El error perseverativo en la esquizofrenia: correlación con el flujo sanguíneo cortical mediante SPECT / Perseverative error in schizophrenia: correlation with cortical blood flow by SPECT

Introducción. El error perseverativo (perseverative error, PE) es un síntoma característico de la esquizofrenia que ha sido propuesto como marcador fenotípico de la enfermedad. Junto a ello, la hipofrontalidad observada mediante neuroimagen funcional durante la ejecución de una prueba cognitiva ha sido igualmente sugerida como signo característico de la esquizofrenia. Nos proponemos combinar síntoma y signo para demostrar la existencia de un patrón de flujo sanguíneo cortical relativo (relative cortical blood flow, RCBF) asociado al PE, lo que podría constituir un marcador biológico de la esquizofrenia. Material y métodos. Mediante tomografía computarizada por emisión de fotón único (SPECT) estudiamos el patrón de RCBF asociado al PE y a la respuesta correcta (Correct Response, CR) del Test de Ordenación de Cartas de Wisconsin (Wisconsin Card Sorting Test, WCST) en 18 pacientes con esquizofrenia y 13 controles. Nos centramos en cinco regiones cerebrales bien definidas bilateralmente, utilizando como línea de base el RCBF de dichas regiones en reposo. Resultados. Los pacientes cometieron más PE que los controles en el WCST. En los pacientes observamos una correlación entre PE y RCBF de la corteza occipital derecha. En los controles encontramos una correlación negativa entre PE y RCBF de la corteza temporal izquierda y una correlación positiva entre CR y RCBF de las cortezas frontobasal izquierda y frontal global izquierda. Conclusiones. La severidad del PE se asocia a una mayor actividad parietooccipital derecha en pacientes con esquizofrenia. La CR del WCST se asocia a mayor actividad frontal izquierda en controles, pero no en pacientes. Probablemente existe una redistribución del RCBF relacionada con la perseveración típica de la esquizofrenia, lo que podría constituir un marcador fenotípico de la enfermedad observable mediante técnicas de neuroimagen funcional

Introduction. Perseverative error (PE) is a core symptom of schizophrenia which has been proposed as a phenotypic marker of the illness. Moreover, hypofrontality observed in functional neuroimaging studies while executing a cognitive task has also been suggested as a characteristic sign of schizophrenia. We propose combining symptom and sign to demonstrate the existence of a regional cortical blood flow (RCBF) pattern associated to PE that might constitute a biological marker of schizophrenia. Material and method. We used Single Photon Emission Computerized Tomography (SPECT), to study the RCBF associated to PE and to correct response (CR), during the execution of the Wisconsin Card Sorting Test (WCST), of 18 patients with schizophrenia and 13 controls. We focused on five well-defined bilateral brain regions, using the RCBF of the same regions at rest as a baseline. Results. Patients made more PE than controls in the WCST. Among patients, we observed a correlation between PEs and right occipital RCBF. Among controls, we found a negative correlation between PEs and left temporal cortex RCBF and a positive correlation between CRs and left frontobasal and overall left frontal cortexes RCBF. Conclusions. The severity of PE is associated to higher right parietal-occipital activity in patients with schizophrenia. CR in the WCST are associated to higher left frontal activity in controls but not in patients. Probably, there is a RCBF redistribution pattern related to the typical perseveration of schizophrenia which might constitute a phenotypic marker of the illness observable by functional neuroimaging techniques

[Pharmacological treatment resistant schizophrenia]. / Esquizofrenia resistente al tratamiento farmacológico.

In the clinical practice, there are three different terms to designate schizophrenic patients who do not improve with antipsychotic medication: treatment-resistant, treatment-refractory and non-respondent patients. Treatment resistance is neither a synonym of chronicity nor of severity nor seriousness. Therefore, for a patient to be considered resistant, several points must be taken into account. These points are: a) whether the schizophrenia is primary or secondary; b) its nature; c) presence of previous substance abuse; d) treatment compliance and tolerance, and presence of minor neurological signs. The most widely accepted criteria to define pharmacological treatment resistance in schizophrenia were initially developed around 1988 by Kane. Nowadays, the BPRS and Independent Living Skills Survey (ILSS) are the scales used to assess the levels of lack or response or of treatment resistance. To attain a suitable therapeutic evolution in schizophrenics resistant to treatment in antipsychotic medication assays, the following guidelines must be considered: Identifying the symptoms clearly and using medication with a suitable dose and duration. Taking into account that treatment resistance can be mistaken for treatment intolerance, non-compliance to treatment, inappropriate social support or inappropriate psychosocial treatment. Using up all single therapeutic agents before applying multiple agents. Preventing extrapyramidal effects by means of an adequate choice of the primary treatment. Maintaining a positive therapeutic attitude.

Regional cerebral blood flow SPECT study, at rest and during Wisconsin Card Sorting Test (WCST) performance, in schizophrenia naive patients or treated with atypical neuroleptics.

INTRODUCTION: To corroborate the hypothesis of hypofrontality in schizophrenia and to study the relationship between positive/negative symptoms (measured by the positive and negative syndrome scale [PANSS]) and regional cortical blood flow (rCBF), both at rest and during the Wisconsin Card Sorting Test (WCST) performance (activation). METHODS: We compared a control group (n = 18) to a group of patients with schizophrenia (n = 21) in terms of rCBF, measured by single photon emission computed tomography (SPECT). RESULTS: We found significantly higher left-frontal- CBF (during the WCST performance and at rest) and right-frontal-CBF (only at rest) in control subjects. Only the control group showed a right-frontal-CBF increase during activation. Only the patients group showed a significant right-occipital-CBF increase during the activation. We observed a positive significant correlation between the PANSS-P score and the left- frontal index at rest. Some negative symptoms such as difficulty in abstract thinking (N5) and lack of spontaneity and flow of conversation (N6) are associated to low frontal blood flow at rest. Affective blunting (N1) is associated to low left-frontal blood flow during activation. CONCLUSIONS: Our data support the hypothesis of hypofrontality, at rest and during activation, which means the incapacity of schizophrenic patients to increase the frontal CBF while performing the WCST (activation). Schizophrenia positive symptoms are associated to high left-frontal blood flow.

Seguridad cardiovascular de venlafaxina retard en pacientes depresivos. Un estudio de farmacovigilancia / Cardiovascular safety of venlafaxine retard in patients with depression. A pharmacovigilance study

FUNDAMENTO: Los efectos indeseables de los fármacos antidepresivos sobre el sistema cardiovascular pueden complicar los tratamientos antidepresivos a largo plazo. Se pretende evaluar la seguridad cardiovascular de la venlafaxina retard en pacientes con trastornos depresivos. PACIENTES Y MÉTODOS: Análisis sobre la seguridad cardiovascular realizado a partir de los datos extraídos de un estudio abierto, observacional y prospectivo llevado a cabo por 882 médicos de atención primaria. Se incluyó en el estudio a pacientes de 18-70 años y sintomatología depresiva susceptible de tratamiento, con una puntuación mínima en la escala de Hamilton para la depresión (HAM-D17) de 14. Venlafaxina retard se administró en dosis de 75 o 150 mg/día durante 24 semanas. Se realizaron exámenes físicos completos con toma de constantes vitales. RESULTADOS: Se analizan los datos de 4.320 pacientes, 493 de los cuales presentaban hipertensión arterial basal controlada con fármacos. El tratamiento con venlafaxina retard no produjo modificaciones clínicamente relevantes en la presión arterial sistólica, diastólica y en la frecuencia cardíaca, en comparación con los datos basales. Mientras que en los pacientes previamente hipertensos la presión arterial sistólica y diastólica disminuyó durante el estudio de forma significativa (p < 0,0001), en los pacientes normotensos la presión arterial sistólica se incrementó en 0,3 ± 10,5 mmHg (p = 0,046) y la diastólica en 0,1 ± 7,6 mmHg (p = 0,323), manteniéndose dentro de los límites normales. CONCLUSIONES: Venlafaxina retard, en dosis de 75-150 mg/día, no ejerce una influencia destacada en las cifras tensionales y en la frecuencia cardíaca

BACKGROUND: The undesirable effects of antidepressants on the cardiovascular system can complicate long-term antidepressant treatment. The aim of this study was to evaluate the cardiovascular safety of venlafaxine retard in patients with depressive disorders. PATIENTS AND METHODS: The cardiovascular safety of venlafaxine retard was analyzed in an open, observational, prospective study performed by 882 primary care physicians. Patients aged 18 to 70 years with treatment-susceptible depressive disorders and a minimum Hamilton Depression Scale (HAM-D17) score of 14. Venlafaxine retard was administered at a dose of 75 or 150 mg per day for 24 weeks. Complete physical examinations with measurement of vital signs were performed. RESULTS: Data from 4,320 patients were analyzed. Of these, 493 had pharmacologically controlled hypertension at baseline. Treatment with venlafaxine retard produced no clinically relevant modifications in systolic or diastolic blood pressure or cardiac frequency compared with baseline data. In patients with prior hypertension, systolic and diastolic blood pressure significantly decreased throughout the study period (p < 0.0001), while in normotensive patients systolic blood pressure increased by 0.3 ± 10.5 mmHg (p = 0.046) and diastolic pressure increased by 0.1 ± 7.6 mmHg (p = 0.323), remaining within normal limits. CONCLUSIONS: Venlafaxine retard at doses of between 75 and 150 mg/day does not have a notable influence on blood pressure or cardiac frequency

Depression in primary care: effectiveness of venlafaxine extended-release in elderly patients; Observational study.

Depression in the elderly is frequent but is often not recognized or treated as such. Few studies have assessed the effectiveness and tolerability of venlafaxine extended-release in patients over 60 years in primary care. This study aims to demonstrate the effectiveness and safety of venlafaxine extended-release in depressive disorders in this kind of population. Observational, multicenter and prospective study in an outpatient population over 60 years with depressive symptoms that needs pharmacological treatment and with a minimum score of 14 on the 17-items Hamilton rating scale for depression (HAM-D17). Effectiveness was assessed by HAM-D17. Physician's assessment of the patient's global status was also used and all the possible adverse effects were recorded. Venlafaxine extended-release was administered for 6 months at 75 mg per day dose, with the possibility of going up to 150 mg per day according to clinical criterion. Data of 1214 patients were obtained, with remission rates (HAM-D17

[Quality of life, in depressed patients in Primary Health Care setting. Effectiveness and safety of venlafaxine extended release]. / Calidad de vida en pacientes con depresión tratados en Atención Primaria. Efectividad y seguridad de la venlafaxina retard.

INTRODUCTION: The aim of this observational study was to evaluate effectiveness, tolerability and impact on quality of life of treatment with venlafaxine extended release at a dose of 75 to 150 mg/day, in depressed outpatients treated in Primary Health Care. METHODS: Observational, prospective, open-labeled study, carried out by 882 Primary Health Care physicians. Outpatients, between 18 and 70 years of age with depressive symptomatology susceptible of treatment, with a Hamilton Depression Scale (HAM-D17) score 14 were included. Daily doses of 75 or 150 mg of venlafaxine extended release were administered orally for 24 weeks. Antidepressant effectiveness was assessed using the HAM-D17 scale and quality of life with the Quality of Life in Depression Scale (QLDS), Spanish version. RESULTS: 4,747 patients were recruited, of which 4,320 were included in a intention to treat effectiveness analysis and 4,557 patients in a safety analysis. HAM-D17 and QLDS mean score significantly decreased from week 4 to the end of study. 86,2% of the patients were responders and 73.8% achieved remission of the symptoms. Likewise, 95% reported absence or mild somatic and psychic anxiety on the final visit. Tolerability was considered good or excellent for 98.7% subjects. 191 patients (4.2%) reported adverse events. CONCLUSIONS: Venlafaxine extended release is a safe and effective drug that reduces depressive symptoms of Primary Health Care patients and improves their quality of life.

Calidad de vida en pacientes con depresión tratados en Atención Primaria. Efectividad y seguridad de la venlafaxina retard / Quality of life, in depressed patients in Primary Health Care setting. Effectiveness and safety of venlafaxine extended release

Introducción. Los objetivos del estudio observacional han sido evaluar la efectividad, tolerabilidad y el impacto sobre la calidad de vida del tratamiento con venlafaxina retard a dosis de 75 a 150 mg/día en pacientes ambulatorios con depresión tratados en Atención Primaria. Métodos. Estudio abierto, observacional, prospectivo, realizado por 882 médicos de Atención Primaria. Se incluyeron pacientes con edad entre 18 y 70 años y sintomatología depresiva susceptible de tratamiento, con una puntuación mínima en la Escala de Hamilton para la depresión con 17 ítems (HAM-D1 7) de 14. La venlafaxina retard se administró a dosis de 75 o 150 mg/día durante 24 semanas. La efectividad antidepresiva se evaluó mediante la HAM-D1 7 y la calidad de vida mediante la Escala de calidad de vida de depresión (ECVD) validada, versión española. Resultados. Se incluyeron 4.747 pacientes, de los cuales 4.320 pacientes fueron evaluables por intención de tratar para efectividad y 4.557 para seguridad. Se redujeron significativamente la puntuación media de la HAM-D17 y la de la ECVD desde la cuarta semana hasta el final del estudio. El 86,2 por ciento de los pacientes mostró respuesta y un 73,8 por ciento presentó remisión de los síntomas. Asimismo, el 95 por ciento mostró ausencia de ansiedad o ansiedad ligera, tanto somática como psíquica, en la visita final. La tolerancia fue considerada buena o excelente en el 98,7 por ciento de los sujetos. Ciento noventa y un pacientes (4,2 por ciento) presentaron algún acontecimiento adverso. Conclusiones . La venlafaxina retard es un fármaco efectivo y seguro que reduce los síntomas depresivos de pacientes tratados en Atención Primaria y mejora su calidad de vida. (AU)

Aspectos etiopatogénicos actuales en la fobia social / Current etiopathogenetic aspects of social phobia

No disponible

[Neuroanatomical bases of attention by means of PET-15O: the role of the prefrontal and parietal cortex in controlled processes]. / Bases Neuroanatómicas de la Atencion mediante PET-15O: el papel de la corteza prefrontal y parietal en los procesos voluntarios.

AIM: The aim of this study was to investigate the changes in the cerebral blood flow that took place in normal subjects during an auditory attention paradigm which included automatic and controlled processing components. METHOD: Participants consisted in 10 normal subjects who were submitted to medical, neuropsychological and neuroimaging evaluation. PET was used to carry out an exploration of each subject in the four experimental conditions: basal, listening to clicks (A), counting while listening to clicks (C+A) and counting without listening to clicks (C). RESULTS: During the condition involving counting while listening to clicks (automatic processing) the subjects displayed a significant increase in the activation of the bilateral precentral convolutions, left dorsolateral prefrontal cortex (DLPFC), left inferior and superior frontal convolutions, left supplementary motor area and the left superior and inferior temporal convolution. During the condition involving counting without listening to clicks (controlled processing), the subjects activated the right precentral convolution, bilateral DLPFC, the right supplementary motor area, anterior cingulate and right inferior parietal convolution. DISCUSSION: The results obtained support the suggestion that regions such as the DLPFC and the inferior parietal convolution play a part in attentional tasks in which the subject is required to make an effort to carry out the controlled processing of information.

Bases neuroanatómicas de la atención mediante PET-15 O:el papel de la corteza prefrontal y parietal en los procesos voluntarios / Neuroanatomical bases of attention by means of pet-15 O: the role of the prefrontal and parietal cortex in controlled processes

Objetivo. Investigar los cambios en el flujo sanguíneo cerebral ocurridos en sujetos sanos mediante PET, durante un paradigma de atención auditiva que incluye componentes automáticos y voluntarios de procesamiento. Sujetos y métodos. Participaron 10 sujetos sanos, que se sometieron a una evaluación médica, neuropsicológica y de neuroimagen. Para cada sujeto se realizó una exploración de PET en las cuatro condiciones experimentales: basal, oír clics (A), contar oyendo los clics (C+A) y contar sin oír clics (C).Resultados. Durante la condición de contar oyendo los clics (procesamiento automático), los sujetos presentaron aumento significativo de la activación de las circunvoluciones precentral bilateral, corteza prefrontal dorsolateral (CPFDL) izquierda, circunvoluciones frontal izquierda superior e inferior, área motora suplementaria izquierda y circunvolución temporal izquierda superior e inferior. Durante la condición de contar sin oír los clics (procesamiento voluntario), los sujetos activaron la circunvolución precentral derecha, la CPFDL bilateral, el área motora suplementaria derecha, el cíngulo anterior y la circunvolución parietal inferior derecha. Conclusión. Los resultados obtenidos apoyan la contribución de regiones como la CPFDL y la circunvolución parietal inferior en tareas atencionales que requieren un esfuezo de procesamiento voluntario de la información por parte del sujeto (AU)

Differences in interleukins' patterns between dysthymia and major depression.

We assessed whether cytokine production-interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNFalpha)-is affected in depressed patients, dysthymia (Dt) and major depression (MD), and its association with various parameters of severity and clinical course. We found a possible different pattern of interleukin production between Dt and MD.

The development and validation of a Spanish version of the quality of life in depression scale (QLDS).

OBJECTIVE: The adaptation of the Quality of Life in Depression Scale, the QLDS, into Spanish. METHODS: The original UK version of the QLDS was considered by two translation panels, who produced a Spanish translation. Priority was given to conceptual rather than semantic equivalence. This version was then field-tested with 15 depressed patients. The final stage of the research involved a postal survey of 62 patients, who were asked to complete the measure on two occasions. RESULTS: The Spanish QLDS was found to be appropriate and acceptable by depressed patients. The questionnaire's test-retest reliability and internal consistency were both high, and QLDS scores correlated as predicted with scores on sections of the Nottingham Health Profile. The measure was sensitive to different levels of depression as assessed by the Hospital Anxiety and Depression Scale. CONCLUSION: The Spanish version of the QLDS is suitable for use in clinical trials and for monitoring individual patients in routine clinical practice.

Perceived quality of life in depression: Effect of clinical and demographic variables.

The objective of the study was the evaluation of the influence of various clinical and sociodemographic factors on the perception of quality of life in 141 patients with depression (CIE-10). We used a multivariate analysis of logistic regression to predict lower quality of life and well-being. The best predictive variables for quality of life were the Hamilton Rating Scale for Depression (HAM-D) score, the number of episodes, personality disorder and gender. For well-being, the best predictive variables were HAM-D score, type of family environment, Hamilton Rating Scale for Anxiety (HAM-A) score, educational level and marital status. We conclude that the severity of the symptoms is the main factor influencing the appraisal of the quality of life, while sociodemographic variables play a more limited role.

[Study of the evolution of some monocytic parameters and neuroendocrine function tests in depressed patients]. / Estudio evolutivo de algunos parámetros monocitarios y pruebas de función neuroendocrina en pacientes deprimidos.

BACKGROUND: The development, evaluation and use of biological markers is extremely important in Psychiatry. However, with certain exceptions, truly sensitive and specific markers have not still emerged. Several studies have reported immune cellular and humoral dysfunction during depression. We specifically focused on the study of the monocyte because it has a key role in the activation of the immune response. We also investigated the relationship between the immune apparatus and the hypothalamic-pituitary activity in depressed patients. METHODS: We used a longitudinal design and assessed monocyte parameters (HLA-DR, CD 35, vimentin filaments and phagocytosis index) and neuroendocrine tests (DST and TRH-test) at intake (pretreatment phase: phase I) and at follow-up (post-treatment phase: phase II) in 49 depressed patients according to Research Diagnostic Criteria (RDC). The mean follow-up interval was 12.2 +/- 2 weeks. The severity of illness was measured by means of the Hamilton Depression Rating Scale (HDRS). RESULTS: Seventy per cent of patients showed a pretreatment marked monocyte dysfunction (82.5% had at least one parameter altered). After treatment, alterations in immunological variables were significantly associated (p < 0.05) with depression scores higher than 15). We did not find any significant association between the severity of depressive symptoms and the results of the neuroendocrine tests. The combined use of both immunological and neuroendocrine tests did not add sensitivity to the immunological identification of depressed patients. Before and after treatment the immunoreactive vimentin filaments significantly increased (p < 0.01) after incubation of monocyte with naloxone. There was a significant correlation (p < 0.05) between the immune parameters studied in both phases of the study. CONCLUSIONS: The findings indicate that the monocyte dysfunction is temporally associated with the state of depression and lead us to consider the role of the monocyte parameters as sensitive depressive state markers, while the combined use of both neuroendocrine and immunological tests in current clinical practice would be debatable. On the other hand, as the cytoskeletal dysfunction was reversed with naloxone, our findings underline previous reports suggesting that an increased opioid activity could mediate monocyte dysfunction.

Neuroendocrine and immunological functions in depressed patients: a follow-up study.

The development, evaluation and use of biological markers with a diagnostic purpose in psychiatry is extremely important. However, with certain exceptions, truly sensitive and specific markers have not yet emerged. In order to investigate the relationship between the immune apparatus and the hypothalamic-pituitary activity on the one hand, and the psychopathological state of the patients on the other, we used a longitudinal design and assessed monocyte parameters (HLA-DR, CD 35, vimentin filaments, and phagocytosis index) and neuroendocrine tests (dexamethasone suppression test [DST] and thyrotropin-releasing hormone [TRH] stimulation test) at intake and at follow-up in 49 depressed patients. Immunological parameters were compared with neuroendocrine tests in both phases of the study. The combined use of both immunological and neuroendocrine tests did not add sensitivity to the immunological identification of depressed patients. The findings lead us to consider the role of the monocyte parameters as sensitive depressive state markers, while the combined use of both neuroendocrine and immunological tests in current clinical practice would be debatable.

[The nosological entity bulimia nerviosa]. / La entidad nosológica de la bulimia nerviosa.

Anorexia nervosa and bulimia nervosa are at the present moment, two well defined clinical entities among the group of the eating disorders. The psychopathological differentiation of both syndromes has a great importance for diagnosis and therapy. The authors make a phenomenological description, based on case histories of patients with diagnostics of anorexia and bulimia nervosa, and try to establish an approach to the essential symptomatology of those disorders. The presence of affective symptomatology--depressive, but not exclusively--in the eating behaviour disorders in general and particularly in bulimia nervosa, is nowadays interpreted as an unspecific emotional lability as a response to stressing situations. That is to say, it is a secondary depressive symptomatology, more than a primary mood disorder preceding or underlying bulimia. There is strong evidence in favour of a dysregulation of serotonin metabolism in patients with bulimia nervosa, in the sense of a reduced activity, which manifest itself clinically by binges with food with a high content in carbohydrates. High levels of 5-HT seem to induce increasing feelings of safety, fullness and lead to an interruption of eating. Fluoxetine and this active metabolite are selective inhibitors of the reuptake of 5-HT and their antibulimic effect could be mediated by this mechanism.

[The psychopathological aspects related to breast cancer]. / Aspectos psicopatológicos relacionados con el cáncer de mama.

During the last 30 years, many articles have been published in scientific journals dealing with psychological aspects of breast cancer and its treatment. This work, through a bibliographic revision, tries to come across the psychopathologic and psychosocial data concerning breast disease. It exposes its influence on body image, symptom appearance (essentially psychopathology, marital and social adjustment) and sets up some adjustment predictors that can improve support for breast cancer patients.