Self-reported Sexual Response in Transgender Women to Audiovisual Stimulation Protocol / Autoinforme de Respuesta Sexual en Mujeres Transgénero ante un Protocolo de Estimulación Audiovisual

Abstract Sexuality changes associated with the medical transition in transgender women are not well known; the few studies present discrepancies in labeling their sexual orientation and controlling surgery conditions. This study aimed to evaluate the self-reported sexual response to audiovisual sexual stimulation protocol in androsexual transgender women on hormone replacement therapy. This study also evaluated their sexual functioning to support the empirical protocol. Participated androsexual transgender women with (n = 16) and without hormone therapy (n = 15) in a non-sex reassignment surgery condition. Androsexual cisgender men (n = 25) and women (n = 24) also were included as contrast groups. All participants were assessed with the Short Form of the Changes in Sexual Functioning Questionnaire; then watched video clips with neutral and sexual content and informed their sexual responses through two self-report scales adapted from the Film Scale. The results showed trans women with hormone therapy, compared to trans women without treatment, experienced a less selective sexual response to sexual stimuli. Also, they registered the lowest scores for every sexual functioning except for pleasure. In conclusion, transgender women on hormone therapy without sex reassignment surgery showed fluidity in their self-reported sexual response and reduced sexual functioning.

Resumen Poco se conoce de los cambios en la sexualidad de las mujeres transgénero que se encuentran bajo un proceso de transición médica. El objetivo de este estudio fue evaluar el autoinforme de la respuesta sexual de las mujeres transgénero bajo terapia hormonal y sin cirugía de reasignación de sexo ante un protocolo de estimulación sexual audiovisual, así como el funcionamiento sexual general para robustecer los resultados del protocolo. Participaron mujeres transgénero sin cirugía de reasignación de sexo con (n = 16) y sin terapia hormonal (n = 15), así como hombres (n = 25) y mujeres (n = 24) cisgénero como grupos de contraste. Todas las personas que participaron reportaron una atracción androsexual. Se evaluaron con la Versión Abreviada del Cuestionario de Cambios en el Funcionamiento Sexual, posteriormente observaron videos con contenido neutro y actividad sexual entre dos mujeres, dos hombres y entre mujer y hombre, y reportaron su respuesta sexual a través de dos escalas de autoinforme adaptadas de la Film Scale. Los resultados mostraron que las mujeres trans bajo terapia hormonal, a comparación de las mujeres trans sin tratamiento, tuvieron una respuesta sexual menos selectiva, aunque esta fue similar a la de las mujeres cisgénero, además puntuaron más bajo para todos los rubros del cuestionario de funcionamiento sexual, excepto para el placer. En conclusión, las mujeres transgénero en terapia hormonal muestran fluidez en su respuesta sexual autoinformada, así como una disminución en el funcionamiento sexual. Estos datos pueden ofrecer un entendimiento más amplio del tratamiento médico y psicológico, con la finalidad de mejorar la atención a la población trans.

Síndrome de jet lag o cambio de zonas de tiempo / The jet lag syndrome or time-zone changes

Resumen Nuestro planeta, así como la vida que en él se desarrolla, se encuentra en constante movimiento. Los ritmos geofísicos influyen en la actividad de los organismos, de tal manera que los seres vivos han desarrollado mecanismos adaptativos para poder responder a las variaciones diarias del medio ambiente. El sistema circadiano es el responsable de responder a estas variaciones cíclicas ambientales. Cuando se modifican las señales ambientales, como en un viaje que implica atravesar varias zonas horarias, se ocasionan cambios fisiológicos que han llevado a buscar estrategias para contrarrestar los síntomas que se presentan; estas estrategias incluyen el ejercicio programado, la exposición a la luz brillante, la melatonina y la alimentación programada.

Abstract Our planet and the life that develops in it are in constant movement, therefore, the geophysical rhythms influence the activity of organisms, in such a way that living beings have developed adaptative mechanims in order to respond to the daily variations of the environment. The circadian system is responsible for responding to these cyclical environmental variations. When the environmental signals are modified, like for instance, on a trip that involves crossing several time zones, physiological changes occur. This results in searching for possible strategies to counteract the symptomatology. These strategies include scheduled exercise, exposure to a bright light, melatonin and scheduled meals.

La diversidad sexo-genérica: Un punto de vista evolutivo / Sexual-gender diversity: An evolutionary point of view

Introducción Hay un grupo de gente con una incoherencia entre el género y su sexo biológico (fenotipo) con el género de autopercepción. Las diferencias entre esta condición y la orientación sexual nos dan una serie de subtipos de género y de diversidad sexual: transexuales, travestis y transgéneros, homosexuales, heterosexuales, bisexuales y asexuales. Objetivo Revisar las evidencias que puedan apoyar si la diversidad de género y la orientación sexual son estrategias evolutivas. Método Se consultaron documentos históricos, médicos y políticos sobre el nacimiento de los conceptos de género y orientación sexual en The National Library of Medicine. Estos se actualizaron en una revisión de la literatura científica de los últimos cincuenta años en los sistemas SCOPUS, PubMed y Science Direct. Se utilizaron las palabras: homosexuality, transsexuality, gender y evolution. Resultados Debido a que la reproducción sexual es tan indispensable y celosamente seleccionada, para continuar la combinación genética, la existencia de la homosexualidad y la transexualidad son una paradoja evolutiva. Hay una gama de este tipo de conductas en los animales de reproducción sexual, en mamíferos, aves, reptiles y peces. Hasta el momento sólo hemos utilizado el comportamiento animal para ilustrar la naturalidad de la homosexualidad. En esencia: hay animales homosexuales en la naturaleza. Por lo tanto, la homosexualidad es natural, y en este artículo se presentan las explicaciones evolutivas al respecto. La transexualidad es una cuestión de género, y en la psiquiatría contemporánea sigue siendo calificada como una enfermedad mental, llamada "disforia de género". Discusión y conclusión Hay bases biológicas para esta alternativa particular en los seres humanos, en los que el papel de los niveles de hormonas elevados, los anticuerpos contra los receptores de testosterona, el orden del nacimiento y el uso de algunas drogas se discuten en el presente artículo. Comprender que los seres humanos no son una especie dicotómica es el objetivo principal de este trabajo, ya que en el homo sapiens, las diferencias en muchos aspectos de nuestras funciones es la norma que nos hace tan diferentes, pero al mismo tiempo iguales en derechos básicos como seres humanos.

Introduction There are people with a gender incoherence between their biological gender (phenotype) and the self-perception gender. Differences among such condition and sexual orientation give us more subtypes of gender and sexual diversity: transsexual, travesties and transgender, homosexual, heterosexual, bisexual and asexual. Objective To review if there are well supported evidences about sexual and gender diversity as part of evolutionary strategies. Method Medical and political historical documents about the birth of the concepts of gender and sexual orientation were consulted at The National Library of Medicine. These were updated, in a review of the scientific literature of the last fifty years in SCOPUS, PubMed and Science Direct systems. The following words were used: homosexuality, transsexuality, gender and evolution. Results Because sexual reproduction is so indispensable and so zealously selected, the existence of homosexuality and transsexuality is a kind of paradox. One must wonder: why would not evolution quickly select against behavior, which diverts an animal from sexual reproduction? Yet despite this apparently unlikelihood homosexuality does exist. Homosexuality is also the innate sexual preference for one's own gender or the biological urge for same-sex coitus. So despite popular non-recognition of the phenomenon, natural history observations have revealed a wide range of homosexuality throughout the animal kingdom. To account for homosexuality -or any phenomenon- using evolution, it is necessary that it be natural, i.e. it must occur naturally without human influence. Thus, animal behavior is used to illustrate the naturalness of homosexuality. In essence: there are homosexual animals in nature; therefore homosexuality is natural. Transsexuality is a gender issue, and in psychiatry remains as a mental disease named "gender dysphoria". Discussion and conclusion There is some biological basis for these particular human beings, in whom the role of high levels of hormones, antibodies against testosterone receptors, order or birth is also discussed in the present article. To understand that humans are not a dichotomist species is the main goal of this work, as homo sapiens differences in many aspects of our functions are the norm.

Adenosine and sleep homeostasis in the Basal forebrain.

It is currently hypothesized that the drive to sleep is determined by the activity of the basal forebrain (BF) cholinergic neurons, which release adenosine (AD), perhaps because of increased metabolic activity associated with the neuronal discharge during waking, and the accumulating AD begins to inhibit these neurons so that sleep-active neurons can become active. This hypothesis grew from the observation that AD induces sleep and AD levels increase with wake in the basal forebrain, but surprisingly it still remains untested. Here we directly test whether the basal forebrain cholinergic neurons are central to the AD regulation of sleep drive by administering 192-IgG-saporin to lesion the BF cholinergic neurons and then measuring AD levels in the BF. In rats with 95% lesion of the BF cholinergic neurons, AD levels in the BF did not increase with 6 h of prolonged waking. However, the lesioned rats had intact sleep drive after 6 and 12 h of prolonged waking, indicating that the AD accumulation in the BF is not necessary for sleep drive. Next we determined that, in the absence of the BF cholinergic neurons, the selective adenosine A1 receptor agonist N6-cyclohexyladenosine, administered to the BF, continued to be effective in inducing sleep, indicating that the BF cholinergic neurons are not essential to sleep induction. Thus, neither the activity of the BF cholinergic neurons nor the accumulation of AD in the BF during wake is necessary for sleep drive.

Caffeine challenge in insomniac patients after total sleep deprivation.

BACKGROUND AND PURPOSE: This study compared the effects of caffeine in patients with primary insomnia and normal volunteers. The main goal was to determine the differences in sensitivity to caffeine between the groups. We investigated the effects on daytime sleep of placebo or caffeine after a night of total sleep deprivation (SD). We hypothesized that insomniacs would be more affected by caffeine, which would suggest a change in adenosine receptor (number or sensitivity) in primary insomniacs. PATIENTS AND METHODS: Six primary insomnia patients (Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) and six normal volunteers with no sleep complaints participated in a double-blind study with caffeine or placebo administered under a cross-over design with each subject serving as his or her own control. The participants did not have a history of drinking coffee or caffeinated beverages. Data from all-night polysomnography and multiple sleep latency test (MSLT) were collected in the sleep research laboratory of National Institute of Medical Sciences and Nutrition Salvador Zubirán. RESULTS: During the baseline night, patients with insomnia had significantly less delta sleep and less total sleep time than the normal volunteers. Mean sleep latency under basal MSLT did not differ between the groups. However, insomnia patients had significantly less total sleep during each nap compared to normal volunteers. After one night of total SD and under caffeine administration, the insomniacs had significantly longer sleep latency and less total sleep time in MSLT compared to normal volunteers. After SD, healthy volunteers reduced sleep latencies in MSLT with or without caffeine. CONCLUSIONS: Patients with insomnia had a higher sensitivity to the diurnal awakening effect of caffeine even after one night of SD. This suggests that changes in the adenosine receptors could, in part, be responsible for the hyperarousal state that has been reported in primary insomnia.

Low delta sleep predicted a good clinical response to olanzapine administration in schizophrenic patients.

INTRODUCTION: Schizophrenic patients show sleep abnormalities, consisting mainly of decreased delta sleep time, short rapid eye movement (REM) sleep latency, and a reduction in sleep continuity variables. Olanzapine is a novel antipsychotic drug with an atypical profile. The goals of the present study were to determine if pre-treatment sleep variables and the initial response to olanzapine administration on the sleep variables can predict the clinical improvement after eight weeks of treatment. MATERIAL AND METHODS: Twenty-one schizophrenic (DSM-IV) patients were studied. They were clinically evaluated using the positive and negative syndrome scale (PANSS), and the Calgary Depression Scale for Schizophrenia. Sleep recordings were as follows: one acclimatization nigh, one night of baseline recordings, and two nights in which the patients receives olanzapine 10 mg, one hour before bedtime. For sleep-comparison purposes, a group of normal volunteers were also studied with acclimatization and baseline nights. After the sleep recordings ended patients continued with the administration of 10 mg/d of olanzapine, that was titrated as needed up to 20 mg/d or down to 5 mg/d. Evaluations were conducted weekly. RESULTS: Awakening and sleep latency variables were significantly higher in schizophrenic patients compared to normal volunteers. Delta sleep was lower in patients than in normal subjects, with no detectable values in some of the schizophrenics. There was not correlation at baseline, between psychopathological scores and delta sleep or other sleep variables. The acute administration of olanzapine 10 mg produced an improvement in continuity sleep variables as well as increase in deltas sleep percentage. Having less than 10% of delta sleep at baseline predicted a good clinical outcome. Eleven of 18 patients showed good clinical improvement after eight weeks of treatment with olanzapine, those were the subjects that had an augmentation of delta sleep above 10% with the first two doses of olanzapine, with minimal side effects. CONCLUSIONS: To have low delta sleep at baseline and the effect of the augmentation of this variable in schizophrenic patients seems to predict a good response to olanzapine. Olanzapine was therapeutically useful, well-tolerated medication, with a favorable safety profile.

Effects of hypocretin2-saporin and antidopamine-beta-hydroxylase-saporin neurotoxic lesions of the dorsolateral pons on sleep and muscle tone.

The hypocretin neurons have been implicated in regulating sleep-wake states as they are lost in patients with the sleep disorder narcolepsy. Hypocretin (HCRT) neurons are located only in the perifornical region of the posterior hypothalamus and heavily innervate pontine brainstem neurons, such as the locus coeruleus (LC), which have traditionally been implicated in promoting arousal. It is not known how the hypocretin innervation of the pons regulates sleep-wake states as pontine lesions have never been shown to increase sleep. It is likely that in previous studies specific neurons were not lesioned. Therefore, in this study, we applied saporin-based neurotoxins to the dorsolateral pons and monitored sleep in rats. Anti-dopamine-beta-hydroxylase-saporin killed the LC neurons but sleep was affected only during a two hour light-dark transition period. Application of hypocretin2-saporin killed fewer LC neurons relative to other adjacent neurons. This occurred because the LC neurons possess the hypocretin receptor 1 but the ligand hypocretin 2 binds to this receptor with less affinity relative to the hypocretin receptor 2. The hypocretin2-saporin lesioned rats compared to controls had increased sleep during the dark period and displayed increased limb movements during REM sleep. None of the lesioned rats had sleep onset REM sleep periods or cataplexy. We conclude that the hypocretin innervation to the pons functions to awaken the animal when the lights turn off (via its innervation of the LC), sustains arousal and represses sleep during the rest of the night (via a wider innervation of other pontine neurons), and modulates muscle tone.

[Prevalence of psychiatric disorders in patients with severe obesity waiting for bariatric surgery]. / Prevalencia de trastornos psiquiátricos en pacientes con obesidad extrema candidatos a cirugía bariátrica.

INTRODUCTION: Obesity is a chronic condition, in which different systems of the body are affected. There are some previous studies in which the prevalence of psychiatric disorders in extreme obese patients has been reported, but there are some methodological problems. As far as we know this is the first report of the prevalence of psychiatric disorders in obese patients that need to have a surgical treatment for this disorder in Mexico. The main goal of this study was to determine the prevalence and risk factors of psychiatric disorders in extreme obese patients candidates to bariatric surgery. MATERIAL AND METHODS: The Structured Clinical Interview for DSM-IV (SCID) axis I disorders, were performed in 70 obese patients that will undergo for bariatric surgery. Also the medical files were reviewed in order to obtain the main medical conditions related to obesity. RESULTS: There were 25 men and 35 women in this study (average age +/- s.d = 39.0 +/- 10.4). The Body Mass Index (BMI) was 53.8 +/- 11.9. Sixty percent of the patients had some psychiatric disorder in the axis I of DSM-IV. The most frequent psychiatric problem that was observed was anxiety disorders. The main medical problems observed were: arterial hypertension (59%), diabetes mellitus type 2 (29%) and obstructive sleep apnea syndrome (29%). The BMI and diabetes mellitus were associated with a lower risk for presenting a psychiatric disorder (for a BMI of 65.5 +/- 10.3 kg/m2: OR 0.26, CI 0.05-1.15, p = 0.04; for diabetes mellitus: OR 0.20, CI 0.03-1.05, p = 0.02). CONCLUSIONS: More than half of the patients had at least one psychiatric disorder in axis 1 of DSM-IV, related mostly to anxiety and mood disorders. Our findings point out the importance of psychiatric and psychological intervention in this group of patients, in which a follow up and adherence of medical, nutritional and psychological problems could be the difference, between a good or bad prognosis. Follow-up studies with obese patients after bariatric surgery, will be important to support our findings.

Narcolepsy-like symptoms in a patient with down syndrome and without obstructive sleep apnea.

OBJECTIVE: The study reports on a 33-year-old Caucasian female with Down syndrome and narcolepsy-like symptoms. METHOD: After medical and genetic screening, docturnal polysomnography followed by a Multiple Sleep Latency Test and HLA typing were performed. The patient was medication free and reported a number of cataplexy attacks everyday. Each time that she came to the sleep disorders clinic, she was observed to have cataplexy. She also felt extremely drowsy. A mean sleep latency of 8.8 minutes with 4 sleep-onset rapid eye movement periods in the Multiple Sleep Latency Test, with no other sleep disorder that accounts for the symptoms, was obtained. The patient was DQB1*0301, DQB1*0602, as revealed by the last high-resolution serologic typing.

Changes in compulsion and anxiety symptoms with nicotine transdermal patches in non-smoking obsessive-compulsive disorder patients.

OBJECTIVE: Some of the obsessive-compulsive disorder (OCD) symptoms can be elicited in rats by the administration of quinpirole (D2/D3 dopaminergic agonist). Nicotine administration blocked some aspect of checking behavior in that model. The main goal of this study was to determine if the clinical manifestations of OCD non smoking patients change with the administration of transdermal nicotine patches. MATERIAL AND METHODS: Eleven patients were studied (6 female and 5 males), average age 29.7 +/- 5.5 years. All of them were OCD according to DSM-IV criteria. Clinical scorings were done with Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Nicotine (17.5 mg/day) or placebo transdermal patches were randomly administered for five continuous days. RESULTS: Nicotine administration reduced the total Y-BOCS and the compulsive score of that scale, but did not reduce obsessions. Also anxiety was reduced as was shown by the BAI scores, when patients were on nicotine patches, no changes were observed in BDI. CONCLUSIONS: The present results replicated the animal findings about reduction in compulsive behavior after nicotine administration. Also suggest that nicotine depending on the dysfunction of the different neurotransmitter systems may produce different behavior or cognitive effects, also that even nicotine showed some beneficial effect in OCD patients, the low rate of nicotine smoking in this type of patients, may show other mechanisms than may protect to smoke in some psychiatric patients.

Nicotine dependence and psychiatric disorders.

Nicotine addiction is the single largest preventable cause of morbidity and mortality in the Western World. Smoking is not any more just a bad habit, but a substance addiction problem. The pharmacological aspects of nicotine show that this substance has a broad distribution in the different body compartnents, due mainly to its lipophilic characteristic. There are nicotinic receptors as members of cholinergic receptors' family. They are located in neuromuscular junction and in the central nervous system (CNS). Although they are similar, pentameric structure with an ionic channel to sodium, there are some differences in the protein chains characteristics. Repeated administration of nicotine in rats, results in the sensitization phenomenon, which produces increase in the behavioral locomotor activity response. It has been found that most psychostimulants-induced behavioral sensitization through a nicotine receptor activation. Nicotine receptors in CNS are located mainly in presynaptic membrane and in that way they regulated the release of several neurotransmitters, among them acetylcholine, dopamine, serotonin, and norepinephrine. In some activities like sleep-wake cycle, nicotine receptors have a functional significance. Nicotine receptor stimulation promotes wake time, reduces both, total sleep time and rapid eye movement sleep (REMS). About nicotine dependence, this substance full fills all the criteria for dependence and withdrawal syndrome. There are some people that have more vulnerability for to become nicotine dependent, those are psychiatric patients. Among them schizophrenia, major depression, anxiety disorders and attention deficit disorder, represent the best example in this area. Nicotine may have some beneficial effects, among them are some neuroprotective effects in disorders like Parkinson's disease, and Gilles de la Tourette' syndrome. Also there are several evidences that support the role of nicotine in cognitive improvement functions like attention, concentration, and memory. Finally there are several strategies to deal with nicotine dependence, Nicotine Replacement Therapy (NRT), which are nicotine chewing-gum, transdermal nicotine patches, and nicotine inhalators device. Also some antidepressants like bupropion has shown to be effective in smoking cessation treatment. To know more about nicotine phenomenon would be important, because that will allow a more mature perspective about the damage and beneficial effects of that substance.

Effects of hypocaloric diet on sleep in young and old rats.

Aging produces a loss in a number of behavioral and cognitive functions, including sleep. Hypocaloric diet is one of the few methods that have been shown to retard the effects due to age. However, the effects of such a diet on sleep have never been investigated. In the present study, 21 months old male F344 rats fed a 60% calorie-reduced diet continued to have a significant reduction in delta power (0.3-4 Hz EEG), less sleep following 12 h total sleep deprivation (TSD) and increased sensitivity to caffeine compared to young rats (3 months) fed a similar diet. These results indicate that caloric restriction is unable to prevent the decline in sleep that occurs with aging.

Relationship between mood improvement and sleep changes with acute nicotine administration in non-smoking major depressed patients.

BACKGROUND: Acute administration of nicotine patches produced rapid eye movement sleep (REM) increases in non-smoking major depressed patients as well as clinical improvement in mood. Antidepressant effect was also observed after four continuous days of nicotine administration. The main goal of the present study was to observe the relationship between changes in REM sleep variables and mood in non-smoking major depressed patients. METHOD: Fifteen major depressed patients (DSM-III-R) were studied under the following sleep laboratory conditions: habituation, two all-night polysomnography recordings, the first one was baseline and the second one was nicotine patch (17.5 mg) night. Patients should had a HAMD-21 punctuation equal or above 18 points for to be admitted in the study. A short HAMD (10 items), and side effect scale was used daily during the two recording nights. RESULTS: A significant increase in REM sleep time and reduction in sleep stage II was observed when patients were on nicotine patches. Ten patients improved (reduction of 30% in the HAMD of 10 items), the morning after nicotine. All of them also increased REM sleep time above their baseline. Eight patients from the one with significant improvement had a short REM sleep latency below 60 minutes at baseline. CONCLUSIONS: The hypersensitivity of the cholinergic system may be related to the REM sleep enhancement effect observed in some of the patients when received nicotine and also related to the clinical improvement. The role of the acetylcholine in depression could be explored with the administration of transdermal nicotine patches.

Relationship between mood improvement and sleep changes with acute nicotine administration in non-smoking major depressed patients

BACKGROUND: Acute administration of nicotine patches produced rapid eye movement sleep (REM) increases in non-smoking major depressed patients as well as clinical improvement in mood. Antidepressant effect was also observed after four continuous days of nicotine administration. The main goal of the present study was to observe the relationship between changes in REM sleep variables and mood in non-smoking major depressed patients. METHOD: Fifteen major depressed patients (DSM-III-R) were studied under the following sleep laboratory conditions: habituation, two all-night polysomnography recordings, the first one was baseline and the second one was nicotine patch (17.5 mg) night. Patients should had a HAMD-21 punctuation equal or above 18 points for to be admitted in the study. A short HAMD (10 items), and side effect scale was used daily during the two recording nights. RESULTS: A significant increase in REM sleep time and reduction in sleep stage II was observed when patients were on nicotine patches. Ten patients improved (reduction of 30 in the HAMD of 10 items), the morning after nicotine. All of them also increased REM sleep time above their baseline. Eight patients from the one with significant improvement had a short REM sleep latency below 60 minutes at baseline. CONCLUSIONS: The hypersensitivity of the cholinergic system may be related to the REM sleep enhancement effect observed in some of the patients when received nicotine and also related to the clinical improvement. The role of the acetylcholine in depression could be explored with the administration of transdermal nicotine patches.

[Accuracy and diagnostic utility of the Hospital Anxiety and Depression Scale (HAD) in a sample of obese Mexican patients]. / Exactitud y utilidad diagnóstica del Hospital Anxiety and Depression Scale (HAD) en una muestra de sujetos obesos mexicanos.

The Hospital Anxiety and Depression Scale (HAD) have been used in Mexico in drug abusers, burned patients, older people, with renal insufficiency and high-risk pregnant women. The aim of this study was to determine reproducibility and accuracy of the questionnaire in a sample of obese subjects. A group of 75 obese patients (BMI > 27) without diabetes mellitus were invited to participated in the study. Diagnosis of anxiety or depression was made by an structured interview based on the DSM-IV criteria, and they were requested to complete the HAD. All subjects were randomized for the manoeuvre sequence. Sensibility specificity, positive predictive value and negative value, and unweighted kappa coefficient (for concordance) were calculated for the two procedures. The questionnaire reproducibility was assessed buy test-retest with other 25 independent subjects. Internal validity was estimated by alpha Cronbach, Guttman and intraclass correlation coefficients. Mean age was 39.7 +/- 11.5 years and BMI 39.1 +/- 9.6. The best cut off point for anxiety was 8 points (Kappa 0.68) and for depression 7 points (Kappa 0.73). Mean age for test-retest was 39.2 +/- 14.5 years and BMI 45.3 +/- 14.6. The alpha-Cronbach was 0.84 for the first tes. and 0.86 for the second. Intraclass coefficient correlation was 0.946. The HAD is applicable for obese subjects, it is reproducible and concordant with a structured interview.

Estudios de los aspectos clínicos, neurobiológicos y psicofarmacológicos de las alteraciones afectivas / Studies of psychopharmacologic, neurobiologic and clinic aspects of affective changes

Proporciona conocimientos teóricos y clínicos sobre trastornos psiquiátricos, fundamentalmente concernientes a la depresión. Los apartados del libro son: Prefacio. Introducción. Historia natural y curso. Cuadro Clínico de la depresión y la alteración bipolar. Clasificación de los trastornos depresivos. Aspectos bioquímicos de la depresión. El funcionamiento normal de la sinapsis química. Neurobioquímica de las neuronas colinérgicas, serotoninérgicas y catecolaminérgicas. Hipótesis bioquímicas de las alteraciones afectivas. Tratamientos antidepresivos. Depresiones resistentes. Regulación neuroendócrina y depresión. Alteraciones afectivas del sueño. Lecturas recomendadas. Descripción de las principales familias de antidepresivos. Antidepresivos heterocíclicos. Inhibidor de la recaptura de serotonina y neropinefrina. Los antidepresivos que vendrán

La pinealectomía y la inyección de melatonina tres veces al día tienen la misma influencia sobre el mesocricetus auratus en su preferencia por el etanol / Pinealectómia and melatonin injection tree times a day have the same influence upon mesocricetus auratus in their etanol preferance

Se investigó la preferencia por el etanol (ETOH) o por el agua, de los cricetos dorados después de practicarles la pinealectomía (Px) o la falsa pinealectomía, y de administrarles tres inyecciones diarias de melatonina (MEL) o vehículo. Para investigar lo anterior se realizaron dos experimentos: en el experimento 1 se utilizaron dos grupos de cricetos machos: el primero se pinealectomizó y al otro se le sometió a cirugía sin quitarle la glándula pineal. Ambos grupos habían estado previamente en un esquema de libre preferencia de etanol/agua (ETOH/H2O) y mostraban una marcada preferenciaa por ETOH. Después de la cirugía se continuó registrando su consumo de una y otra sustancia, durante cuatro semanas. Ambos grupos de animales redujeron la ingestión de ETOH y aumentaron el consumo de H2O, pero únicamente se encontró una diferencia significativa en los animales Px, los cuales cambiaron su índice de preferencia por el agua durante 2, semanas. El experimento No. 2 se llevó a cabo en tres grupos de cricetos machos, de los cuales un grupo se pinealectomizó cuatro semanas antes de la evaluación de libre elección ETOH/H2O. Los animales pinealectomizados y otro grupo de animales intactos recibieron inyecciones de melatonina (25 microng en cada inyección) tres veces al día: a las 09:, 12:00 y 15:00 hrs, durante una semana, mientras que un tercer grupo de anaimales intactos recibió únicamente el vehículo, por medio del mismo esquema de administración. Soló en el grupo intacto + melatonina se encontró que aumentara su consumo de H2O y que cambiara por agua su anterior preferencia por ETOH. Al parecer, la glándula pineal juega un papel importante en la modulación de la ingestión de alcohol en el criceto y en otros roedores, posiblemente por un mecanismo no mediado directamente por lelatonina, sino por alguno de sus otros productos. La inyección de melatonina tres veces al día produjo un efecto similar a la pinealectomía. Se ha reportado este mismo efecto en otras glándulas después de la administración exógena de la hormona que secretan

Características polisomnográficas de enfermos narcolépticos comparadas con las de otro tipo de hipersomnia / Polysomnographic characteristics of narcoleptic patients compared with another hipersomnia type

Se estudiaron 6 pacientes narcolépticos, los cuales fueron comparados con 4 pacientes con hipersomnia idiopática y 2 pacientes con hipersomnia debido al síndrome de sueños en fase retrasada. Todos los pacientes completaron cuatro pruebas de latencias múltiples al sueño (PLMS) a las 10:00,12:00, 14:00 y 16:00 hrs; y dos noches de registro polisomnográfico (noches de habituación y basal). Ambos grupos de pacientes, los narcolépricos y los hipersomnes no narcolépticos, mostraron una latencia al sueño menor de 10 minutos, por lo menos en dos ocasiones. Pero solamente los narcoléoticos tuvieron al menos dos ingresos a sueño en fase de SMOR en las siestas. En las noches de registro basal, los narcolépticos mostraron un mayor número de despertares, y un aumento en el tiempo de despertarses después del inicio del sueño. Los pacientes narcolépticos tuvieron más alteraciones en el SMOR, tales como inicio del sueño en fase de SMOR y fragmentación del SMOR, en comparación con los pacientes hipersomnes no narcolépticos. Estos datos sugieren que la narcolepsia no es únicamente un trastorno por alteración del SMOR, ya que estos pacientes presenta una incapacidad para permanecer en un estado neural específico, en comparación con los sujetos normales y aun con pacientes con otras formas de trastornos por somnolencia excesiva diurna