Etiopatogenia de la esquizofrenia: el valor de la neurobiología, el neurodesarrollo y la neurodegeneración / Ethiopathogenesis of schizophrenia: the role of neurobiology, neurodevelopment and neurodegeneration

La Esquizofrenia esun síndrome muy complejo y heterogéneo formado por superposición de multitud de fenómenos que coexisten a lo largo de la evolución del proceso morboso en proporción variable. Gran parte de pacientes muestran en el momento de la eclosión de síntomas psicóticos algunos marcadores que hacen pensar que la enfermedad se asienta sobre un sustrato neurobiológico disfuncional (signos físicos y neurológicos menores, hallazgos en neuroimagen). La hipótesis del neurodesarrollo trata de explicar el modo en que algunos factores tempranos dañinos indicirían sobre los procesos del desarrollo cerebral normal (neurogénesis, proliferación neuronal, migración y establecimiento de redes neurales), generando cambios orgánicos duraderos capaces de justificar la clínica de los pacientes. Existen todavía grandes interrogantes acerca de la sensibilidad, especificidad, y valor predictivo de los marcadores biológicos, así como de su utilidad en prevención y detección precoz de casos. Sin embargo, algunos pacientes parcen sufrir un curso deteriorante después de la aparición de las primeras manifestaciones clínicas. La hipótesis neurodegenerativa aboga por la existencia de fenómenos patológicos de aparición más tardía y carácter progresivo, y que serían responsables de la progresión de algunas variables clínicas y de neuroimagen. El glutamato parece estar presente a lo largo de los procesos de desarrollo normal, y maduración cerebral postnatal, y posiblemente en la etiopatogenia de la esquizofrenia (AU)

Concepto de esquizofrenia / The concept of schizophrenia

El mejor conocimiento de la(s) esquizofrenia(s) como entidad clínica ha acaparado los mayores esfuerzos de la Psiquiatría durante más de cien años. El concepto moderno de esquizofrenia, aún hoy eminentemente clínico, se construye sobre las nociones que heredamos sucesivas generaciones de clínicos, legadas durante más de una centuria, y los conocimientos que nos ofrecen viejas y nuevas disciplinas dentro y fuera de lo estrictamente médico. Hemos revisado las distintas formas de aprehender lo esquizofrénico hasta nuestros días (AU)

[Depressive pseudodementia: Diagnostic frontiers]. / Pseudodemencia depresiva: fronteras diagnósticas.

In the limits between dementia and depression we find a clinical entity in permanent controversy; Depressive Pseudodementia. Depressive pseudodementia is defended by some authors and criticised by others and set us in the diagnostic frontier palced between the cognitive and the affective, between neurology and psychiatry. The entity is not well delimited and reaches diagnostic relevance clinical, evolution and response aspects. In the present issue, we realize a reflection on the term depressive pseudodementia with a review of the scientific literature with special attention in clinical and diagnostic subjets. We conclude that depressive pseudodementia although considering diagnostic limitations is still a valid term in clinical practice, and it eases the approximation, diagnosis and treatment of patients with mixed symptoms of cognitive and depressive type.

Pseudodemencia depresiva: fronteras diagnósticas / Depressive pseudodementia: diagnostic frontiers

En los límites que separan la demencia de la depresión nos encontramos con una entidad permanentemente sujeta a controversia: la pseudodemencia depresiva. Defendida por unos autores y criticada por otros, nos sitúa en la frontera diagnóstica existente entre lo cognitivo y lo afectivo, entre la Neurología y la Psiquiatría, entidad no bien delimitada donde alcanzan relevancia diagnóstica tanto aspectos clínicos como evolutivos y de respuesta a tratamiento. Realizamos una reflexión sobre el término de pseudodemencia depresiva revisando la literatura científica, prestando atención especial a aspectos clínicos y diagnósticos. Concluimos que la pseudodemencia depresiva, a pesar de las opiniones en contra y limitaciones diagnósticas, continúa siendo un término válido en el ejercicio de la práctica clínica, que facilita la aproximación, diagnóstico y tratamiento de los pacientes que manifiestan sintomatología mixta; afectiva y cognitiva. (AU)

[The epidemiology of eating disorders and the influence of mass media: a literature review]. / Epidemiología de los trastornos de la conducta alimentaria e influencia mediática: una revisión de la literatura.

The aim of this study was to provide an update of the epidemiology of eating disorders (anorexia nervosa and bulimia nervosa), focusing on incidence and prevalence as well as other factors as age and sex. We made a review of the existing literature in the matter in the last decades. Likewise, we made an extent evaluation of the hypothetical pathogenic impact that exerts mass media (television and printed mass media) in these pathologies. We found an evident increase in incidence as well as prevalence of these disorders though it's far from being considered epidemic. We also found an undeniable influence of mass media in the genesis and maintenance of these disorders. However, mass media would exert a positive influence in the popularization of these entities to the general population that would result in a higher demand in general practice.

Epidemiología de los trastornos de la conducta alimentaria e influencia mediática: una revisión de la literatura / The epidemiology of eating disorders and the influence of mass media: a literature review

El propósito de este trabajo es realizar una actualización sobre la epidemiología de los trastornos de la conducta alimentaria (anorexia nerviosa y bulimia nerviosa). Prestamos especial atención a la incidencia y prevalencia de los mismos, así como a los factores edad y sexo. Para ello realizamos una revisión de la literatura existente al respecto en las últimas décadas. Realizamos, del mismo modo, una amplia valoración del hipotético impacto patogénico que ejercen los medios de comunicación (televisión y medios de comunicación impresos) en estas patologías. Encontramos un evidente aumento tanto en la incidencia como en la prevalencia de estos trastornos, aunque distan mucho de poder ser considerados como una 'epidemia'. Del mismo modo, apreciamos una innegable influencia mediática en la génesis y mantenimiento de estos trastornos. Sin embargo, los medios de comunicación ejercerían una acción beneficiosa facilitando la divulgación de estas entidades a la población general, lo que se traduciría en una mayor demanda de atención sanitaria (AU)

[A prospective study of patient with schizophreniform disorder: a nosological dilemma?]. / Un estudio prospectivo de pacientes con trastorno esquizofreniforme: dilema nosológico?

We study retrospectively 42 inpatients of the psychiatry department of the Ramón y Cajal Hospital, through a period between 1st January of 1988 and the 31st December 1993. All of them were diagnosed at discharge of schizophreniform disorder according to DSM-III R diagnostic criteria and it was in all of them the index episode of the psychosis. Sociodemographic, clinical, evolutive, and therapeutical variables are analyzed. We made a new assessment of the patients in the sample during April 1994 through a direct interview. The mean follow-up period was 4.18 years. The main results were: A predominance of male/female proportion (2/1), nearly half of the sample had emotional or psychosocial stressors previous to the episode. Previous schizoid personality traits were found in 57.1%. 11.9% had first degree relatives antecedents of schizophrenia and 19% of non-bipolar affective disorders. At follow-up 40.4% needed to be hospitalized again. It is noteworthy that 80.9% were rediagnosed during follow-up as schizophrenia.

[Personality disorders in a psychiatric unit: retrospective study]. / Trastornos de la personalidad en una unidad psiquiátrica: un análisis retrospectivo.

From those patients who were admitted to the psychiatric in-patient unit of the Hospital Ramón y Cajal of Madrid across a period of eight years, those who received a diagnosis of personality disorder according to the axis II of DSM-III or DSM-III-R were selected. We analyzed the patterns of comorbidity between axis I and II, length of the admission, the percentage of readmissions and general variables as age and sex. 17.35% of the patients admitted for the first time and 27.03% of those readmitted received a clinical diagnosis of personality disorder. The most frequent disorders were: unspecified, histrionic, obsessive-compulsive and dependent. In the 93.81% of the patients admitted for the first time, comorbidity with axis I disorders was found. Cluster A personality disorders were most frequently associated to schizophrenia and delusional disorder, cluster B diagnoses with dystimia and alcohol-related problems and cluster C disorders with depression, dystimia and OCD. The cluster A was the one that presented more frequently without axis I comorbidity (14.28%). Cluster B disorders were associated with a shorter length of the admission but, as the unspecified personality disorder, were readmitted more frequently. We discuss the results and compare them with those obtained by other authors.

[Progress and therapeutic response in the obsessive-compulsive disorder]. / Evolución y respuesta terapéutica en el trastorno obsesivo-compulsivo.

The purpose of the present work was to analyze the outcome of patients diagnosed of Obsessive Compulsive Disorder (OCD) after Hospital discharge from our Unit, focusing on therapeutical efficacy immediately after discharge and in the follow up, searching for good evolution predictors. We have studied 42 patients (26 females and 16 males) diagnosed of OCD according to ICD-9 diagnostic criteria, all patients were hospitalized during a seven years period 1981 and 1988. Therapeutical response was evaluated through a (1-4 punctuation) of a Clinical Global Impression Scale considering the changes from the moment the patient was hospitalized, the day of discharge and in the follow up (mean 4.1 years). 73.8% and 71.4% were considered as treatment "responders" the day discharged and in the follow up respectively. Through a multiple logistic regression, treatment with serotonergic drugs and insidious onset of the illness were identified as short-term treatment response predictors, while the absence of a previous obsessive personality was a long-term therapeutical response predictor. Our results show the efficacy of serotonergic drugs and the tact that the presence of a previous obsessive personality could have a prognostic value in OCD.

[Psychopharmacologic treatment of bulimia nervosa]. / Tratamiento psicofarmacológico de la bulimia nerviosa.

Since the inclusion of Bulimia Nervosa (BN) in DSM-III as a nosological entity, it has been a focus of attention in the literature. To the present day several therapeutical approaches have been developed, pharmacological, psychological either separated or combined with diverse results. We have studied 20 patients diagnosed of BN according to DSM-III-R diagnostic criteria, from a psychopathological, and evolution point of view, the therapeutical response to a fixed daily dose of Fluoxetine 80 mg., during three months, with evaluations on days: 0-14-30-90. The mean age of the sample was 19.5 years; in 70% at the onset of the illness the Anorexia Nervosa symptomatology was prominent; there was a predominance of affective-obsessive previous personality traits in 60%, 100% showed unsatisfied or altered body image. We want to point out the quick improvement of various parameters such as: the constant eating desire, the binge eating episodes, the vomiting, the misuse of laxatives and the affective and anxious symptomatology. We compare our results with previous studies and make a review of the literature on this topic, we also give an efficacy profile of the different psychopharmacological drugs used in the treatment of eating disorders and a clinical guide to identify those patients who could improve with a psychopharmacological treatment.