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.
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.
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.
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.
BACKGROUND:Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. The comsumption pattern associated with psychiatric complications is unknown.METHOD:Thirty-six case reports about psychiatric complications due to ecstasy and published from 1985 to 1997 were studied.RESULTS:The disorders with higher prevalence were psychosis (n = 21), panic attacks (n = 12) and depressive symptoms (n = 3). Seventy two per cent were substance abusers. Urinary drugs screening were present in 28%, only in two subjects might detect amphetamine. Men had higher MDMA doses compsumption and higher prevalence of background psychiatric disorders than women. Subjects with psychotic symptomatology had more psychiatric background, higher doses of MDMA comsumption and for a long time than individuals with depressive or panic attacks symptomatology.CONCLUSIONS:The review of the case reports of psychiatric complications related to ecstasy use do not allow to conclude that ecstasy use was the main responsible factor for psychiatric symptoms. They could be related to an individual vulnerability and or to lasting of comsumption.
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.
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.
The recognition and differentiation of conversive 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 psychiatic semiology, which phenomenologically different, related with their physical deficits. The psychopathological assessment was made try means of a standarized instrument for diagnosis (SCAN) and suitable paraclinical techniques for each case. The test MMPI (Minnesota Multiphasic Personality Inventory) wa used in both cases, and nn exploration with Thiopenthal was carried out in one of them. The pertinent differential diagnoses, the advantages of coordinated interdisciplinar 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.
Since the introduction of benzodiacepines in the medical practice their use has been generalized to numerous clinical situations. One of them is schizophrenia. In this article we analize the main settings for its use and the possible mechanisms of action, trying to draw some recomendations applicable to the psychiatric practice.
Objectives: The objective of this study was to compare, in a naturalistic setting, the efficacy and tolerability of currently available Selective Serotonin Re-uptake Inhibitors (SSRIs) and venlafaxine in out-patients from a primary psychiatric-care center Material and methods: The sample was composed of 194 patients with mood disorders (major depressive disorder or dysthymic disorder according to tbe DSM-IV criteria) who initiated treatment either with a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram) or with venlafaxine. Baseline severity of the mood disorder was assessed using the Hamilton Depression Rating Scale and State-Trait Anxiety Inventory, and therapeutic response was measured with the Clinical Global Impression for Therapeutic Improvement. Tolerability was assessed by recording spontaneously reported adverse experiences. Patients were followed up for six months, with subjects made three o more intermediate visits. Results: There were no significant differences in the efficacy, of the antidepressants under study, but there were differences in the incidence and profiles of adverse events. Fluoxetine was associated with the lowest incidence of adverse effects in a logistical regression model. Particular events seemed to be associated with certain treatments; gastrointestinal discomfort (fluvoxamine), tremor (sertraline) and anticholinergic effects (venlafaxine).
Event related Potentials, which seem to be an objective parameter reflecting cognitive functions, have been examined in depression. To evaluate the influence of visual and auditory stimuli on the P300 latency we studied 42 patients with major depression and 21 normal subjects. The experimental tasks applied were first a series of 300 auditory stimuli [255 (85%) were tones of 1000 Hz, and considered the frequent stimulus, whereas 45 (15%) were tones of 2000 Hz and referred to as the rare stimulus and second a series of 300 visual stimuli 255 (85%) were black circles on a white background, and considered the frequent stimulus, 9 cm diameter, 200 ms duration whereas 45 (15%) were back squares on a white background and referred to as the rare stimulus, 9 cm diameter, 200 ms duration] in the center of a computer screen. The results shown an increase of P300 latency in depressive patients during auditory and visual tasks. Non differences were found in reaction time to visual or auditory stimuli. These results are consistent with an impairment in brain function in depressive patients that is associated with cortical hypoactivity and deficits in perceptive, auditory or visual, functions.
Introduction: Interater agreement is a main aspect in the planning and conducting a clinical trial. The objective of this study is to show tbe application of assessing levels of interexaminer's agreement when multiple ratings are made on a single subject as an efficient method of evaluating the interater's reliability in Planning a multicenter clinical trial. Method: 39 psychiatrist assessed videotape of a Patient with depression. The use of any reliability statistics is failed in the analysis of multiple independent ratings of a single subject since we used the methodology proposed by Cichetti et al. This method is able to identify raters whose ratings differ significantly from the average ratings and is sensitive for different levels of agreement. Results: Interarter agreement was between good and excellent. The raters show an adequate agreement in total and items scores. Conclusion: The design proposed permits evaluate the interater agreement in an efficient way (only in one session).
Aims: To determine the factors associated with the maintenance of HIV-related risk behaviours lit 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 Clinico Universitario in Valencia, Spain. Study sample: Study subjects (n=110) were consecutive first nti,admissions to tbe 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 (C195 % = 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; C195%=1.04-5.48), a current benzodiacepine dependence (OR=6.81; C195% =2. 67-17.38) and being HIV positive (OR=2.5; C195%=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; C195%=1.18-5.84) and particularly with the antisocial personality disorder (OR=3.75; C195%=1.61-8.75). The logistic regression analysis showed that the existence of benzodiacepine 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 misusers that showing HIV-related risk behaviours.
The prevalence of personality disorders in penal population was studied with two instruments, the classic MMPI and the recently published IPDE, authorized bq, 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 commited were related to drug traffic and drug abuse (thefts, robberies, mimes 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: Psychophatic deviation (59%), Paranoia (46% and Schizophrenia (41%). There was a good clinical correlation between tbe IPDE and the MMPI results.
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 wich suggest the display of these subtypes.
Main studies which have shown an association between the variation in apolipoprotein genes and human neuropsychological impairment are reviewed in this work. Data from literature indicate a special relevance of apolipoprotein E (ApoE) in relation to Central Nervous System (CNS) functions, basically memory. ApoE epsilon 4 is a well documented risk factor for late-onset Alzheimer's Disease (AD). Memory changes in older adults and in AD are also associated with ApoE genotype. Furhtermore, ApoE may play a role information or degeneration of some neural structures related to memory. In some studies a relation between ApoE's alleles and cerebral vascular disorders like ischemic, haemorrhagic, Vascular (VD) and Multi-infarct (MD) Dementias is also reported The role of the remaining apolipoproteins in cognitive impairment is still unknow, and these molecules have been considered as risk factors associated with environmental factors in CNS pathologies, essentially the vascular ones.
Some evidence suggests that temperament and personality traits could influence the development and severity of eating disorders. This study was designed to study these aspects. Methods: 72 patients with DSM-IV eating disorders including 25 anorexia nervosa restricting type, 17 with anorexia nervosa binge eating-purging type and 30 with bulimia nervosa were studied and compared with thirty healthy controls. Personality disorders and temperament were studied with the Eysenck's EPQ, Cloninger's TCI and SCID-II. Impulsive and clinical features were studied with specific rating scales. Results: 61.8% of patients had at least one personality disorder. Avoidant personality disorder was the most commonly diagnosed in anorexia restricting type (25%). Borderline personality disorder was the most frequent in bulimia nervosa. Dimensionally, the group of eating disorders presented high scores in neuroilicism and low scores in self-directedness. Higher harm avoidance was associated with anorectic patients. Bulimic patients were significantly more impulsive than anorectic and controls. Conclusions: Temperament and personality traits differ in anorectic and bulimic patients. Bulimic symptoms are linked to impulsive temperament traits and to impulsive personality features. Anorectic symptoms are linked to persistent temperament traits and anxious personality features.
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.
Background. Ecstasy use have raised in recent years and it have been related to psychopathological symptoms. The consumption pattern associated with psychiatric complications is unknown. Method. Thirty-six case reports about psychiatric complications due to ecstasy and published from 1985 to 1997 were studied. Results. The disorders with higher prevelence were psychosis (n = 21), panic attacks (n = 12) and depressive symptoms (n = 3). Seventy two per cent were substance abusers. Urinary drugs screening were present in 28%, only in two subjects might detect amphetamine. Men had higher MDMA doses compsumption and higher prevalence of background psychiatric disorders than women. Subjects with psychotic symptomatology had more psychiatric background, higher doses of MDMA comsumption and for a long time than individuals with depressive or panic attacks symptomatology. Conclusions. The review of the case reports of psychiatric complications related to ecstasy use do not allow to conclude that ecstasy use was the main responsible factor for psychiatric symptoms. They could be related to an individual vulnerability and or to lasting of comsumption.
