El metilfenidato en el trastorno por despersonalización: a propósito de un caso / Methylphenidate in depersonalization disorder: a case report

El síntoma de despersonalización aparece frecuentemente asociado a otros trastornos mentales, a efectos fisiológicos de substancias o a enfermedades médicas. Raramente, como es el caso presentado, las experiencias de despersonalización forman una entidad aislada, un trastorno de despersonalización primario. Entre los múltiples psicofármacos estudiados, ninguno de ellos ha demostrado ser el tratamiento de elección. Entre los que obtienen mejores resultados destacan: los antagonistas de los receptores de los opioides (naloxona y naltrexona), la combinación de inhibidores selectivos de la recaptación de la serotonina con lamotrigina y la clorimipramina. Y, aunque con prácticamente nula evidencia, se presenta un caso que respondió de forma espectacular al metilfenidato (AU)

The symptom of depersonalization is frequently associated with other mental disorders, physiological effects of substances or medical diseases. However, it is rare that, as in the case presented, the experiences of depersonalization form an isolated entity, a primary depersonalization disorder. Among the many psychoactive drugs studied, none of them has been shown to be the treatment of choice. Among those with which the best results are obtained are opioid receptor antagonists (naloxone and naltrexone), the combination of selective serotonin reuptake inhibitors with lamotrigine and clorimipramine. Although with virtually no evidence, we are presenting a case that responded spectacularly to methylphenidate (AU)

Methylphenidate in depersonalization disorder: a case report.

The symptom of depersonalization is frequently associated with other mental disorders, physiological effects of substances or medical diseases. However, it is rare that, as in the case presented, the experiences of depersonalization form an isolated entity, a primary depersonalization disorder. Among the many psychoactive drugs studied, none of them has been shown to be the treatment of choice. Among those with which the best results are obtained are opioid receptor antagonists (naloxone and naltrexone), the combination of selective serotonin reuptake inhibitors with lamotrigine and clorimipramine. Although with virtually no evidence, we are presenting a case that responded spectacularly to methylphenidate.

Factores de riesgo de aparición de esquizofrenia / Risk factors for schizophrenia

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Efectividad y seguridad del topiramato en el trastorno bipolar resistente / Effectiveness and safety of topiramate in treatment-resistant bipolar disorder

Introducción: Se describe un estudio abierto de serie de casos diseñado para evaluar la efectividad y seguridad de topiramato como tratamiento coadyuvante del trastorno bipolar fármacorresistente. Pacientes y método: Se reclutaron 21 pacientes con trastorno bipolar según criterios DSM-IV, considerados resistentes a litio, carbamacepina o valproico. Los pacientes dieron consentimiento informado para realizar el tratamiento coadyuvante con topiramato para su sintomatología maníaca (n= 9), depresiva (n= 6), hipomaníaca (n= 3), mixta (n= 2) o esquizoafectiva bipolar maníaca (n= 1). El estudio duró seis semanas durante las cuales el tratamiento eutimizante concomitante se mantuvo constante. Se evaluaron semanalmente a los pacientes con las escalas YMRS, HDRS-17 y CGI. Resultados: De los 21 pacientes iniciales, 15 completaron la totalidad del estudio. Seis pacientes (40 por ciento de los que terminaron el estudio, 29 por ciento por intención de tratar) fueron considerados como respondedores al tratamiento (reducción > 50 por ciento en la escala YMRS o HDRS-17 y disminución de dos o más puntos en la CGI). El tratamiento fue menos efectivo en aquellos pacientes con depresión inicial. El topiramato fue bien tolerado y sólo un paciente abandonó debido a efectos secundarios. El efecto adverso más frecuente fueron las parestesias (n= 2). Diez pacientes experimentaron descenso moderado de peso durante el estudio. La dosis media de topiramato al final del estudio fue de 158 mg/día. Conclusiones: Estos resultados preliminares sugieren que topiramato puede ser útil en el tratamiento del trastorno bipolar, con resultados prometedores incluso en los pacientes más refractarios a otras terapéuticas (AU)

Seizure activity and safety in combined treatment with venlafaxine and ECT: a pilot study.

Some authors have described the combined use of ECT and psychotropic drugs, emphasizing possible interactions and synergisms of this combined therapy. We are unaware of reports of the concurrent use of the new antidepressant venlafaxine with ECT. The goals of our study were to assess the possible effects of venlafaxine on seizure length during ECT and the possible cardiovascular effects of this combined treatment. Nine severely ill, depressed patients were treated simultaneously with bilateral ECT and venlafaxine 150 mg/day and were compared with nine control, depressed subjects taking tricyclic antidepressants (TCA) and ECT. No patients had prolonged seizures and no spontaneous/tardive seizures outside ECT were observed. With regard to mean seizure length, no statistically significant differences were observed between the control group and the venlafaxine group. Neither significant increases in arterial blood pressure nor electrocardiographic recording abnormalities were found in venlafaxine patients when compared with the tricyclic group. Even though the small number of patients used is a significant limitation of this study, we found that combined venlafaxine and ECT appears to be safe when used in depression.

Analysis of the polymorphic (GT)(n) repeat at the dopamine beta-hydroxylase gene in Spanish patients affected by schizophrenia.

The presence of a polymorphic (GT)(n) repeat, a microsatellite repeat, at the human dopamine beta-hydroxylase (DBH) gene had been previously investigated in healthy people and in schizophrenic patients. The different DBH genotypes had been found to be associated to different DBH biochemical function, but no differences were found in the allelic and genotype frequencies between schizophrenic and control groups. To further clarify the potential involvement of the variation at the DBH gene in schizophrenia we have studied the DBH (GT)(n) repeat in a sample of 47 Spanish schizophrenic patients, in their healthy relatives (n = 72), and in a control population (n = 74). We have been able to identify five different variants of the DBH gene (A1, A2, A3, A4, A5) in the different groups. Subsequent statistical analysis revealed that the genotypes as well as the allele frequencies did not differ significantly among schizophrenic patients and the control population. Interestingly, the allelic variant A2 and the genotype A4/A2 were significantly more frequent in schizophrenic patients as compared with their healthy relatives. However, the association of the A2 allele with schizophrenia was not supported by the haplotype relative risk analysis of transmitted versus nontransmitted alleles. Therefore, although it will be important to extend the present analysis in a larger sample of schizophrenic patients and controls, our results suggest that the (GT)(n) does not seem to play a major role in the genetics of schizophrenia at least in this group of Spanish schizophrenic patients. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:88-92, 2000.

[Management and treatment of severe mental disorders in pregnancy]. / El manejo y el tratamiento de los trastornos mentales graves en la embarazada.

The pharmacological treatment of serious mental disorders in the pregnancy, supposes a clinical dare by the possible repercussions on the fetus and the pregnancy: theratogenesis, perinatal syndrome or postnatal sequels in the development. The electroconvulsive therapy (ECT) as much takes implicit a minimum risk for the mother as for the fetus and therefore, it must be located in the highest positions of the therapeutic decision trees. In the present article, are reviewed the consequences of the pharmacological treatment and the ECT in the serious mental disorders during the pregnancy. Is referenced to all of the pharmacological groups and with respect to the ECT: their indications, counterindications, complications and technical procedures advisables. Finally is reviewed the guide line for each syndromical group of psychiatric diseases.

[The management and treatment of severe mental disorders in pregnancy]. / El manejo y el tratamiento de los trastornos mentales graves en la embarazada.

The pharmacological treatment of serious mental disorders in the pregnancy, supposes a clinical dare by the possible repercussions on the fetus and the pregnancy: theratogenesis, perinatal syndrome or postnative sequels in the development. The electroconvulsive therapy (ECT) as much takes implicit a minimum risk for the mother as for the fetus and therefore, it must be located in the highest positions of the therapeutic decision trees. In the present article, are reviewed the consequences of the pharmacological treatment and the ECT in the serious mental disorders during the pregnancy. Is referenced to all of the pharmacological groups and with respect to the ECT: their indications, counterindications, complications and technical procedures advisables. Finally is reviewed the guide line for each syndromical group of psychiatric diseases.

[Patterns of the use of electroconvulsive therapy in Barcelona]. / Patrones de uso de la terapéutica electroconvulsiva en Barcelona.

BACKGROUND: To study the prevalence of use and the characteristics of current utilization of electroconvulsive therapy (ECT) in Barcelona. METHODS: A descriptive study was carried out in August of 1993. A structured interview designed by the authors was administered to psychiatrists in 20 hospitals, including general hospitals with Department of Psychiatry and psychiatric hospitals. RESULTS: In 12 hospitals of the sample (60%) ECT was practised. The most frequent indication was depression (83%) followed by schizophrenia (17%). In all these hospitals pharmacological treatment was simultaneously used and the application of electrodes was bilateral. Most of them used stimulation by sinusoidal wave, thiopental was used as anesthetic agent, the duration of seizures was not evaluated, EEG monitoring was not performed and treatment in a surgeon's room was not applied. In 10 hospitals written consent was obtained. CONCLUSIONS: ECT was used in general hospitals with psychiatric department of Barcelona, Spain, with high coincidence in indications but not in the technical aspects.