Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand.

In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.

Estimulación cerebral para el trastorno obsesivo-compulsivo resistente a tratamiento médico / Deep brain stimulation for drug-resistant obsessive-compulsive disorder

Aproximadamente un 10% de los pacientes con trastorno obsesivo-compulsivo tienen formas crónicas muy incapacitantes de la enfermedad, resistentes a las terapias conservadoras actuales, lo que conlleva un deterioro significativo para su calidad de vida y altas tasas de suicidio. Para estos pacientes se dispone de nuevas terapias efectivas mediante tratamiento neuroquirúrgico. A continuación revisamos de forma exhaustiva las técnicas neuroquirúrgicas actuales y las tasas de remisión y efectos adversos, con sus aspectos metodológicos fundamentales. La realización de pequeñas lesiones en dianas específicas del circuito límbico, como la cingulotomía, la capsulotomía, la tractotomía subcaudada o la leucotomía límbica, está siendo sustituida por la estimulación cerebral profunda mediante electrodos en estas dianas, lo que permite efectuar una terapia reversible y adaptable a las necesidades del paciente. Además, el desarrollo de la neuroimagen y el mejor conocimiento de los circuitos cerebrales han permitido la identificación de nuevas dianas para la neuroestimulación en este trastorno, con buenos resultados. La investigación debe continuar progresando para mejorar el tratamiento de los pacientes con trastorno obsesivo-compulsivo resistente (AU)

Approximately 10% of patients with obsessive-compulsive disorder have very disabling chronic forms of the disease, which are resistant to all current conservative therapies. These patients experience a significant deterioration in their quality of life and high rates of suicide. The development of new effective neurosurgical treatments has led to an improvement in a significant percentage of patients that would otherwise have remained severely disabled. We comprehensively review remission rates, adverse effects and fundamental methodological aspects of the current neurosurgical techniques for medication resistant obsessive-compulsive disorder. The making of small lesions in specific targets of the limbic circuit, such as cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy, is being replaced by deep brain stimulation through electrodes located in these targets, which is reversible and adaptable to every patient's need. Furthermore, the development of neuroimaging techniques and a better understanding of brain circuits in the last decades, have allowed the identification of new targets for neurostimulation in this disorder, with good results. Research must continue in order to help in the treatment of medication-resistant obsessive-compulsive disorder (AU)

Long-term results of posteromedial hypothalamic deep brain stimulation for patients with resistant aggressiveness.

OBJECT: Erethism describes severe cases of unprovoked aggressive behavior, usually associated with some degree of mental impairment and gross brain damage. The etiology can be epileptic, postencephalitic, or posttraumatic, or the condition can be caused by brain malformations or perinatal insults. Erethism is often refractory to medication, and patients must often be interned in institutions, where they are managed with major restraining measures. The hypothalamus is a crucial group of nuclei that coordinate behavioral and autonomic responses and play a central role in the control of aggressive behavior. Deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) has been proposed as a treatment for resistant erethism, although experience with this treatment around the world is scarce. The objective of this study was to examine the long-term outcome of PMH DBS in 6 patients with severe erethism treated at the authors' institution. METHODS: Medical records of 6 patients treated with PMH DBS for intractable aggressiveness were reviewed. The therapeutic effect on behavior was assessed by the Inventory for Client and Agency Planning preoperatively and at the last follow-up visit. RESULTS: Two patients died during the follow-up period due to causes unrelated to the neurosurgical treatment. Five of 6 patients experienced a significant reduction in aggressiveness (the mean Inventory for Client and Agency Planning general aggressiveness score was -47 at baseline and -25 at the last follow-up; mean follow-up 3.5 years). Similar responses were obtained with low- and high-frequency stimulation. In 4 cases, the patients' sleep patterns became more regular, and in 1 case, binge eating and polydipsia ceased. One of the 3 patients who had epilepsy noticed a 30% reduction in seizure frequency. Another patient experienced a marked sympathetic response with high-frequency stimulation during the first stimulation trial, but this subsided when stimulation was set at low frequency. A worsening of a previous headache was noted by 1 patient. There were no other side effects. CONCLUSIONS: In this case series, 5 of 6 patients with pathological aggressiveness had a reduction of their outbursts of violence after PMH DBS, without significant adverse effects. Prospective controlled studies with a larger number of patients are needed to confirm these results.

Psychopathological consequences after a terrorist attack: an epidemiological study among victims, the general population, and police officers.

BACKGROUND AND AIM: To assess the prevalence and correlates of post-traumatic stress disorder (PTSD), major depression and anxiety disorders other than PTSD, among three samples with different level of exposure to the March 11, 2004 terrorist attacks in Madrid. METHOD: We sampled three groups of persons-those injured in the attacks, the residents of Alcala de Henares, and police officers involved with the rescue effort-with different exposure to the March 11, 2004 terrorist attacks, using random sampling from comprehensive censuses of all three groups. In person interviews were conducted with all three groups between 5 and 12 weeks after March 11, 2004. Questionnaire included assessment of socio-demographic characteristics, of PTSD using the Davidson trauma scale, and of a range of psychiatric illnesses using the mini international neuropsychiatric interview (MINI). RESULTS: The overall sample included 127 persons injured in the attack, 485 residents of Alcalá de Henares, and 153 policemen involved in rescue. Of all three groups 57.5%, 25.9% and 3.9% of persons, respectively, reported symptoms consistent with any assessed psychiatric disorder. The use of psychoactive medication before March 11, 2004 was consistently the main predictor of PTSD and major depression among those injured and of major depression and anxiety disorders others than PTSD among residents of Alcala. CONCLUSIONS: There was a substantial burden of psychological consequences of the March 11, 2004 terrorist attacks two months after the event. Persons with prior mental illness are at higher risk of post-event psychopathology, across groups of exposure.

Variables predictoras de gravedad del parasuicidio / Predictable variables of the gravity of the parasuicide summary

El parasuicidio constituye un grupo muy heterogéneo de conductas autolíticas, con muy diferente letalidad unas de otras y posiblemente muy distintas repercusiones clínicas y sociales. Objetivo: Identificar variables psicosociales y clínicas asociadas con severidad de conductas parasuicidas. Se valora severidad por el grado de intencionalidad suicida (SIS) y por el tiempo de hospitalización requerido. Método: Estudio transversal de una serie de 170 casos, atendidos consecutivamente en el Servicio de Urgencias de un Hospital General por parasuicidio. Resultados. El 75 por ciento de los casos tenían muy escasa intención suicida. El modelo multivariante que mejor explica mayor intencionalidad suicida incluye: edad, trastorno depresivo, trastorno psicótico y antecedentes familiares de suicidio. Existe una correlación débil entre intencionalidad y tiempo de hospitalización, de forma que pacientes con poca intención suicida tienen hospitalizaciones largas. Las variables más asociadas a un mayor tiempo de hospitalización fueron: ser varón, con patología psiquiátrica como trastorno psicótico o abuso de sustancias, con un bajo funcionamiento social previo y utilización de fármacos y alcohol en el intento: Conclusión: La edad avanzada, antecedentes familiares y presencia de depresión o trastorno psicótico, se asocian con mayor intención suicida. Aunque la mayoría de los pacientes parasuicidas presentan muy baja intencionalidad suicida, la repercusión sociosanitaria inmediata puede ser elevada (AU)

El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España / Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain

FUNDAMENTO: En el contexto de una investigación multinacional europea sobre gestión de calidad en psiquiatría de enlace (financiada por el programa BIOMED 1 de la Unión Europea), se analiza la naturaleza de la actividad asistencial de las unidades de psicosomática y psiquiatría de enlace (UPPE) de los seis hospitales generales españoles que participaron en el estudio. PACIENTES Y MÉTODO: Se estudiaron 3.608 pacientes, atendidos consecutivamente por las unidades de psiquiatría de enlace de cinco hospitales generales de la red pública (Clínico de Zaragoza, Clínico de Barcelona, General de Alicante, Ramón y Cajal de Madrid y Princesa de Madrid) y un centro privado monográfico (Instituto Dexeus de Barcelona), a partir de los datos recogidos con un instrumento de registro (CL-BDok-P) estandarizado y validado en investigaciones previas. RESULTADOS: La petición de consulta psiquiátrica se hizo a los 10,6 días (como promedio) del ingreso del paciente, la mitad de las peticiones fueron urgentes y el promedio de tiempo de respuesta de la psiquiatría de enlace fue de 1,9 días. Los principales motivos de petición de consulta fueron la existencia de síntomas psiquiátricos (50,3 por ciento), los síntomas somáticos sin explicación médica (15,2 por ciento), el abuso de sustancias (9,2 por ciento), la existencia de antecedentes psiquiátricos (8,5 por ciento), el riesgo de sucidio (6 por ciento) y el afrontamiento de la enfermedad (5,8 por ciento). Los servicios que hicieron más demandas fueron los de medicina interna (17,2 por ciento), traumatología (7,5 por ciento) y cirugía general (7,3 por ciento). Se documenta una importante actividad asistencial en pacientes a menudo 'complejos', con medidas diagnósticas e intervenciones de amplio espectro y seguimientos intrahospitalarios y al alta del paciente. Por el contrario, se ponen de manifiesto algunos problemas en el 'proceso' de intervención. CONCLUSIONES: De los resultados se infiere la indudable importancia de la psiquiatría de enlace española en el contexto de la asistencia especializada, pero también la posibilidad de mejorar su eficiencia con la propuesta de modelos integradores, de modificaciones organizativas y de la implementación de un moderno modelo de 'gestión de calidad' (AU)