Mitos y delirios: una reivindicación de Sarró / Myths and Delusions: A Vindication of Sarró

La experiencia mítica es consustancial a la especie humana. Para Carl Gustav Jung la experiencia mitopoyética era clave para el desarrollo de culturas, civilizaciones e individuos y una disfunción de la misma acarreaba enfermedad mental. Jung estableció una serie de arquetipos o patrones míticos recurrentes universales. Algunos autores, utilizando la psicología analítica jungiana como una protorreligión, proponen la equiparación del proceso místico con el esquizofrénico, aserto poco verosímil. Sin embargo el psiquiatra español Ramón Sarró, desde un abordaje mítico-fenomenológico, realizó estudios exhaustivos de los temas recurrentes de la esquizofrenia, a los cuales denomina mitologemas o deliremas. Sarró estableció que la temática predominante de los delirios esquizofrénicos es mítico-religiosa, si bien la religiosidad del paciente esquizofrénico es pseudomística. Modernamente se han hecho trabajos donde se ha visto la fecundidad del pensamiento de Sarró y su perfecto entronque y vigencia con la fenomenología psiquiátrica actual(AU)

Mythical experience is inherent to human beings. Carl Gustav Jung considered mythopoietic experience to be key in the development of cultures, civilizations and individuals, while its dysfunction led to mental illness. Jung established a series of archetypes or universally recurrent mythical patterns. Some authors, using analytical psychology as a proto-religion, propose to equate mystical process with the schizophrenic one, something not plausible. However, the Spanish psychiatrist Ramón Sarró, from a mythical phenomenological approach, researched exhaustively those recurrent themes of schizophrenia, which he labeled mythologemas or delusemas. Sarró held that the predominant themes in schizophrenic delusions are mythical-religious, though schizophrenic people religiosity is pseudo-mystical in nature. Nowadays, some works have illustrated the fertility of Sarró’s thoughts, and their compatibility and validity in relation to modern psychiatric phenomenology(AU)

Discrepancias diagnósticas entre la CIE-10 y el DSM-IV en los trastornos de personalidad / Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders

Introducción. Un 50 % de los pacientes atendidos en salud mental presentan trastornos de la personalidad; su diagnóstico es fundamental para el pronóstico y tratamiento de los pacientes. Habitualmente el clínico utiliza una de las nosologías, o la CIE-10 o la DSM-IV; es consciente de las diferencias entre ambas, pero da por buenos los resultados obtenidos con su nosología preferida. Material y método. Se incluyeron en el estudio 248 pacientes atendidos en un centro de salud mental con trastornos de ansiedad (n = 121) y trastornos depresivos (n = 127), con una media de edad de 32,3 años para los trastornos de ansiedad y de 32,4 años para los pacientes depresivos. Se les administró el Cuestionario de Screening IPDE en sus dos versiones (DSM-IV y CIE-10) para observar el grado de concordancia entre ambas nosologías. Resultados y discusión. En la muestra obtenida fue predominante la población femenina en tratornos de ansiedad (35,5 % hombres y 65,5 % mujeres) y en tratornos depresivos (29,10 hombres y 70,9 mujeres). Se realizó un estudio observacional en el que se valoró el porcentaje con tres o más ítems positivos y también el porcentaje con seis o más ítems positivos; es destacable que se obtiene mayor número de diagnósticos positivos y de comorbilidad con la versión DSM-IV del cuestionario de detección International Personality Disorders Examination (IPDE), por lo que se presenta la duda sobre si la CIE-10 subdiagnostica trastornos de la personalidad o el DSM-IV da falsos positivos. Además, hay diferencias cualitativas; que la CIE-10 subdivida en dos el trastorno límite de la personalidad, no incluya el trastorno narcisista de la personalidad y considere el trastorno esquizotípico de la personalidad una psicosis, hace que un paciente pueda recibir diferentes diagnósticos según se empleen criterios DSM-IV o CIE-10. Conclusiones. En la muestra estudiada de pacientes las discrepancias diagnósticas entre los trastornos de la personalidad con el DSM-IV y la CIE-10 son tan importantes que la Organización Mundial de la Salud y la Asociación Americana de Psiquiatría deberían considerar en las próximas nosologías la unificación de las categorías diagnósticas y los criterios diagnósticos en los trastornos de la personalidad

Introduction. 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient’s prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. Material and method. A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. Results and discussion. The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. Conclusions. In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies

Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders.

INTRODUCTION: 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient's prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. MATERIAL AND METHOD: A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. RESULTS AND DISCUSSION: The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. CONCLUSIONS: In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies.

Estudio sobre la eficacia y seguridad de la gabapentina en el trastorno límite de la personalidad / Safety and effectiveness of gabapentin in borderline personality disorder

Objetivos: Valorar la eficacia y la seguridad de la gabapentina en el tratamiento de la inestabilidad afectiva y la impulsividad de pacientes con trastorno límite de personalidad con escasa o nula respuesta al tratamiento previo. Pacientes y Método: Estudio abierto, prospectivo y multicéntrico, en condiciones asistenciales reales, de 6 meses de duración. Se evalúa el objetivo principal mediante la Escala de Impulsividad de Barratt, la Escala de Manía de Young, la Escala de Evaluación de la Depresión de Montgomery-Asberg, y la Escala de Ansiedad de Hamilton. Además, se valoró el estado general de los pacientes mediante la Evaluación Global de Funcionamiento (GAF) y la Impresión Clínica Global (ICG). Resultados: Los 73 pacientes que completaron el estudio fueron tratados con una dosis media de gabapentina de 1.800 mg/día. El cambio en las puntuaciones de todos los instrumentos de evaluación utilizados (visita final a los 6 meses frente a la visita basal) fue siempre estadísticamente significativo (p < 0,0001). Escala de Montgomery-Asberg: de 24,0 (ó = ± 10,2) basal a 7,2 (ó = ± 6,8) final. Escala de Young: de 5,7 (ó = ± 5,2) basal a 2,3 (ó = ± 3,9) final. Escala de Hamilton-A: de 20,3 (ó = ± 9,5) basal a 5,9 (ó = ± 5,7) final. Escala de Barratt: de 80,4 (ó = ± 14,3) basal a 66,9 (ó = ± 11,2) final. Escala GAF: de 54,1 (ó = ± 14,5) basal a 74,6 (ó = ± 12,2) final. ICG-G, de la puntuación: de 4,7 basal a 2,6 final. ICG-M: de 2,7 basal a 1,5 final. Conclusiónes: El tratamiento con gabapentina se ha manifestado eficaz y seguro en todos los parámetros evaluados, y es especialmente destacable su efecto ansiolítico

Aims: To evaluate the safety and effectiveness of gabapentin in the treatment of affective instability and impulsiveness in patients with borderline personality disorder with inadequate or nil response to prior treatment. Patients and Method: We performed an open, prospective, multicenter study under conditions of daily clinical practice for 6 months. The main aim was assessed using the Barratt Impulsiveness Scale, the Young Mania Rating Scale, the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Scale. In addition, patients' general health status was assessed using the Global Assessment of Functioning (GAF) and the Clinical Global Impression (CGI) scales. Results: Seventy-three patients completed the study. The mean dose of gabapentin was 1800 mg/day. The change in scores of all the rating scales used (final visit at 6 months versus baseline visit) was always significant (p < 0.0001). Baseline and final scores were as follows: Montgomery-Asberg scale: from 24.0 (ó = ± 10.2) to 7.2 (ó = ± 6.8); Young scale: from 5.7 (ó = ± 5.2) to 2.3 (ó = ± 3.9); Hamilton Anxiety scale: from 20.3 (ó = ± 9.5) to 5.9 (ó = ± 5.7); Barratt scale: from 80.4 (ó = ± 14.3) to 66.9 (ó = ± 11.2); GAF scale: from 54.1 (ó = ± 14.5) to 74.6 (ó = ± 12.2); CGI-severity from 4.7 to 2.6; and CGI-improvement: from 2.7 to 1.5. Conclusions: Treatment with gabapentin was safe and effective in all the parameters assessed. Particularly noteworthy was the drug's anxiolytic effect

[Psychotherapy of personality disorders]. / Psicoterapia de los trastornos de la personalidad.

A review of classical psychodynamic concepts in the psychotherapy of personality disorders (PD) is carried out. New approaches, such as dialectic behavioral therapy or cognitive analytic therapy, are also studied. Whenever possible, evidence is given on the efficacy of these approaches. The article finishes with a PD by PD study of relevant psychotherapeutic issues.

Psicoterapia de los trastornos de la personalidad / Psychotherapy of personality disorders

Se proporciona una revisión de los conceptos psicodinámicos clásicos en la psicoterapia de los trastornos de la personalidad (TP). Se estudian asimismo nuevos abordajes, como la terapia dialéctica conductual o la terapia cognitivo analítica. Cuando es posible, la evidencia sobre la eficacia de estos métodos es señalada. El artículo acaba con un estudio de los aspectos psicoterapéuticos más importantes de cada TP (AU)

[Factors associated to the diagnoses of borderline personality disorder in psychiatric out-patients]. / Factores asociados al diagnóstico de trastorno límite de la personalidad en pacientes psiquiátricos ambulatorios.

INTRODUCTION: Borderline personality disorder (BPD) is the most common personality disorder in clinical settings, however, this disorder presents diagnostic difficulties because of the own heterogeneous character. The purpose of this study was to describe and examine the possible relationship between clinic-psychobiographical aspects of the patients and diagnoses of BPD. METHOD: A transversal study was assessed in 73 psychiatric outpatients, by protocol of data collection about social and demographic aspects, psychobiographic aspects about childhood, sexual history and psychiatric earlier. International Personality Disorders Examination (IPDE) was used to evaluate the personality disorder. RESULTS: Borderline patients self-reported of traumatics experiences, physical and/or sexual abuse in childhood in more percentage than the group without BPD. Sexual identity disturbance and homosexual relations were associated with BPD. Psychiatry earlier of hospitalization, suicide attempts and substance use disorders were more frequent in BPD patients. CONCLUSIONS: These results suggest a profile that can be use to suspect a BPD and help to do precocious diagnoses.

Factores asociados al diagnóstico de trastorno límite de la personalidad en pacientes psiquiátricos ambulatorios / Factors associated to the diagnoses of borderline personality disorder in psychiatric out-patients

Introducción. Dentro de los trastornos de la personalidad el trastorno límite (TLP) es el más prevalente en poblaciones clínicas, sin embargo presenta dificultades diagnósticas en parte debidas a su propia heterogeneidad. El propósito de este estudio es describir y evaluar la posible relación entre variables clínico-psicobiográficas y el diagnóstico de TLP. Método. Se realizó un estudio de tipo transversal en 73 pacientes psiquiátricos ambulatorios, mediante un protocolo de recogida de datos que contenía aspectos sociodemográficos, psicobiográficos de la infancia e historia sexual y antecedentes psiquiátricos. Como instrumento de evaluación de la personalidad se utilizó el International Personality Disorders Examination (IPDE). Resultados. Los pacientes límites autoinformaban de experiencias traumáticas, abusos físicos y/o sexuales en la infancia en mayor proporción que el grupo sin TLP. Las dudas sobre la identidad sexual y la existencia de relaciones homosexuales eran características que diferenciaban a los pacientes con TLP. El análisis de los antecedentes psiquiátricos indicaba un mayor porcentaje de ingresos e intentos autolíticos y de trastornos por consumo de sustancias en el eje I. Conclusiones. La consideración de estas características sugieren un perfil que puede ser de utilidad al clínico para sospechar la existencia de un TLP ayudando a realizar un diagnóstico precoz. (AU)

Aspectos socioculturales en la génesis de los trastornos de la personalidad / Sociocultural aspects of the genesis of personality disorders

Los trastornos de la personalidad parecen estar en aumento en las últimas décadas. Muchos sociólogos e historiadores piensan que desde el final de la Segunda Guerra Mundial ha habido grandes cambios culturales, sociales y económicos, que podrían indicar que se ha entrado en una nueva edad: la Edad Postmoderna tras 500 años de Edad Moderna. La postmodernidad se caracteriza por un aumento de la velocidad en todos los ámbitos de la vida, cambios continuos, materialismo, predominio del modelo económico capitalista, cambios de roles, etc. Se especula sobre la posibilidad de que las características de la sociedad postmoderna pudiesen contribuir al aumento de la prevalencia de los trastornos de la personalidad en general, y de algunos en particular (AU)

[A study of the burnout syndrome in medical personnel of a general hospital]. / Estudio del síndrome de desgaste profesional entre los profesionales sanitarios de un hospital general.

INTRODUCTION: We studied the existence of the burnout syndrome, the state of general health and their relation with sociodemographic and work factors in the sanitary personnel of a Spanish general hospital. We established three professional categories A: physicians, B: nurses and technicians of a similar level, C: nurses' aides. MATERIALS AND METHODS: The sample studied includes a total of 363 individuals, both male and female. Of them 102 of category A, 168 of category B and 93 of category C. The instruments used for evaluation were a sociodemographic questionnaire, the Maslach Burnout Inventory (M.B.I.) and the Goldberg's General Health Questionnaire-28 (G.H.G. -28). RESULTS, DISCUSSION AND CONCLUSIONS: The results showed the existence of a middle degree of burnout in the sample studied not related neither with the profesional category nor with the sociodemographic factors studied. Some correlations were found between the burnout degree and general health with seniority, daily leisure time, smoking habits and use of analgesics and tranquillizers. 29.25% of the total sample presented bad general health (23% of group A, 30.7% of group B and 33.3% of group C).

[Archetypal aspects of aging: from Eros to Thanatos]. / Aspectos arquetípicos del envejecimiento: del Eros al Tánatos.

From a Junguian point of view, the different archetypal roles of the aging process, along the life cycle, are studied: eros, puer, logos, hero, persona, mascara, anima, animus, king, warrior, magician, lover, mother, virgin, afrodite, witch, self, senex, shadow, tanatos.

[The evaluation of personality disorders among inmates by IPDE and MMPI]. / Evaluación de trastornos de la personalidad en una población penal con el IPDE y el MMPI.

The prevalence of personality disorders in penal population was studied with two instruments, the classic MMPI and the recently published IPDE, authorized by the WHO for the diagnosis of personality disorders in both, DSM-IV and ICD-10 versions. A sample of 56 prisoners from a Spanish prison was studied, mean age 22, all male, 98% of them had never requested psychiatric help. The crimes most frequently committed were related to drug traffic and drug abuse (thefts, robberies, crimes against public health). There were also cases of homicide, homicide attempt, rape and kidnapping. 91% of the studied sample presented one or more personality disorders, being the most frequent: Antisocial (79%), Paranoid (52%) and Borderline (41%). The MMPI scales most frequently obtained were: Psychopathic deviation (59%), Paranoia (46%) and Schizophrenia (41%). There was a good clinical correlation between the IPDE and the MMPI results.

[Importance of the early diagnosis of malignant neuroleptic syndrome: report of 2 cases]. / Importancia del diagnóstico precoz del síndrome neuroléptico maligno a propósito de dos casos.

Two cases of neuroleptic malignant syndrome presented in a psychiatry inpatient unit are commented, as well as their positive evolution.

[The evolution of the concept of archetypes in Jungian psychology]. / Evolución del concepto de arquetipo en la psicología junguiana.

The concept of archetype is basic in the Junguian conception of the human mind. Without archetypes the Junguian theory of the collective unconscions is absurd. Jung himself recognized that the concept of archetype had originated the worst misunderstandings of his theories. Within Junguian schools there is an archetypal school which has originated archetypal conceptions quite apart from the initial junguian ideas. In this paper the evolution of the concept of archetype is studied, and its implications for the practice of Junguian psychotherapy are considered.