One might consider that the first Spanish psychiatrists were a group of alienists, that have been forgotten for many years, who worked in isolated conditions in the asylums of the 19th Century. On the other hand, there were a group of personalities, university professors specialised in other disciplines, that were not psychiatrists but had a much greater influence than the former during the early stages of the development of Spanish psychiatry as a differentiated medical speciality. This development was produced (considerably later than in other European countries) in two successive stages: a preliminary one, with local or aborted institutions (from the 15th Century to the year 1919) and a further one, with institutions that extended throughout the entire country, and were developed between 1920 and 1936. These national institutions were the ones that defined the beginning of Spanish psychiatry. The first one, that appeared in January of 1920, was the journal Archivos de Neurobiología, that related each other, stimulated and served as on organ of expression to the remaining institutions that established this specialty. Finally, a summary is offered of the characteristics and the historical evolution of this journal emblematic of Spanish psychiatry, that is currently commemorating its 75th anniversary.
From 1990 a research and surgical treatment project about epilepsy is being carried out in Hospital of the Princesa in Madrid, A multiprofessional team composed of neurosurgeons, neurologists, neurophysiologist, neuropsychologists and psychiatrics are working in that project. The main goals of the neuropsychological focus are a descriptions of the individual general cognitive condition and the specifical functions for identifying the seizure and the observer the effects of the surgery on the high functions. In the present study we have evaluated 33 epileptic patients, who didn't react to the pharmacological treatment, in three phases: before surgery, 6 months later and one year later. Our finding show that to brain damage according neuropsychological results have a predictive value of 61% (20/23) control and follow-up evaluations show improvement after surgery,, with no other neuropsychological disorders, but this improvement is only referred to the general cognitive testing, while the specifical disorders still keep going months and one year later.
This paper reviews the outstanding studies which have dealt with the circadian rhythm of the psychophysiological activation. It stands out the importance of studing the influence of circadian rhythms on behaviour and at the same time the difficulties of measuring them. Afterwards, the types of rhythms as well as the parameters for their description are defined. Next is discussed the question of the endogenous and exogenous components of circadian rhythms. Finally, the paper reviews the actual knowledges about the circadian rhythms of various psychophysiological functions (peripheral temperature, electroencephalographical activity, heart rate and electrodermal activity).
An increasing amount of recent findings suggest that rapid cycling bipolar patients generally correspond to lithium-resistant patients. Several compounds and associations of these drugs have been used as alternative agent for lithium therapy in such sort of patients. Besides, although a great therapeutical effort has been carried out in the last years very few works report about treating patients with mixed or dysphoric mania. A case of 65 y. o. lithium-resistant female patient, suffering form a bipolar disorder over thirty years, with mixed mania and rapid cycling in the last years is reported, symptomatic stability was achieved undergoing simultaneously treatment with carbamazepine, clonazepam and dipropylacetamide. Clinical implications of using alternative stabilizers to lithium for preventive treatment, in particular anticonvulsant agents, is discussed, outlining their utility and advantages in these type of patients.
A never treated obsessive-compulsive patient was studied before and after treatment with a serotonin selective reuptake inhibitor The blood flow distribution was analyzed with HMPAO-SPECT and the electrical activity and evoked potentials with quantitative electroencephalography. A metabolic hyperactivity was found in qualitative and quantitative SPECT images, in caudate and orbitofrontal regions, predominantly in the right side. The amplitude of the P50 and N100 waves of the auditory evoked potential was decreased, and the quantitative analysis of the electrical power showed a pattern coherent with the metabolic hyperactivity These abnormalities disappeared after treatment with a good clinical response. The findings are discussed regarding biochemical, physiologic and anatomical facts.
This paper presents some aspects in relation with an already classic controversy which confronts the victims of childhood sexual abuses with their abusers, when the former are prepared to face and report the offence. The author also presents in this article the problem of <<false memories>> of presumed victims who denounce abuses that never happened, and the creation in the USA of the False Memory Syndrome Foundation which takes care of the rights of those falsely reported. This paper brings likewise into discussion some of the scientific arguments in support of the existence of a causal relation between childhood sexual abuse and some well developed forms of dissociative disorders. In this sense, the possibility of the real existence of sexual child abuse must be in the mind of those clinicians and therapists who detect dissociative disorders in their patients. A psychotherapeutic attitude, however, should always be accompanied by legal advice for those cases in which the presence of abuse is evident.
Although the use of benzodiazepines has been significantly reduced as a consequence of their negative side effects, these drugs have been, and continue to be, in widespread use all over the world, very often without a medical prescription. This paper makes a detailed description of the current situation of several aspects of benzodiazepines: epidemiology, pharmacokinetics, pharmacodinamics, most frequent uses, interaction with other substances, negative side effects and alternatives to these problems.
This article reviews the main publications over the last years about the clinical relevance of the plasmatic levels of different psychotropic drugs. The control of toxicity produced by antidepressant, lithium salts, anticonvulsivants and, probably neuroleptics is a widely accepted indication for these determinations. A therapeutic window has been described for some antidepressants, like nortriptiline. The clozapine plasmatic level determination appears to be a promising technique, since a linear relationship seems to exist between clinical response and plasmatic levels under the toxic limit.
Brain injuries, are according to the literature an infrequent cause of secondary mania. We present, two clinical case reports with maniform symptomatology, both preceded by a brain injury. In both cases, neuroimage techniques, showed brain posttraumatic damage (subcortical atrophy bifrontal injury in the first case and subcortical atrophy associated with a small subdural hematoma in the second case) that, in previous studies have been related with the presence of posttraumatic mania. None, of our two cases, had previous personal or familial antecedents of affective disorder. We shortly review the literature, focussing on clinical, pathogenesis, associated factors, and therapeutical alternatives.
We present a patient suffering from obsessive compulsive disorder without clinical response to antidepressant treatment but with a good response to carbamazepine. We discuss the carbamazepine therapeutic posibilities in the treatment of obsessive compulsive disorder.
The Charles Bonnet Syndrome was named by G de Morsier in 1936, honouring the naturalist from Geneva who described it in the 18 th century. It is defined as a syndrome with complex visual hallucinosis which mostly occur in elderly people with visual impairment, although they keep their intellectual abilities without suffering any other psychiatric disorders. Different theories and ethiopathogenic topographies are analysed and an explanatory theory about its pathogenic mechanism is given. A great part of the published cases ave revised (N = 119) and their clinic and epidemiologic characteristics are analysed too.
Psychiatric outpatients in general present a higher Stress Reactivity Index (SRI) than the general population When considering the CIE-10 diagnostic categories, schizophrenics present the lowest global SRI of the entire psychiatric patient group. The vegetative subindex of schizophrenics is the lowest and the cognitive subindex the highest of the whole group. Interestingly, the group of depressive patients present an inverse profile, with the highest SRI-vegetative subindex and the lowest SRI-cognitive subindex of the whole group.
This is an assesment of the psychiatric consultations in a outpatient clinic at a general hospital setting. We focus on the comparison between the patients referred from medical divisions and surgical divisions. Chi-square test was used to compare from a total number of 273 patients, 197 arising from medical divisions and 76 arising from surgical divisions. The survey yielded that the 72% were referred from medical departments, that the most common reason for consultation was the phisical and psychiatric coexisting symptomatology, that the affective disorders were the most frequent conditions and that half of patients were followed-up.
Although many authors consider pregnancy to be a period with good psychological adjustment, recent studies suggest a high incidence of emotional disturbances and look for associated psychosocial factors. We study 53 women include in a prematernal program. Those with greater levels of antenatal anxiety showed higher scores in STAI-trait (t=2.24, p < 0.05) and lesser marital satisfaction (t=1.88, p < 0.05). Women with negative attitudes toward pregnancy had also higher scores in STAI-trait.
The authors study the evolution of 29 patients diagnosed with Paranoid Psychogenic psychosis. The patients were follow up during periods of two and eight years. This syndrome appears as a clinically independent concept, its symptomatology is closely related to provoking factors, its stability in the symptoms observed in each episode, positive response to treatment and a tendency to relapse.
The present work analyses the neuropsychological data in relation to clinical disfunction in Parkinson's disease. Patients with Parkinson's disease, without generalized dementia, show some several cognitive alterations affecting visuospatial and frontal functions. The dopaminergic depletion present in Parkinson's disease causes the characteristic motor symptoms that show this patients (tremor, rigidity, bradikinesia, etc.), but it could be also in relation with its cognitive deterioration. A fronto-striatal disfunction caused by the dopaminergic depletion in the substancia nigra might explain the neuropsychological disfunction associated with Parkinson's disease when there are no sings of dementia.
The effects that changes in reaction time tasks (simple reaction time vs choice reaction time) have over motor response of patients with Parkinson's disease still remains unclear. In our work, we control the stimulus-onset probability (Oddball paradigm). Normal individuals produce slower reaction times in presence of low probability stimuli (rare) than in presence of high ProbabilitY stimuli (frequent). We can appreciate that the patients with Parkinson's desease always are slower but this effect was only significant in presence of frequent stimuli; also, the typical disminution in response time due to changes in experimental tasks disapear. These results are interpreted under the point of view of some theories that associate basal ganglia function with motor preporgraming.
