[Spinal cord injury due to suicide attempt, psychiatric profile and functional disability]. / Lesion medular por intento de suicidio, perfil psiquiatrico y discapacidad funcional.

INTRODUCTION: Studies published in other countries indicate that 1.6-3% of spinal cord injuries are acquired due to suicide attempt, the majority being produced by precipitation in patients with previous psychiatric disorders. AIMS: To determine the frequency of attempted suicide as a cause of spinal cord injuries in a neurorehabilitation hospital and to describe the characteristics of these patients in psychiatric terms and functional disability. PATIENTS AND METHODS: Retrospective study in which all patients with spinal cord injuries due to suicide attempt in a period of 15 years in a neurorehabilitation hospital were reviewed. RESULTS: Suicide attempt caused 2% (n = 61) of spinal cord injuries in our population. Although 93% of the patients were diagnosed with psychiatric pathology, 60% were linked to mental health facilities and only three consulted for emergency the days before the precipitation. Six attempts were made in the context of psychiatric services and 26% of patients had made previous attempts. The most frequent medical diagnosis was paraplegia associated with fractures in the lower extremities and chest trauma. CONCLUSIONS: Precipitation due to suicide attempt causes 2% of spinal cord injuries, with depression and psychotic disorders being the most prevalent psychiatric disorders. After the rehabilitation period, this population requires special attention from the mental health teams since they combine risk factors to commit suicide such as the history of previous attempts and the presence of a chronic disabling condition.

TITLE: Lesion medular por intento de suicidio, perfil psiquiatrico y discapacidad funcional.Introduccion. Estudios realizados en otros paises señalan que el 1,6-3% de las lesiones medulares se adquieren por intento de autolisis, y la mayoria se producen por precipitacion. Objetivos. Determinar la frecuencia de intento de suicidio como causa de lesion medular en un hospital de neurorrehabilitacion y describir las caracteristicas de estos pacientes en terminos psiquiatricos y de discapacidad funcional. Pacientes y metodos. Estudio retrospectivo en el que se revisaron todos los pacientes con lesion medular por intento de autolisis en un periodo de 15 años en un hospital de neurorrehabilitacion. Resultados. El intento de autolisis ocasiono el 2% de las lesiones medulares en la muestra (n = 61). El 93% de los pacientes estaba diagnosticado de patologia psiquiatrica y el 26% habia realizado tentativas previas. Aunque el 60% estaba vinculado a salud mental, solo tres consultaron por urgencias dias antes de la precipitacion y seis realizaron la tentativa en el contexto de servicios psiquiatricos. El diagnostico mas frecuente fue la paraplejia asociada a fracturas en las extremidades inferiores y traumatismos toracicos. Conclusiones. La precipitacion por intento de autolisis provoca el 2% de las lesiones medulares, y la depresion y los trastornos psicoticos son las patologias psiquiatricas previas mas prevalentes. Tras el periodo de rehabilitacion, esta poblacion requiere especial atencion por parte de los equipos de salud mental, ya que combina factores de riesgo para cometer suicidio, como la historia de tentativas previas, y la presencia de una condicion cronica discapacitante.

[Pharmacotherapy of the cognitive sequelae secondary to traumatic brain injury]. / Farmacoterapia de las secuelas cognitivas secundarias a traumatismo craneoencefálico.

AIM: To review and correlate the most common cognitive disorders secondary to traumatic brain injuries (TBI), the neurobiology of these deficits and their possible modulation by neuropharmacological means. DEVELOPMENT: As of a complex cascade of injuries to the brain, patients with TBI may experience alterations that affect the cognitive domain on different levels and to varying degrees, the most common being alteration of the level of alertness; slowing of the speed at which information is processed; attention, memory and learning deficits; language and communication disorders; and impaired executive functions. Brain damage may be caused by a range of pathological mechanisms, such as focal bruising, diffuse axonal damage, cytotoxic damage and neurotransmitter excitotoxicity. Certain pharmacological agents have an effect on the cognitive functions. Pharmacological agents that improve cognitive performance include dopaminergic agents, psychostimulants, some antidepressants and cholinesterase inhibitors. CONCLUSIONS: Studies into the pharmacological neuromodulation of the cognitive disorders secondary to TBI are currently in the early stages. The information we have available on the neurochemical bases of cognition and cognitive disorders due to TBI suggest that the most important goals of pharmacological intervention in this group of patients are the stimulation of the catecholaminic and cholinergic functions.

Behavioral scales used in severe and moderate traumatic brain injury.

UNLABELLED: Neurobehavioral disorders are common consequences of traumatic brain injury (TBI) that should be objectively assessed in this population. The use of scales allows us to unify terms both in clinical practice and investigative work; it also constitutes a useful guide in clinical interviews and makes it possible to see outcome changes in patients with or without intervention. The aim of this study is to review the most frequently neurobehavioral scales used to measure the non-cognitive disorders of conduct in TBI patients. METHOD: A systematic and descriptive literature review was done in Medline, without time limit, which focused on scales applied to behavioral disorders in moderate and severe TBI patients. RESULTS: Ninety articles were selected for the final review and thirty-seven different scales were identified. Seven of these instruments represent sixty-five percent of all behavioral scales applied in the studies collected and were selected for the present review. There are scales that are more general and include a wide range of neurobehavioral symptoms, like the Neurobehavioral Rating Scale and the Neuropsychiatric Inventory. On the opposite, there are questionnaires that focus on specific symptoms like aggressiveness, agitation and apathy such as the Agitated Behavior Scale or the Apathy Evaluation Scale. The forms for caregiver or staff were the most prevalent in our review. The most representative behavioral scales applied to moderate and severe TBI patients were analyzed using clinical useful, covered domains, item descriptions, administration procedures and psychometric properties.

[Comparative study of psychiatric disorders in general traumatism and brain injured patients]. / Estudio comparativo de patología psiquiátrica en pacientes con traumatismos generales y traumatismo craneoencefálico.

INTRODUCTION: This study evaluates the presentation of different psychiatric pathologies secondary to traumatic injuries; assessing the presentation frequency and how it correlates with whether it is a brain injury (TBI) or one in a different corporal area. METHODS: The study group consisted of 249 patients, 122 with TBI and 127 with injuries from different body areas. The patients conditions were evaluated at baseline and at 6 and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. RESULTS: Depressive and anxiety disorders were observed in frequencies similar to previous reports; without significant differences between TBI and non-TBI groups. The organic change of personality was significantly more frequent among patients with TBI than among the non-TBI with apathy features. There was a significant decrease in quality of life one year after the traumatism in both groups. CONCLUSIONS: Psychiatric disease is a frequent complication of injured patients; and it is associated with deterioration of general health and quality of life. TBI patients have more probability of developing an organic change of personality.