Análisis de los trastornos psicóticos en pacientes con epilepsia parcial refractaria, diagnóstico psiquiátrico y características clínicas / Analysis of psychotic disorders in patients with refractory partial epilepsy, psychiatric diagnoses and clinical aspects

Introducción. La asociación entre trastornos psicóticos y epilepsia ha sido motivo de controversias. Actualmente se describen en la literatura diferentes subtipos de trastornos psicóticos en los pacientes con epilepsia de acuerdo con la relación temporal con las crisis: las psicosis postictales (PPI), interictales (PII) y bimodales (PB).Objetivos. Determinar las características clínicas de pacientes con epilepsia parcial refractaria y psicosis y compararlos hallazgos con un grupo control de pacientes con epilepsia parcial refractaria sin psicosis. Métodos. Se estudiaron 57 pacientes con epilepsia parcial refractaria y trastornos psicóticos (GP) y 56 pacientes con epilepsia parcial refractaria sin psicosis (GnP) de acuerdo con los criterios del DSM-IV. En todos los pacientes se realizó una evaluación neurológica completa, estudios neurofisiológicos, neuroimágenes y evaluaciones psiquiátricas DSM-IV y SCID-I. Las variables clínicas, demográficas y psiquiátricas fueron comparadas entre los pacientes GP y GnP.Resultados. En el GP 15 pacientes (26%) cumplían criterios para PPI, 29 pacientes (51 %) para PII y 13 pacientes(23 %) para PB. Encontramos una duración más prolongada de la epilepsia y una mayor incidencia de esclerosis hipocámpica bilateral en los pacientes GP. Los pacientes de GP presentaron un mayor tiempo de evolución de la epilepsia y una mayor incidencia de esclerosis hipocámpica bilateral (p < 0,05).No se observaron diferencias entre los distintos subtipos de psicosis. Conclusiones. El mayor tiempo de evolución de las crisis epilépticas y la presencia de una esclerosis hipocámpica bilateral podrían incrementar el riesgo de desarrollar psicosis en pacientes con epilepsia parcial refractaria (AU)

Introduction. The association between psychotic disorders and epilepsy has been controversial. Different subtypes of psychotic disorders in epilepsy patients have been described according to temporal relationship with seizures-postictal (PIP), interictal (IIP) and bimodal (BP) psychoses are described in literature. Objectives. Determine clinical characteristics of patients with refractory partial epilepsy and psychoses and compare the results with a control group of patients with refractory partial epilepsy without psychoses. Methods. A total of 57 patients with refractory partial epilepsy and psychotic disorders (psychotic group [PG]) and 56 patients with refractory partial epilepsy and without psychoses (control group, CG) were evaluated according to DSM-IV criteria and SCID-I. All patients underwent complete neurological, neuroimaging, neuropsychological, and psychiatric assessment. Clinical, demographic and neuroimaging data were compared between patients in CG and PG. Results. In PG 15 patients (26%) had criteria for PIP,29 patients (51 %) for IIP and 13 patients (23 %) for BP. Epilepsy time duration and bilateral hippocampal sclerosis were significantly more frequent in patients with psichosis.PG patients had a longer evolution time of epilepsy and greater frequency of bilateral hippocampal sclerosis (p < 0.05). No differences were found between psychoses subtypes. Conclusions. Longer evolution of seizures and the presence of bilateral hippocampal sclerosis may increase propensity to develop psychoses in patients with refractory partial epilepsy (AU)

[Analysis of psychotic disorders in patients with refractory partial epilepsy, psychiatric diagnoses and clinical aspects]. / Análisis de los trastornos psicóticos en pacientes con epilepsia parcialrefractaria, diagnóstico psiquiátrico y características clínicas.

INTRODUCTION: The association between psychotic disorders and epilepsy has been controversial. Different subtypes of psychotic disorders in epilepsy patients have been described according to temporal relationship with seizures-postictal (PIP), interictal (IIP) and bimodal (BP) psychoses are described in literature. OBJECTIVES: Determine clinical characteristics of patients with refractory partial epilepsy and psychoses and compare the results with a control group of patients with refractory partial epilepsy without psychoses. METHODS: A total of 57 patients with refractory partial epilepsy and psychotic disorders (psychotic group [PG]) and 56 patients with refractory partial epilepsy and without psychoses (control group, CG) were evaluated according to DSM-IV criteria and SCID-I. All patients underwent complete neurological, neuroimaging, neuropsychological, and psychiatric assessment. Clinical, demographic and neuroimaging data were compared between patients in CG and PG. RESULTS: In PG 15 patients (26 %) had criteria for PIP, 29 patients (51%) for IIP and 13 patients (23%) for BP. Epilepsy time duration and bilateral hippocampal sclerosis were significantly more frequent in patients with psichosis. PG patients had a longer evolution time of epilepsy and greater frequency of bilateral hippocampal sclerosis (p < 0.05). No differences were found between psychoses subtypes. CONCLUSIONS: Longer evolution of seizures and the presence of bilateral hippocampal sclerosis may increase propensity to develop psychoses in patients with refractory partial epilepsy.

[Schizophrenia: relationship between negative symptoms and schizotypic features of personality]. / Esquizofrenia: relación entre síntomas negativos y rasgos esquizotípicos de personalidad.

We studied the negative and schizoid-schizotypic features in 19 males chronics schizophrenic inpatients. Our findings prove a direct relation between negative symptoms and schizotypical personality features. We think that the negative symptoms not form a unity and one of them are part of the prior personality.

Esquizofrenia: relación entre síntomas negativos y rasgos esquizotípicos de personalidad. / [Schizophrenia: relationship between negative symptoms and schizotypic features of personality]

We studied the negative and schizoid-schizotypic features in 19 males chronics schizophrenic inpatients. Our findings prove a direct relation between negative symptoms and schizotypical personality features. We think that the negative symptoms not form a unity and one of them are part of the prior personality.

[Akinetic catatonia and antidepressants]. / Catatonia acinética y antidepresivos.

Acute akinetic catatonic syndromes three adult male patients suffered from within the chronic evolution of a schizophrenia are discussed. Cases were treated with tricyclical antidepressants, intravenously applied, thus causing the psychomotor symptoms to rapidly disappear. The success of an antidepressant treatment when such presenting problem is at stake leads the author to speculate about the production mechanisms of this problem at the different organization levels of personality.

[Review of the concept of personality deterioration in schizophrenia]. / Revisión del concepto de deterioro de la personalidad en las esquizofrenias.

Thirty-two patients suffering from schizophrenia (according to DSM-III, and chronic evolution characteristics, have been studied for 10 years. All of them presented signs of schizophrenic deterioration. They had been institutionalized for five years at least, with no leave at all. Some trends of psychiatry highlighting schizophrenic deterioration as an irreversible residual phenomenon are referred to as well as the biological studies relating causitively deterioration to atrophic alterations of the brain. During research, combined features from both therapeutic, and rehabilitation techniques were administered to the population under study, namely: Individual Psychotherapy, Family Psychotherapy, Occupational Therapy, and biological treatments. Nine patients presented a paranoidical form of schizophrenia; 6, a disorganized form; 4, an indifferenciated form; 5, a residual form, and 5, a catatonic form. Close to the end of research, 22 patients were given their discharge certificate after recovery; two were discharged but came back to hospital for short admissions; four are still institutionalized with no improvement foreseen; two are still institutionalized, however at a rehabilitation stage. Finally, two patients passed away during research. It is the author's contention that these results show a symptomatic variability determining that 70% of cases considered as clinical observations are intended to be construed as a dynamic phenomenon--and not as a static-crystallized one.

Revisión del concepto de deterioro de la personalidad en las esquizofrenias. / [Review of the concept of personality deterioration in schizophrenia]

Thirty-two patients suffering from schizophrenia (according to DSM-III, and chronic evolution characteristics, have been studied for 10 years. All of them presented signs of schizophrenic deterioration. They had been institutionalized for five years at least, with no leave at all. Some trends of psychiatry highlighting schizophrenic deterioration as an irreversible residual phenomenon are referred to as well as the biological studies relating causitively deterioration to atrophic alterations of the brain. During research, combined features from both therapeutic, and rehabilitation techniques were administered to the population under study, namely: Individual Psychotherapy, Family Psychotherapy, Occupational Therapy, and biological treatments. Nine patients presented a paranoidical form of schizophrenia; 6, a disorganized form; 4, an indifferenciated form; 5, a residual form, and 5, a catatonic form. Close to the end of research, 22 patients were given their discharge certificate after recovery; two were discharged but came back to hospital for short admissions; four are still institutionalized with no improvement foreseen; two are still institutionalized, however at a rehabilitation stage. Finally, two patients passed away during research. It is the authors contention that these results show a symptomatic variability determining that 70

of cases considered as clinical observations are intended to be construed as a dynamic phenomenon--and not as a static-crystallized one.

Catatonia acinética y antidepresivos. / [Akinetic catatonia and antidepressants]

Acute akinetic catatonic syndromes three adult male patients suffered from within the chronic evolution of a schizophrenia are discussed. Cases were treated with tricyclical antidepressants, intravenously applied, thus causing the psychomotor symptoms to rapidly disappear. The success of an antidepressant treatment when such presenting problem is at stake leads the author to speculate about the production mechanisms of this problem at the different organization levels of personality.

Catatonia acinética y antidepresivos. / [Akinetic catatonia and antidepressants]

Acute akinetic catatonic syndromes three adult male patients suffered from within the chronic evolution of a schizophrenia are discussed. Cases were treated with tricyclical antidepressants, intravenously applied, thus causing the psychomotor symptoms to rapidly disappear. The success of an antidepressant treatment when such presenting problem is at stake leads the author to speculate about the production mechanisms of this problem at the different organization levels of personality.