospitalizations, and the high level of studies diminish the risk of rehospitalization.

Unlabelled: Current categorical classifications of the personality disorders are based on psychological perspectives. Consequently, biological research using these models has been unsuccessful since the nosological categories do not come out from the psychobiological systems underlying personality psychopathology. By contrast, biological research on dimensional models of personality has been more useful. All dimensional models agree on a neurotic-inhibitory dimension and an exploratory dimension of personality but they differ on other primary traits like dependence, emotionality or impulsiveness. However, gathering together all biological data support the existence of five biological axes of personality: a cognitive axis, a mood axis, an anxious-inhibitory axis, an exploratory axis and a action-control axis.

Conclusion: Considering these biological axes is bringing a new perspective on the classification of personality disorder and gives way to new pharmacological therapeutic options.

We present the six months prospective study results assessing clinical, social and demographic features in defectual psychiatric patients (chronic psychosis, dementia syndrome, intellectual deficit) who went to Basurto Hospital's Emergency room during that period of time. The studio data were obtained applying a clinical epidemiological questionnaire. Some problems derived from attending these patients were analyzed. Suggestions to improve the efficacy of the defectual psychiatric patient's assessment are proposed.

Lacunar infarcts have a high prevalence, about 10%, mainly in the elderly. Although the most frequent feature are the lacunar syndromes as a neurologic form, psychiatrist should bear them in mind because it is possible the presence of psychiatric symptoms as the only manifestation of them. We report two examples of it. The first case in a man with a transitory episode of uninhibition, with maniform characteristics, and frontal disturbance signs. The second one is a woman with a peduncular ballucinosis. The only neuroradiological finding were lacunar infarcts in both of them. We discuss a pathogenic hypothesis to explain these features. The first case may be a disconnection of the system that integrates the basal ganglia, thalamus and thalamocortical projections; the second one can be originated because of interruptions of the nigroestriatal connections.

The Center for Epidemiologic Studies-Depression (CES-D) is a short self-rating scale composed of 20 items, designed to detect depressive symptomatology. It has demonstrated its sensibility in psychiatric patients and general population. The CES-D was administered to 99 patients, 33 men and 66 women with mean age of 44.14 years. The patients had been diagnosed of: Major Depressive Disorder (74%), Bipolar Disorder (10%), Adaptive Disorder with depressive mood (10%) and other mood disorders (6%) according to DSM-IIIR criteria. In order to study the validity and reliability of the CES-D, we administered the Hamilton Rating Depression Scale, the Beck Depression Inventory and analogical scales to all the patients. In the reliability analysis we obtain 0.9 alpha. The factor analysis show 4 factors who explain the 58.8% of the variance: "depresses Affect/Somatic", "Positive Affect", "Irritability/Hopelessness", "Interpersonal/Social". The scale shows a 0.95 sensibility and 0.91 specificity to depressive symptomatology detection (according to scores equal or over 9 on HRSD) taking as cutoff scores equal or over 16 on CES-D. Our results show that the CES-D is a sensitive and specify tool for depressive symptomatology detection in psychiatric population. The CES-D is easy to be completed and evaluated, therefore may be useful in epidemiologic studies in general populations.

Background: Cost-effectiveness of olanzapine in comparison with haloperidol, in Spanish schizophrenic patients, was analysed using a clinical decision model.

Methods: The model represents a simulation of the different clinical and therapeutic possibilities that an hypothetical cohort of patients could experienced in a 5-years period of treatment. Efficacy was measured as months with partial-complete remission. Most information was obtained from the HGAJ randomised clinical trial. Other information was estimated through literature reviews and the opinion of an expert panel.

Results: Average cost-effectiveness for olanzapine was lower (116,476 pesetas per month with partial-complete remission) than for haloperidol (134,762 pesetas per month with partial-complete remission). Olanzapine produced more than half year (6.7 months) with partial complete remission, in comparison with haloperidol, with antincrementar cost-effectiveness of 32,516 pesetas per month with partial-complete remission, in comparison with haloperidol. The results were not sensitive to changes in the values of the main variables used in the analysis.

Conclusions: According to this analysis, olanzapine presents a good cost-effectiveness relationship in comparison with baloperidol, in Spanish schizophrenic patients. The analysis will be completed when new studies comparing olanzapine with other antipsychotics are available.

Introduction: Premenstrual Dysphoric Disorder (PMDD) is characterized by debilitating mood and behavioral changes in the weed preceding menstruation that interfere with normal functioning. The diagnosis requires that symptoms be recurrent and persistent. We report here the results of an open-label study with 20 patients with PMDD according DSM-IV with and without a concomitant diagnosis of MDD (Major Depression) treated with fluoxetine during 6 and 18 months.

Method: 9 patients with PMDD and MDD, and 11 patients only with PMDD were treated with fluoxetine 20 mg/d during 6 months. After that, 9 women continued treatment until complete 18 months of treatment and 11 women discontinued by their own decision, because the complete absence of symptomatology. Women who discontinued treatment were followed at the 18 months to the assessment of the evolution. The efficacy was assessed by CGI, HAMA, HAMD and un TDP scale monthly during the first 6 month and in the visit at 18 month.

Results: All patients completed the 6 months of treatment with a good tolerance. The most common adverse events were decrease of the libido, gastric complains, nervousness and insomnia. These events were mild and don't produce any withdrawn. There were a significant change in all scales at 6 month assessment: HAM-D (22.4 vs. 5.3, p < 0.000), HAM-A (23.8 vs 8.7, p < 0.000) and TDP (36.4 vs. 18, p < 0.000). There weren't differences among patients with and without concomitant diagnosis of MDD. Among patients who continued taking fluoxetine the improvement was maintained at the 18 month-assessment. Patients who discontinued treatment with fluoxetine after 6 months suffered a worsening in their symptomatology at the 18 month assessment (CGI = 3.18 vs. CGI = 4.81, p < 0.005).

Conclusions: Fluoxetine is an effective and well-tolerated treatment for the long treatment of PMDD. The remission is maintained at least during 18 month of treatment. Symptomatology reappears after treatment discontinuation in most of the women.