Substance use and course of bipolar disorder in an inpatient sample.

INTRODUCTION: Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription. METHODS: The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects. RESULTS: Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them. CONCLUSIONS: The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years.

Uso de sustancias y curso del trastorno bipolar en una muestra de pacientes hospitalizados / Substance use and course of bipolar disorder in an inpatient sample

Introducción. Los pacientes con trastorno bipolar (TB) presentan un consumo de sustancias comórbido con elevada frecuencia. Nuestro estudio pretende establecer una relación entre el consumo de sustancias y el TB, en cuanto a una mayor dificultad diagnóstica, un peor pronóstico y cambios en la prescripción farmacológica. Métodos. La muestra estuvo compuesta por 394 sujetos que a lo largo de veinte años fueron hospitalizados con un diagnóstico de TB en la unidad de agudos de Psiquiatría de un hospital general (10,6% del total de 3704 pacientes ingresados). Las historias clínicas fueron analizadas para obtener datos demográficos, clínicos y relativos al grupo familiar de los sujetos. Resultados. Se obtuvieron datos completos de 319 pacientes. De ellos 165 (51,7%) presentaban antecedentes personales de consumo de sustancias (abuso/dependencia). Este fue más frecuente en hombres (79,7% vs. 34,2%), en menores de 65 años (58,4% vs. 16,7%) y en el TB tipo I respecto al II (55% vs. 35%). Los pacientes consumidores de sustancias presentaban una edad de inicio de la enfermedad más precoz así como más dificultades diagnósticas. Respecto al tratamiento, recibían al alta más estabilizadores del estado de ánimo y más antipsicóticos, así como dosis más elevadas de la mayoría de ellos. Conclusiones. Los casos de patología dual fueron detectados en más de la mitad de la muestra, siendo los más graves y con peor pronóstico, presentando además un debut más temprano de la enfermedad. La asociación TB / consumo de sustancias fue más frecuente en hombres y en menores de 65 años

Introduction. Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription. Methods. The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects. Results. Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them. Conclusions. The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features.

OBJECTIVE: Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied. METHODS: Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment. RESULTS: When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients. DISCUSSION: The results support the association between blunted cortisol response and bulimic features.

Fluoxetine, topiramate, and combination of both to stabilize eating behavior before bariatric surgery.

INTRODUCTION: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). MATERIAL AND METHODS: We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). RESULTS: Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. CONCLUSIONS: The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery.

Fluoxetina, topiramato y combinación de ambos en el control de la conducta alimentaria antes de la cirugía bariátrica / Fluoxetine, topiramate, and combination of both to stabilize eating behavior before bariatric surgery

Introducción. El tratamiento farmacológico de la obesidad está dirigido principalmente a la pérdida de peso, mantenimiento de la pérdida de peso y la reducción del riesgo (reducción de la grasa corporal, factores de riesgo cardiovasculares y la incidencia de diabetes mellitus). Entre los fármacos que han sido evaluados para bajar de peso están los antidepresivos (fluoxetina) y antiepilépticos (topiramato). Material y Métodos. Se analiza la conducta alimentaria y la pérdida de peso en una muestra de pacientes con obesidad mórbida antes de la cirugía bariátrica. Aquellos pacientes que sufrían trastornos alimentarios se agruparon en tres grupos: un grupo recibió 40 mg de fluoxetina/día (Grupo A); topiramato 200 mg/día (Grupo B) y el otro fluoxetina 40 mg y 200 mg de topiramato (Grupo C). Resultados. Los pacientes tratados con fluoxetina más topiramato perdieron más peso a los 3 y 6 meses antes de la cirugía. Conclusiones. El uso de psicofármacos (fluoxetina y topiramato) en pacientes obesos mórbidos con trastornos de la alimentación puede representar una ayuda para el manejo de la conducta alimentaria antes de la cirugía bariátrica

Introduction. Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). Material and Methods. We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). Results. Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. Conclusions. The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery

Rabdomiolisis inducida por paliperidona: a propósito de un caso / Paliperidone-induced rhabdomyolysis: a case report

No disponible

Concurrencia de múltiples factores en la aparición de arritmia ventricular en paciente en tratamiento con aripiprazol / Concurrence of multiples factors in the ocurrence of ventricular arrhythmia in patient treated with aripiprazole

Introducción. Importancia de los efectos cardiovasculares, fundamentalmente las arritmias ventriculares, producidos por los antipsicóticos. Caso clínico. Paciente de 28 años con obesidad mórbida, por la que fue intervenido obteniendo buenos resultados, sufre una taquicardia ventricular no sostenida polimórfica mientras realizaba tratamiento farmacológico con aripiprazol y fluoxetina. Conclusiones. Valorar la influencia de diversos factores en la producción de arritmias ventriculares, destacando fundamentalmente las interacciones de los antipsicóticos y la pérdida de peso (AU)

Introduction. The Importance of the cardiovascular effects, fundamentally the ventricular arrhythmias, produced by the antipsychotic ones, is discussed. Clinical case. 28 year old patient with morbid obesity, operated by bariatric surgery, with good result, suffers a ventricular no supported polymorphic tachycardia while he was heightening treatment with aripiprazole and fluoxetine. Conclusions. To value the influence of diverse factors for the production of ventricular arrhythmias emphasizing fundamentally the interactions of aripiprazole and the loss of weight (AU)

Concurrence of multiples factors in the occurrence of ventricular arrhythmia in patient treated with aripiprazole.

INTRODUCTION: The Importance of the cardiovascular effects, fundamentally the ventricular arrhythmias, produced by the antipsychotic ones, is discussed. CLINICAL CASE: 28 year old patient with morbid obesity, operated by bariatric surgery, with good result, suffers a ventricular no supported polymorphic tachycardia while he was heightening treatment with aripiprazole and fluoxetine. CONCLUSIONS: To value the influence of diverse factors for the production of ventricular arrhythmias emphasizing fundamentally the interactions of aripiprazole and the loss of weight.

Oseltamivir- related psychiatric manifestations.

The importance effect on the population of the new virus Influenza A/H1N1 and the potential therapeutic with Oseltamivir. Clinical case. Patient of 62 years old, without history of interest, contracted Influeza A, that she undergoes a confusional syndrome responding to antipsychotics and with complete recovery after the episode. Conclusions. Establish the possible relationship between the various factors are influencing the onset confusional syndrome in a patient infected with Inluenza A treated with Oseltamivir.

Manifestaciones psiquiátricas relacionadas con oseltamivir / Oseltamivir-related psychiatric manifestations

Destacar la afectación en la población del nuevo virus Influenza A/H1N1 y la posibilidad terapéutica con oseltamivir. Caso clínico. Paciente de 62 años, sin antecedentes de interés, que contrajo la Gripe A, sufre un Síndrome confusional, que responde a antipsicóticos y con recuperación completa tras el episodio. Conclusiones. Establecer la posible relación entre los diversos factores que influyen en la aparición de un síndrome confusional en un paciente infectado con la gripe A que recibe tratamiento con Oseltamivir (AU)

The involvement of the new Influenza A/H1N1 virus and the treatment potential with Oseltamivir in the populationis stressed. Clinical case. A 62-year old patient, with no history of interest, who contracted Influenza A, suffered a confusional syndrome that responded to antipsychotics, with complete recovery after the episode. Conclusions. To establish the possible relationship between the various factors that affect the onset of a confusional syndrome in a patient infected with Influenza A treated with Oseltamivir (AU)

Cognición y enfermedad por cuerpos de Lewy / Cognition and lewy body disease

Introducción. Asistimos en los últimos años a un cambio importante en las manifestaciones clínicas de la Enfermedad de Parkinson (EP). Los problemas motores para los que hoyen día existen mejores tratamientos que hace unas décadas, han dado paso a manifestaciones no motoras como principal fuente de incapacidad en la EP avanzada, siendo el deterioro cognitivo la más grave por su prevalencia y devastadoras consecuencias. Caso Clínico. Presentamos el caso de una paciente mujer de 72 años que llega a nuestro servicio aludiendo quejas de tipo cognitivo y depresivas, posiblemente compatibles con un síndrome depresivo, y a la que finalmente se diagnostica de Enfermedad por Cuerpos de Lewy pese a ser dichas manifestaciones cognitivas más propias de los cuadros avanzados. Conclusión. Mostrar un caso clínico de Enfermedad por Cuerpos de Lewy de interés por su sintomatología incipiente de tipo cognitivo (de interés para la valoración psiquiátrica), de tipo motor o parkinsonianos (de interés para la valoración neurológica) y de tipo orgánico, a la luz de las pruebas complementarias efectuadas. Asimismo, justificamos el uso de la rivastigmina como tratamiento de elección para este tipo de cuadros de Enfermedad por Cuerpos de Lewy que debutan con sintomatología cognitiva (AU)

Introduction. We’re assisting in last years to an important change in clinical manifestations of Parkinson disease. Nowadays motor symptoms have best treatments if we compare with those existing some decades ago, which in last term, permits other manifestations being the main disabilities in an advanced Parkinson disease. Among these disabilities cognitives are the most severe due to it’s prevalence and devastating consecuences. Clinical Case. We present the clinical case of a 72 aged woman who complains of cognitive and depressive symptoms, probably compatible with a depressive disorder, but finally diagnosed with Lewy body disease despite these cognitive manifestations are most common in advanced disease. Conclusions. We’ re showing an interesting case of Lewy body disease due to it’s incipient symptomatology in cognitive manifestations (which makes it interesting for psichiatric value), motor manifestations (interesting for neurological value) and organic manifestations as complementary tests demostrate. Finally, we justificate the usage of rivastigmine as the choice of treatment in these cases which onset is mainly composed by cognitive symptoms (AU)

Cognition and Lewy body disease.

INTRODUCTION: We're assisting in last years to an important change in clinical manifestations of Parkinson disease. Nowadays motor symptoms have best treatments if we compare with those existing some decades ago, which in last term, permits other manifestations being the main disabilities in an advanced Parkinson disease. Among these disabilities cognitives are the most severe due to it's prevalence and devastating consecuences. CLINICAL CASE: We present the clinical case of a 72 aged woman who complains of cognitive and depressive symptoms, probably compatible with a depressive disorder, but finally diagnosed with Lewy body disease despite these cognitive manifestations are most common in advanced disease. CONCLUSIONS: We' re showing an interesting case of Lewy body disease due to it's incipient symptomatology in cognitive manifestations (which makes it interesting for psichiatric value), motor manifestations (interesting for neurological value) and organic manifestations as complementary tests demostrate. Finally, we justificate the usage of rivastigmine as the choice of treatment in these cases which onset is mainly composed by cognitive symptoms. Key words: Parkinson, Lewy Bodies, dementia, cognitive impairment, rivastigmine, dopamine.