Evaluation of thyroid function in lithium-naive bipolar patients.

A high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfunction parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.

[Obsessive-compulsive symptoms in schizophrenia: remission with anti-obsessive treatment]. / Síntomas obsesivo-compulsivos en la esquizofrenia: remisión con tratamiento antiobsesivo.

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.

Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy.

These guidelines for depot antipsychotic treatment in schizophrenia were developed during a two-day consensus conference held on July 29 and 30, 1995 in Siena, Italy. Depot antipsychotic medications were developed in the 1960s as an attempt to improve the long-term treatment of schizophrenia (and potentially other disorders benefiting from long-term antipsychotic medication). Depot drugs as distinguishable from shorter acting intramuscularly administered agents can provide a therapeutic concentration of at least a seven day duration in one parenteral dose. The prevention of relapse in schizophrenia remains an enormous public health challenge worldwide and improvements in this area can have tremendous impact on morbidity, mortality and quality of life, as well as direct and indirect health care costs. Though there has been debate as to what extent depot (long-acting injectable) antipsychotics are associated with significantly fewer relapses and rehospitalizations, in our view when all of the data from individual trials and metaanalyses are taken together, the findings are extremely compelling in favor of depot drugs. However in many countries throughout the world fewer than 20% of individuals with schizophrenia receive these medications. The major advantage of depot antipsychotics over oral medication is facilitation of compliance in medication taking. Non-compliance is very common among patients with schizophrenia and is a frequent cause of relapse. In terms of adverse effects, there are not convincing data that depot drugs are associated with a significantly higher incidence of adverse effects than oral drugs. Therefore in our opinion any patient for whom long-term antipsychotic treatment is indicated should be considered for depot drugs. In choosing which drug the clinician should consider previous experience, personal patient preference, patients history of response (both therapeutic and adverse effects) and pharmacokinetic properties. In conclusion the use of depot antipsychotics has important advantages in facilitating relapse prevention. Certainly pharmacotherapy must be combined with other treatment modalities as needed, but the consistent administration of the former is often what enables the latter.

HIV infection in psychiatric patients: an unlinked anonymous study.

BACKGROUND: Recent surveys suggest that psychiatric patients are at increased risk of being infected with HIV, although very little information is available concerning the seroprevalence of HIV infection among this population outside the US. The aim of this study is to determine the seroprevalence of HIV-I among patients admitted to a psychiatric in-patient unit and to gather linked anonymous risk-factor information. METHOD: An unlinked serosurvey was made, using HIV-1 antibody testing of remnant blood specimens collected for routine medical purposes, of patients consecutively admitted to an acute psychiatric unit in Madrid. RESULTS: Blood was obtained from 390 of the 477 eligible patients (81.8%). The prevalence of HIV was 5.1% (20/390). Patients aged between 18 and 39 accounted for 63.4% of the admissions and 75% of the positive results. Of the 29 patients who presented with injecting drug use, 14 were HIV-infected (48.3%; 95% CI 29.4 67.5). Of the 51 patients for whom any risk behaviour was noted on the admission chart, 18 were HIV-infected (35.3%; 95% CI 22.4 49.9). CONCLUSIONS: This study demonstrates that there is a substantial prevalence of HIV infection in psychiatric patients admitted to an acute in-patient unit. History of injecting drug use was strongly associated with seropositivity. Clinicians recognised risk factors for HIV infection in the majority of the HIV-infected cases.

Social phobia: a debilitating disease that needs treatment.

Social phobia is a recognized clinical condition and is at least as well defined as other psychiatric disorders in which no brain damage has been identified. There are both qualitative and quantitative differences between pathological and normal anxiety. The separation of social phobia from normal shyness is clear from the distress suffered, the impact on daily activities, the duration of the condition and the qualitative difference of the anxiety experienced in social phobia.

[Validity and reliability of the anticipatory cognition questionnaire. Study Group ACQ. Anticipatory cognition questionnaire]. / Validez y seguridad del cuestionario de cogniciones anticipatorias. Grupo de Estudio ACQ. El Cuestionario de Cogniciones Anticipatorias.

INTRODUCTION: From the cognitive perspective, the inability in order to advance the future positively, it is an essential characteristic in the depression. The Anticipatory Cognitions Questionnaire (ACQ), with eight items with a proposal cognitive-anticipatory, has been developed with the objective of detecting cases of depression by means of the screening of the existence of that difficulty of bringing forward. MATERIAL AND METHODS: It have been carried out a multicentric study between Spain and several countries of Spanish America (Argentina, Chile, Costa Rica, Mexico and Venezuela). For it, a Spanish version of the ACQ was used, agreed between the investigators of both sides of the Atlantic Ocean. Were interviewed 291 out and in depressed patients (CIE-10), and 158 healthy controls. Evaluated them in four serial occasions (two for the controls), using the ACQ, the Hamilton's and Zung's scales for Depression, and a Global Clinical Impression. RESULTS: From their outputs seems to deduce that the ACQ has a good internal consistency (alpha = 0.72), elevated temporal reliability (r = 0.81, good screening capacity for depression with a cut-off equal to "7" (kappa = 0.48-0.70), and good sensitivity to change. CONCLUSIONS: Everything it support that ACQ, in their Spanish version, it is an useful instrument for the ends that was developed.

Factors influencing relapse in the long-term course of schizophrenia.

Highly effective neuroleptic drugs have been available for the past 40 years, but 50% of schizophrenic patients, under normal treatment conditions, relapse within 1 year after their latest episode, frequently spending 15-20% of their time in psychiatric institutions. The term relapse usually refers to a deterioration or recurrence of positive rather than negative features, and relapses appear to impair the course of the disease. Impairment is often longer than expected for those patients who discontinue antipsychotic medication and then relapse to their prediscontinuation clinical state of function. Drug therapy is an important defense against relapse. Marked differences in relapse rate between patients receiving placebo and neuroleptic drugs have been observed (approximately 69% after 1 year for the placebo group versus 26% for the neuroleptic group). First-year relapse rates can be reduced from 75% to 15% with prophylactic treatment with neuroleptics. Follow-up studies suggest that noncompliance with medication, pharmacological factors, psychosocial factors and alcohol and drug abuse contribute to setting off new psychotic episodes. The most important of these is noncompliance with medication. The overwhelming majority of schizophrenic patients who suffered a clinical exacerbation and required hospitalization (73%) did not comply with the treatment prescribed. The effect of new antipsychotic agents should be examined in patients who relapse despite maintenance treatment with conventional neuroleptics. We have found that the rate of current drug abuse among patients with schizophrenic relapse (44%) was significantly higher than that in schizophrenic patients who regularly attended outpatient clinics. Also, the rate of alcohol and substance abuse is higher in males (79%) than in females (21%). Psychiatric units should integrate addiction treatments with psychotic-relapse management.

Ansiedad de separación y trastorno de pánico / Separation anxiety and panic disorder

Hemos revisado la literatura sobre la relación entre el trastorno de ansiedad de separación en la infancia y el trastorno de pánico en la edad adulta. La mayoría de los estudios apoyan esta relación al encontrar una mayor frecuencia de antecedentes de ansiedad de separación en los adultos con trastornos de ansiedad especialmente con trastorno de pánico. La ansiedad de separación parece estar implicada como un factor de riesgo precoz en el trastorno emocional del adulto. Además hemos presentado los datos de un estudio en el que se utilizó el sistema HLA para evaluar la distribución de los diferentes antígenos en los miembros de una familia con alta morbilidad de trastorno de pánico y de trastorno de ansiedad de separación. El objetivo era comprobar la existencia de los mismos haplotipos en los miembros afectados. Los resultados sugieren un componente genético común para el trastorno de pánico y el trastorno de ansiedad de separación ya que se encontró el mismo haplotipo en los seis miembros adultos de la familia con trastorno de pánico y en dos niños con trastorno de ansiedad de separación frente a la ausência en los miembros de la familia libres de estos trastornos.

[Neuroimaging and fundamental symptoms in schizophrenia]. / Neuroimagen y síntomas fundamentales en esquizofrenia.

The complexity of the clinical picture of schizophrenia is an essential feature of the disease that has led to attempts at organizing the symptoms and clinical course into different subtypes or grouping them into symptom constellations. Variations in response to treatment, particularly biological treatment, justifies the effort of differentiation. Various authors have tried to define primary or fundamental symptoms, that are directly related with the underlying abnormality, and secondary symptoms, which involve adaptive or reactive mechanism. Similarly, first-order symptoms, pathognomic symptoms, and second-order symptoms have been described. A constant latent problem in psychopathology is to determine the degree in which first-order symptoms are primary.

Open trial of fluvoxamine in the treatment of bulimia nervosa.

Twenty patients suffering from bulimia nervosa received 50-150 mg fluvoxamine daily for a period of 8 weeks. Primary end-points included the Eating Disorders Inventory (EDI), the Severity Index of Bulimic Condition (BINGE), Clinical Global Impression (CGI) scores, and the number of binge eating episodes per week. Other variables assessed included the 17-item Hamilton Depression Scale and adverse experience checklist. Compared with baseline, total EDI scores increased significantly from 137.8 to 155.3 after 8 weeks of fluvoxamine treatment (p < .001); CGI score fell significantly from 3.5 to 2.3 (p < .01) during this period. The mean number of binge eating episodes recorded by patients significantly decreased (p < .001). Further significant improvements in bulimic behavior were noted using the BINGE questionnaire. Nine of 20 patients complained of adverse experiences, all of which were mild; the most common symptoms were somnolence (n = 4) and insomnia (n = 3). Fluvoxamine appears to be a safe and effective treatment for bulimia nervosa.

[Serotonergic function and aggressive-impulsive behavior]. / Función serotoninérgica y conducta agresivoimpulsiva.

Considerable interest has been paid to the biological basis of the aggressive behavior, in the last two decades. The 5-HT function has been the most studied function in animal models, and studies carried out with either psychiatric patients, antisocial subjects, or normal people. An overwhelming evidence favors the importance of the 5-HT function in the modulation of aggressive behavior, particularly when 5-HT function is associated to loss of impulse control. Data from literature are reviewed. Results of a challenge serotonin test with fluoxetine in normal subjects are presented. The therapeutic implications of such studies are also discussed.

Función serotoninérgica y conducta agresivoimpulsiva. / [Serotonergic function and aggressive-impulsive behavior]

Considerable interest has been paid to the biological basis of the aggressive behavior, in the last two decades. The 5-HT function has been the most studied function in animal models, and studies carried out with either psychiatric patients, antisocial subjects, or normal people. An overwhelming evidence favors the importance of the 5-HT function in the modulation of aggressive behavior, particularly when 5-HT function is associated to loss of impulse control. Data from literature are reviewed. Results of a challenge serotonin test with fluoxetine in normal subjects are presented. The therapeutic implications of such studies are also discussed.

Course of schizoaffective psychosis: further data from a retrospective study.

This study investigated the clinical course and outcome of 72 patients, diagnosed as suffering from schizoaffective psychosis (according to ICD-9 criteria) who also satisfied Research Diagnostic Criteria for schizoaffective disorder. The current overall functioning of these patients was related to the number and frequency of episodes, regardless of the duration of the illness: the lesser the number or frequency of relapses, the better the overall functioning. In addition, there were no statistically significant differences in psychosocial impairment between bipolar and unipolar schizoaffective disorder.

[Genetic studies of panic disorder]. / Estudios genéticos del trastorno de pánico.

We review the literature on genetic factors in anxiety disorders and present data from a study in which we used the HLA system to evaluate distribution of different antigens in the members of a family with high morbidity of Panic Disorder. Our aim was to look for HLA haplotype sharing among the affected subjects. All members of the family were interviewed with the SCID interview to detect any psychiatric disorder. Third generation members under 18 were evaluated with a structured interview especially designed to identify separation anxiety disorder. In all cases we assessed 11 HLA-A, 16 HLA-B and 5 HLA-Cw antigens. The results suggest a genetic component for Panic Disorder, based on the presence of the same haplotype (A3B18) in the six members of the family suffering from Panic Disorder and Agoraphobia, compared with its absence in the others who were free of such disorders.

Course of schizoaffective psychosis: a retrospective study.

This study investigated the clinical course and outcome of 72 patients diagnosed as suffering from schizoaffective psychosis according to ICD-9 criteria who also satisfied RDC criteria for schizoaffective disorder. The results show a clear relationship between patients' overall functioning and premorbid personality: a better premorbid social adjustment indicates a better current state. Those who met DSM-III criteria for schizophrenic or schizophreniform disorder had an earlier age of onset and a higher frequency of relapse, followed by schizoaffective and affective patients. Patients who presented interepisodic psychotic symptoms differed from those who did not in that they showed more recurrences, an earlier age of onset and a premorbid personality with poorer social adjustment. The age of onset of the disease was significantly earlier in patients who had hyperthymic episodes. Schizoaffective disorders therefore are a heterogeneous group as regards premorbid personality, DSM-III diagnosis, and the presence or absence of interepisodic psychotic symptoms and hyperthymic episodes.

El test de supresion con dexametasona y la separacion endogena: no endogena de la depresion / El test de supresion con dexametasona y la separacion endogena: no endogena de la depresion

El Test de Supresion con Dexametasona (TSD) se ha propuesto como un marcador de estado de la melancolia, aunque existen resultados discrepantes seguin los autores. En nuestro trabajo, realizado con 117 pacientes hospitalizados diagnosticados de transtorno afectivo mayor y subclasificados seguin los criterios de Newcastle en endogenos (67) y no endogenos (50), encontramos una mayor frecuencia de respuestas anormales al TSD, en el grupo endogeno, aunque estos resultados no nos permitem afirmar que esta prueba pueda considerarse especifica de la depresion endogena.