Trastornos generalizados del desarrollo. Evaluación diagnóstica e intervención para pediatras de Atención Primaria con criterios de evidencia científica / Pervasive developmental disorders. Diagnostic evaluation and intervention with scientific evidence criteria for Primary Care pediatricians

Contextualizar el incremento de la prevalencia de los trastornos mentales prioriza revisar y actualizar los criterios diagnósticos para evaluar su fiabilidad y su pertinencia a la hora de hacer el diagnóstico. Esto es más importante si no existe ninguna prueba específica para el diagnóstico y el determinante es el criterio clínico. En el caso de los trastornos generalizados del desarrollo, o del espectro autista, la confusión puede aparecer por la imprecisión en la traducción de los términos utilizados. En estos procesos hay que tener mucha sutileza en la recogida de los datos clínicos, pues son síntomas inespecíficos y la semántica induce a errores. Elaboramos diagramas de flujo para el diagnóstico de los procesos, con gran utilidad para el pediatra y otros profesionales de la salud, sobre todo de Atención Primaria. Se termina con recomendaciones dirigidas a la intervención del pediatra de Atención Primaria en estos procesos (AU)

Contextualizing the increase in the prevalence of mental disorders prioritizes review and update the diagnostic criteria to evaluate their reliability and relevance when making the diagnosis. It is more important if there is no specific test for the diagnosis and the clinical criterion is the determinant. In the case of pervasive developmental disorders or autism spectrum disorders, the confusion can arise from the imprecision that occurred in the translation of the terms used. In these processes, a lot of subtlety is necessary in the collection of clinical data because they are non-specific symptoms and the semantics induce errors. We developed flow diagrams for the diagnosis of the processes, with great utility for Pediatricians and other health professionals, especially Primary Care professionals. Recommendations aimed at the intervention of the Primary Care Pediatrician in these processes (AU)

Motivaton for change as a predictor of treatment response for dysthymia / Motivación para el cambio como predictor de la respuesta terapéutica en la distimia

OBJECTIVE: Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. METHOD: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck's Depression Inventory) and treatment attendance. RESULTS: stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. CONCLUSIONS: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted

OBJETIVO: la distimia constituye un trastorno afectivo crónico caracterizado por una respuesta heterogénea al tratamiento. Se han postulado diversas variables predictoras de dicha respuesta terapéutica, aunque la investigación acerca del papel de las variables psicológicas es todavía escasa. MÉTODO: cincuenta y cuatro pacientes diagnosticados de distimia completaron un tratamiento naturalístico bimensual de 16 meses de duración basado en la psicoterapia interpersonal. Como posibles variables predictoras se evaluó al inicio del tratamiento la alianza terapéutica, las estrategias de afrontamiento, la autoeficacia percibida y la motivación para el cambio. Las variables de tratamiento fueron la respuesta terapéutica (Escala de Impresión Clínica Global e Inventario de Depresión de Beck) y la adherencia terapéutica. RESULTADOS:los análisis de regresión múltiple indicaron que una mayor motivación para el cambio predijo una mejor respuesta al tratamiento. Por otra parte, una mayor motivación para el cambio también predijo una mayor adherencia al tratamiento. La alianza terapéutica no fue una variable predictora ni de la respuesta ni de la adherencia al tratamiento. CONCLUSIONES: estos resultados preliminares apoyan el uso complementario de la entrevista motivacional en el tratamiento de la distimia. Son necesarios estudios adicionales con un mayor tamaño muestral y evaluaciones adicionales durante el seguimiento postratamiento

Psicosis parece, encefalitis es (o un caso de inicio con síntomas psiquiátricos en una encefalitis límbica) / Psychiatric symptoms as initial presentation in limbic encephalitis: case report

Introducción: La encefalitis límbica esuna enfermedad autoinmune y con frecuencia paraneoplásica,caracterizada por síntomas neuropsiquiátricosy asociada con frecuencia a diferentes tumorescomo el cáncer de células pequeñas de pulmón, timoma,teratoma testicular o cáncer de mama. Se hanidentificado varios autoanticuerpos, uno de los cualeses anti-NMDAR, asociado con más frecuencia a teratomaovárico y síntomas psiquiátricos en pacientesjóvenes. Caso clínico: Una paciente de 14 años conalucinaciones auditivas, problemas de lenguaje, agitación,movimientos anormales y pobre respuesta aantipsicóticos es finalmente diagnosticada de encefalitisanti-NMDAR, encontrando y tratando despuésen ella un teratoma ovárico. Discusión: La encefalitisanti-NMDAR es tratada con frecuencia primero porpsiquiatras por su presentación con cambios de personalidad,alucinaciones, agitación etc. Los psiquiatrasdeberíamos conocer esta enfermedad autoinmune paradar a los pacientes un correcto y temprano diagnósticoy tratamiento (AU)

Introduction: Limbic encephalitis isan autoimmune and often paraneoplastic disorder,characterized by neuropsychiatric symptoms andfrequently associated with several tumors such assmall cell lung cancer, thymoma, testicular teratomaor breast cancer. Several autoantibodies havebeen identified linked to limbic encephalitis, i.e.the anti-NMDAR, frequently associated with ovarianteratoma and psychiatric symptoms in youngpatients. Case report: A 14-year-old girl with auditoryhallucinations, speech problems, agitation,abnormal movements and poor response to antipsychoticswas diagnosed of anti-NMDAR encephalitis,and there after an ovarian teratoma wasdetected and treated. Discussion: Anti-NMDARencephalitis is often first treated by psychiatristsbecause of its presentation with personality changes,hallucinations, agitation etc. Psychiatristsshould consider this autoimmune disorder in orderto give patients correct and early diagnosis andtreatment (AU)

Sintomatología depresiva en ancianos. La influencia del género / Depressive symptoms in elderly women. The influence of gender

Objetivo. Examinar las posibles diferencias de género en la presencia de sintomatología depresiva en personas mayores de 75 años de la comunidad. Métodos. Se trata de un estudio transversal descriptivo. La fuente de datos fue la encuesta realizada para el estudio de fragilidad en Lleida (encuesta FRALLE). Los síntomas depresivos se midieron con The Center for Epidemiologic Studies Depresion Scale (CES-D). Para analizar la relación del género con los síntomas depresivos se usaron técnicas de regresión logística. Resultados. La prevalencia de síntomas depresivos fue del 33,1% para el conjunto de la muestra, del 22,8% para los varones y del 40,3% para las mujeres. En toda la población, el género obtuvo resultados estadísticamente significativos en los 3 modelos construidos. Así, las mujeres tenían un mayor riesgo de depresión que los varones, incluso después de ajustar por los factores sociodemográficos y por los de estado de salud, presentando casi el doble de probabilidades de padecer depresión. Conclusiones. Los datos obtenidos sugieren que las mujeres tienen más riesgo de presentar síntomas depresivos que los varones. Así mismo, los factores protectores de sintomatología depresiva son el nivel alto de estudios en las mujeres y la presencia de pareja en los varones(AU)

Objective. To examine gender differences in depressive symptoms in people over 75 years of age in the community. Methods. This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms. Results. The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status. Conclusions. The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men(AU)

No correlation between lithium serum levels and psychopathological features during the euthymic interval of patients with recurrent affective disorder.

INTRODUCTION: The aim of this prospective study was to investigate the influence of lithium serum levels on subclinical psychopathological features during the euthymic interval in patients with an affective disorder. METHODS: The study included 54 patients with a recurrent affective disorder undergoing a continuous prophylactic lithium treatment (31 unipolar, 23 bipolar). The observation period lasted for 2 years and included 332 visits. Visits consisted of a detailed interview, a continuous measurement of lithium levels and the collection of validated scales including HAMD, YMRS, CGI, VAMS and the SCL-90R. Several correlations between lithium serum levels and different psychopathological features during the euthymic interval were calculated on an individual patient basis and on a group basis to reveal generally occurring correlations. RESULTS: No generally occurring significant correlations between lithium serum levels and specific psychopathological features were found. Only on a single patient level, 32 significant correlations between lithium level and specific psychopathological features were found, partly indicating a negative and partly indicating a positive influence of higher lithium levels on psychopathological symptoms. Nevertheless, in the group analyses no significant correlations were found. DISCUSSION: Higher lithium levels were not associated with an improved psychopathological status, but they were not associated with a worse status (due to a higher burden of side effects) either. According to the literature there is currently no strong evidence to treat patients with a higher lithium level. It is recommended to start with a lower level and to continue with individual adjustments in accordance to prophylactic efficacy and tolerability.

Estudio psicológico del trastorno distímico en la mujer / Psychological study of the dysthymic disorder in the woman

En este artículo estudiamos a dos mujeres distímicas a quiénes tratamos mediante psicoterapia y, a partir de ahí, se pusieron de manifiesto aquellos componentes “internos” que sustentan los síntomas depresivos. Estos mismos hallazgos se confirmaron en otras pacientes con idéntico diagnóstico. El resultado consistió en descubrir una desinserción sentimental respecto a sus parejas, permaneciendo con ellos sin separarse, al tiempo que van apareciendo insidiosamente las manifestaciones depresivas. Este desarrollo las lleva a la caída del “ideal de amor” al que aspiraban, que sostenía sus vidas y funcionaba como una “agarradera de la personalidad”. Tales apreciaciones ponen en cuestión las nociones clásicas acerca del “duelo” (AU)

In this article, we study two dysthymic women who we are treating with psychotherapy in order to reveal the inner components that maintain depressive symptoms. The same findings have been confirmed in other dysthymic patients. The result of the study consisted in discovering a sentimental separation from their love object, while the woman still lives with her partner and while the depressive symptoms are appearing insidiously. This development leads them to the deterioration in the “ideal of love” they sought, that supported their lives and served as an “anchor of their personality”. This point of view places classic notion about mourning into doubt (AU)

Fumar en las psicosis afectivas: revisión sobre el consumo de nicotina en el trastorno bipolar y esquizoafectivo / Smoking in affective psychosis: review about nicotine use in bipolar and schizoaffective disorders

Las psicosis afectivas incluyen aquellos trastornos con síntomas psicóticos y afectivos descritos en el DSM-IV-TR. En ellas, la prevalencia de la dependencia de nicotina es muy elevada. El objetivo es revisar la relación entre el consumo de nicotina y las psicosis afectivas a nivel epidemiológico, clínico, pronóstico, y de tratamiento. Se revisan los artículos publicados en la base PubMed que incluyen las palabras fumar, tabaco, nicotina y trastorno esquizoafectivo o bipolar. La comorbilidad del trastorno bipolar y el trastorno esquizoafectivo con el consumo de nicotina es de 66-82,5% y del 67% respectivamente. Tras esta revisión se puede concluir que el hábito tabáquico determina un peor pronóstico y mayor gravedad clínica del trastorno bipolar y esquizoafectivo. El consumo de otras sustancias, el diagnóstico, el consumo de cafeína y la gravedad clínica son factores de riesgo para el consumo de nicotina. El tratamiento más efectivo es el farmacológico en combinación con el psicológico. Los medicamentos de primera línea para la desintoxicación y deshabituación tabáquica son la terapia sustitutiva (parches transdérmicos, aerosoles, tabletas sublinguales, comprimidos para chupar o chicles de nicotina), la vareniclina y el bupropion. El tratamiento indicado para los síntomas psicóticos son los antipsicóticos atípicos por su mejor perfil de tolerabilidad y mejores resultados para el abandono del hábito tabáquico (AU)

Affective psychoses include those disorders with psychotic and affective symptoms described in the DSM-IV-TR. In these pathologies, the prevalence of nicotine dependence is very high. The objective here is to carry out a review of the relation between nicotine use and psychiatric disorders considered as affective psychoses at the epidemiological, clinical, prognostic and treatment levels. We review studies published in the PubMed database that include the keywords smoking, tobacco, nicotine and schizoaffective or bipolar disorder. Comorbidity of bipolar and schizoaffective disorder with nicotine consumption is 66-82.5% and 67%, respectively. On the basis of this review it can be concluded that smoking results in poorer prognosis and greater clinical seriousness of bipolar and schizoaffective disorders. Use of other substances, psychiatric diagnosis, clinical seriousness and caffeine consumption are risk factors for nicotine use. The most effective treatment approach is pharmacological treatment in combination with psychological interventions. The first-line medication for tobacco detoxification and dishabituation are substitution therapy (transdermal patches, sprays, sublingual tablets, sucking pills or nicotine chewing gums), varenicline and bupropion. The medically indicated treatment for psychotic symptoms is atypical antipsychotics, due to their better tolerability profile and better results in smoking cessation (AU)

Factores de riesgo para padecer trastornos psicóticos: ¿es posible realizar una detección preventiva? / Psychosis risk factors: is there a chance for preventive identification?

Introducción: Revisión de los factores de riesgo para las psicosis desde la perspectiva de la literatura internacional y desde la perspectiva de la experiencia clínica e investigadora del equipo. Objetivo principal: Se presenta el diseño y las primeras pruebas de un instrumento de exploración y cribaje de señales de alarma y factores de riesgo de trastornos mentales severos, y en especial trastornos psicóticos, aplicable en los primeros años de vida por parte de los servicios de atención primaria de salud y los equipamientos de salud mental vinculados con ellos. Se trata del LISMEN(Listado de ítems de Salud Mental en edades preescolares y escolares). Metodología: 5 muestras diferentes, tanto de edad infantil como de adultos. El trabajo se centra en la muestra A del Proyecto LISMEN: Se trata de un estudio descriptivo retrospectivo de los dossieres de los pacientes que han desarrollado una psicosis (N=838) y se habían visitado previamente, ya durante la infancia, en la misma Unidad de Salud Mental (N=120). Resultados: Se utilizan los resultados de las muestras anteriormente estudiadas para encuadrar el tema y presentar los primeros resultados de la muestra A: Estos señalan una constelación de factores de riesgo que aparecen ya en las historias o dossiers clínicos de la infancia de los pacientes que van a desarrollar una psicosis postpuberal. Conclusiones: Aunque hoy poseemos un amplio acervo de conocimientos sobre factores de riesgo de la esquizofrenia y otras psicosis, eso no implicaque podamos predecir el trastorno en base a los mismos. El LISMEN es un intento en ese sentido (AU)

This paper reviews risk factors associated with psychosis from both a literatureperspective and the clinical and research practice. The development of atool for the diagnosis and screening of alarm signs and risk factors of severemental disorders is described along with preliminary tests. The tool is aimedto be administered by primary health care systems and associated mentalhealth teams during a person’s early years. The tool is called LISMEN–standing for “list of mental health items at pre-school and school ages”.The list was administered to 5 different samples including children andadults. This paper focuses on Project LISMEN sample A. It is an investigationof medical records of patients who had developed a psychosis (N = 838). Anumber of them (N = 120) had already been assisted by the same MentalHealth Unit during their childhood. Samples already assisted were used as abenchmark for sample A preliminary results. A constellation of risk factors hadalready been identified in medical records during the childhood of people whowould develop a psychosis after their adolescence.Even though there is a broad pool of knowledge on risk factors associatedwith schizophrenia and other psychoses, this does not mean that prediction ofthe disorder can be made on this base. Nevertheless, LISMEN is a contributionin this direction (AU)

[Mixed affective disorders]. / Gemischt-affektive Störungen.

The Kraepelin concept of "mixed states" has experienced a renaissance over the last two decades. This has been caused by clinical as well as theoretically relevant factors. Of particular clinical relevance is the fact that more than 40% of all patients with bipolar disorders show at least one mixed affective episode during the course of their illness. However, the correct assessment and the precise classification of the symptoms are very important. A diagnosis according to the tight criteria of ICD-10 or DSM-IV, or perhaps based on the moderate Pisa or Cincinnati criteria, is recommended, whereas the use of broader definitions cannot be advised. Mixed schizoaffective episodes are under-diagnosed in comparison to pure affective mixed episodes, although both are defined by ICD-10 as well as by DSM-IV, and the frequency of occurrence is almost the same. Mixed schizoaffective episodes appear to be one of the most severe forms of bipolar disorders. Their clinical relevance is mainly caused by their unfavourable prognosis and difficulty in treatment. Atypical neuroleptics combined with anticonvulsives have proved to be more effective than any other psychopharmacological substances. The occurrence of mixed depressive and manic symptoms during one and the same episode is theoretically important, especially in the sense of their nosological and etiological differentiation.

Resolution of SPECT-determined anterior cerebral hypoperfusion correlated with maintenance ECT-derived improvement in residual symptoms in a case of late-life psychotic depression.

A 70-year-old widow with recurrent psychotic depression was successfully treated with maintenance electroconvulsive therapy (ECT) for 4 years up to the present. Anterior cerebral hypoperfusion visualized by single photon emission computerized tomography (SPECT) before ECT persisted (second SPECT study 14 days after the last ECT session) despite a response to the first course of acute ECT. Only mild symptoms remained. Relapse occurred 2 weeks after the post-ECT SPECT study. The hypoperfusion improved after response to a second course of acute ECT (per SPECT 5 days after the last ECT session), and perfusion was normalized after 2-year maintenance ECT (per SPECT 14 days after the last ECT session). The normalization coincided with improvement in depressive symptoms remaining after the second course of acute ECT. We speculate that the effectiveness of maintenance ECT might have been in part the result of the improvement in residual symptoms and that resolution of the persistent anterior hypoperfusion, which might underlie medical refractoriness, illness chronicity, and relapse tendency in late-life depression, might have been associated with the improvement in residual symptoms achieved by maintenance ECT.

Depresión en adolescentes hijos de padres emigrantes; estudiantes de Octavo, Noveno y Décimo años de Eduación Básica de los Colegios Mixtos Jorge Icaza y del Instituto de Investigación, Educación y Promoción Popular del Ecuador (INEPE) del Sur Occidente de Quito / Depression in Adolescent Children of parents Emigrants; eighth students, ninth and tenth years of Basic Education of the Mixed Schools Jorge Icaza and the Institute of Investigation, Education and Popular Promotion of Ecuador (INEPE) of the South Wes

En los adelscentes hijos de padres emigrantes; estudiantes de octavo, noveno y décimos años de educación básica en los Colegios mixtos Jorge Icaza y el Instituto de Investigación, Educación y Promoción Popular del Ecuador (I.N.E.P.E) del sur occidente de Quito, se investigó la prevalencia de depresión.Jóvenes que a consecuencia de la emigración de sus padres, experimentaron la desestructuración de su familia, quedando si el soporte emocional fundamental para su desarrollo normal en esta etapa de la vida.A todos los estudiantes de octavo, noveno y décimo años de educación básica de los dos establecimientos educativos se aplicó un primer cuestionario; el mismo que identificó los hijos e hijas de padres emigrantes y nos mostró una primera aproximación de su sentir ante tal situación

How long should patients with psychotic depression stay on the antipsychotic medication?

BACKGROUND: Patients who have major depression with psychotic features have greater morbidity and mortality than patients with nonpsychotic major depression. In particular, relapse and recurrence have been reported to occur more frequently in patients with psychotic depression than nonpsychotic depression. Despite the frequent relapse and recurrence in major depression with psychotic features, there are few studies of the efficacy of continuation and maintenance treatments. METHOD: Forty patients with a diagnosis of unipolar DSM-III-R major depression with psychotic features were treated with fluoxetine and perphenazine for 5 weeks after granting written informed consent. The patients who responded to treatment continued to receive the combination for an additional 3 months. If a patient was stable for 4 months on treatment with the combination, the patient was then gradually tapered off perphenazine treatment. For patients who exhibited impending relapse, perphenazine was restarted. Impending relapse was defined as any of the following: (1) symptoms meeting DSM-IV criteria for major depressive disorder (with or without psychotic features), (2) a total score of > or = 17 on the HAM-D, or (3) the presence of any psychotic symptoms. After 1 year of taking fluoxetine, patients were tapered off fluoxetine treatment. Data were gathered from 1992 to 1997. RESULTS: Thirty patients responded to the initial 5 weeks of treatment with perphenazine and fluoxetine. After taper of perphenazine following 4 months of treatment with fluoxetine and perphenazine, 22 (73%) of the 30 patients exhibited no signs of relapse over the next 11 months (8 months of fluoxetine monotherapy followed by a taper of fluoxetine and 3 additional months of assessment). Patients who showed signs of relapse after taper of the antipsychotic were more likely to have had a longer duration of the current episode and a history of more frequent past episodes and were more likely to be younger (under the age of 30 years). CONCLUSION: The data from this study suggest that a majority of patients who have major depression with psychotic features do not require treatment with antipsychotic medication for more than 4 months.

Estrogen administration does not reduce the rate of recurrence of affective psychosis after childbirth.

BACKGROUND: High rates of postpartum relapse occur in women with histories of bipolar or schizoaffective disorder. These relapses may be triggered by the postdelivery fall in circulating estrogen through alteration of central neurotransmitter (especially dopaminergic) systems. This study tested the hypothesis that estrogen administration after childbirth would prevent postpartum relapse and would alter dopamine receptor sensitivity. METHOD: Twenty-nine pregnant women with a Research Diagnostic Criteria diagnosis of hypomania (bipolar II), mania (bipolar I), or schizoaffective disorder participated in an open clinical trial. Three transdermal dose regimens of estrogen (17beta-estradiol) were tested. Starting doses were 200 (N = 13), 400 (N = 3), and 800 (N = 13) micro g/day, beginning within 48 hours after delivery and reduced by one half every 4 days for a total of 12 days. On the fourth day after starting estradiol therapy (before relapse occurred), subjects participated in a neuroendocrine challenge test that measured the sensitivity of the central nervous system (tubero-infundibular) dopaminergic system (plasma prolactin and growth hormone responses to apomorphine). RESULTS: Estradiol at all dose regimens did not reduce the rate of relapse. However, of the 12 women who relapsed, those who had taken the highest dose of estradiol (800 micro g/day) needed less subsequent psychotropic medication (fewer chlorpromazine equivalents) and were discharged sooner than those who had taken either of the 2 lower doses. No differences in neuroendocrine responses to apomorphine were detected between women receiving the high-dose and the lower-dose regimens. CONCLUSION: The results do not support the hypothesis that a fall in circulating concentrations of estrogens precipitates relapse in subjects at risk of postpartum affective psychosis. The use of prophylactic estrogen in such circumstances is therefore highly questionable.

Prediction and prevention of transition to psychosis in young people at incipient risk for schizophrenia.

The treatment of psychotic disorders, particularly schizophrenia, had been viewed with pessimism until a recent shift in focus from established or chronic illness to earlier phases of illness around the onset highlighted opportunities for enhanced recovery. Associated with this change in focus of research and clinical efforts has been the recognition that the biological and social changes underpinning the development of psychotic disorders may already be active in the pre-psychotic or prodromal phase. It has therefore been suggested that efforts toward the prevention of psychotic disorders should focus on the emerging illness. This article provides a review of work that has been conducted at the PACE Clinic in Melbourne, Australia since 1994. This clinical research program was established to develop strategies for the identification of young people at high risk of developing a psychotic disorder within a short period of time- primarily by virtue of recent mental state changes. Additionally, biological and psychological processes that have been proposed to underlie the development of illness have been investigated and potential preventive interventions have been evaluated.

[The use of verapamil for the prevention of relapses of affective and schizoaffective psychoses]. / Primenenie verapamila dlia profilaktiki retsidivov affektivnogo i shizoaffectivnogo psikhoza.

Efficiency of verapamil was studied in secondary prophylaxis of phasic affective disorders, 50 patients with affective and schizoaffective psychoses were treated during 2 years. Daily dose of verapamil was 80-320 mg (average dose-240 mg). Three groups were formed. Group 1 (10 patients) included patients which didn't receive any prophylactic therapy during previous 2 years. In group 2 (25 patients) and 3 (15 patients) verapamil was administrated after 2 years of prophylactic therapy with either lithium carbonate or carbamazepine, respectively. Clear prophylactic activity of verapamil was observed. There was preference of its reducing effect on the depressive phases. The data obtained and good tolerance of verapamil evidence for effectiveness of prolonged administration of this preparation as a drug with antirelapsed properties.

[The efficacy of lithium carbonate and Contemnol in preventing affective and schizoaffective psychoses]. / Effektivnost' karbonata litiia i kontemnola pri profilaktike affektivnykh i shizoaffektivnykh psikhozov.

Two groups of patients (30 patients in each group) were treated by lithium carbonate and contemnol. High preventive efficiency of both drugs was found: average annual duration of manic and depressive exacerbation as well as their frequency decreased practically by equal value--40-50%. The efficiency was somewhat higher in the group of patients treated by contemnol (80%) as compared with the group on lithium carbonate (70%). Total number of side-effects and spontaneous complaints was twice as much in prophylaxis by lithium carbonate. Wide application of contemnol in psychiatric practice for prophylaxis of aggravations (fits) of affective and schizoaffective psychoses is recommended.

5-HT brain function in affective disorder: d,l-fenfluramine-induced hormone release and clinical outcome in long-term lithium/carbamazepine prophylaxis.

Prolactin (PRL) and Cortisol (CORT) responses to d,l-fenfluramine (FEN) challenge (60 mg) were examined in patients with affective disorders on two occasions under euthymic conditions: drug-free before admission to prophylactic treatment and after about 9 months of medication with lithium or carbamazepine. Response to treatment was assessed by a complex algorithm using continuous ratings in outpatient clinic over a period of 2 years. In general, treatment resulted in a delayed and diminished CORT release (n.s.); subgroup analysis revealed an attenuated CORT response (P < 0.05) in responders, whereas nonresponders showed no change in CORT secretion pattern except an enhanced CORT baseline value (P < 0.05). Cross-sectional comparison of responders with nonresponders under medication yielded a trend for greater CORT stimulation in nonresponders. This result was not affected by FEN/NorFEN or lithium/carbamazepine serum levels, baseline CORT values, age, sex, diagnostic distribution, number of appointments to the outpatient clinic or duration of medication at the time of FEN test session. Before onset of prophylactic medication responders and nonresponders could not be discriminated significantly regarding stimulated hormone release, probably due to the small sample size (n = 17). CORT response to FEN was increased in drugfree unipolar patients compared to bipolar (P < 0.05) and to schizoaffective patients (P < 0.1). In accordance with its well-documented presynaptic 5-HT-agonistic action lithium medication resulted in a significantly greater increase in CORT release than carbamazepine (P < 0.05). Evaluation of PRL stimulation showed patterns of secretion quite similar to those of CORT, without reaching statistical significance in most cases. Perhaps due to methodological differences in assessing treatment response, these data do not confirm former results, which supposed an enhanced 5-HT net activity in long-term prophylactic lithium treatment. Because of high interindividual variances of hormone parameters, the FEN-test procedure is not a useful tool for the prediction of therapeutical outcome in terms of clinical routine use. Relations of stimulated hormone response as a marker of central serotoninergic activity and clinical outcome are discussed.

[Genetic counseling in psychiatric diseases]. / Genetische Beratung bei psychiatrischen Erkrankungen.

We review current knowledge and application of genetic counselling for psychiatric disorders. Empirical data for genetic counselling exist for affective disorder, schizophrenia, Alzheimer's and Huntington's disease. In Huntington's chorea and partly in Alzheimer's disease molecular genetic methodology may be applied, whereas for affective disorder and schizophrenia only empirical risk figures are available. We describe the principles of genetic counselling and their application in the respective diseases. Problems of presymptomatic testing are particularly outlined. In addition, teratogenic aspects of therapy with psychopharmacological agents during pregnancy are discussed.

[A trial of the use of nifedipine for preventing relapses in affective and schizoaffective psychoses]. / Opyt primeneniia nifedipina dlia profilaktiki retsidivov affektivnogo i shizoaffektivnogo psikhozov.

Nifedipine was applied for the secondary prophylaxis of affective phasic disorders. 21 patients with both affective and schizoaffective psychoses were treated with nifedipine for 1-3 years (mostly for 2 years) in a dose of 20-60 mg daily (usually 30-40 mg). The clear prophylactic effect of nifedipine was observed in 76.2% of cases. The duration of affective phases reduced by 44.8% while their frequency decreased by 40.4% as compared with the control group. The positive therapeutic effect was more pronounced for manic disorders (the transition of the disturbances to subclinical, ambulant level). The preventive effect of the drug was more clear in affective than in schizoaffective psychoses (91.7% and 55.6%, respectively) as well as it was more expressed in bipolar (84.6%) than in monopolar (62.5%) patients. The low frequency (23.8%) of side-effects occurred to be the positive characteristics of nifedipine treatment especially in long-term therapy.