[Impact on mental healthcare after collaboration between primary healthcare and mental health services]. / Impacto en la asistencia en salud mental tras la colaboración entre atención primaria y salud mental.

INTRODUCTION: The primary care physician is the professional with whom the psychiatric patient has contact first and most frequently. For this reason, a good coordination between the Primary Healthcare (PHC) and Mental Health (MH) services is essential to provide the best care to patients and at the same time optimise the limited resources of this service. The aim of this work is to determine whether the collaboration between PHC and MH results in a more efficient use of the limited resources in MH. METHODOLOGY: An observational, retrospective, mirror study was carried out with a total sample of 135 patients over 16 years old referred for the first time from PHC to Psychiatry. The results during the first 6 months of the collaboration between PHC and MH (POST Group) are compared with those of the 6 months prior to the intervention (PRE Group). RESULTS: After collaboration meetings, the percentage of patients who are discharged by the psychiatrist after the first visit decreases (32.2% vs. 16%) and the percentage of follow-up by psychiatry and psychology increases. Furthermore, the percentage of patients who do not attend the first visit decreases (23.3% vs. 13.7%). CONCLUSIONS: The data suggest that the collaboration between PHC and MH improves the effectiveness and functioning of MH services.

Involuntary outpatient treatment (IOT) in Spain.

In recent decades there have been significant legislative changes in Spain. Society develops faster than laws, however, and new challenges have emerged. In 2004, the Spanish Association of Relatives of the Mentally Ill (FEAFES) proposed amending the existing legislation to allow for the implementation of involuntary outpatient treatment (IOT) for patients with severe mental illness. Currently, and after having made several attempts at change, there is no specific legislation governing the application of this measure. Although IOT may be implemented in local programmes, we consider legal regulation to be needed in this matter.

Involuntary outpatient treatment in patients with severe mental illness: a one-year follow-up study.

INTRODUCTION: Involuntary outpatient treatment (IOT) aims to ensure adherence to therapy in patients with serious mental disease who are unaware of their illness and for whom treatment discontinuation carries a high risk of relapse. OBJECTIVES: To evaluate the effectiveness of IOT in preventing relapse among patients with serious mental disease. METHOD: A retrospective observational study was carried out on all of the patients (n=140) receiving IOT in the city of Valencia, Spain. Hospital service uses (emergency care, admissions and mean stay times) during the 12 months before and after the introduction of IOT were compared. RESULTS: Patients with schizophrenia, delusional disorder or schizoaffective disorder showed a significant reduction in the number of admissions and days spent in the psychiatry ward during the year of IOT. The reduction in the number of visits to the emergency department was only significant for the patients with schizophrenia. DISCUSSION: We conclude that involuntary outpatient treatment may be effective for patients with serious mental disease who are unaware of their illness and for whom treatment discontinuation carries a high risk of relapse.

A proteomics approach to quantify protein levels following RNA interference: case study with glutathione transferase superfamily from the model metazoan Caenorhabditis elegans.

Loss-of-function phenotypic analysis via interference RNA (RNAi) technology is a revolutionary approach to assigning gene function. While transcript-based methodologies commonly validate RNAi gene suppression investigations, protein-based validation is less developed. This report illustrates the potential for two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (2-DE) and gel analysis to quantify protein levels following RNAi. This case study involves three glutathione transferase (GST) genes targeted by RNAi from the model organism Caenorhabditis elegans.

Activation of soluble guanylate cyclase by nitric oxide is increased in lymphocytes from both rats chronically exposed to 2,5-hexanedione and workers chronically exposed to n-hexane.

Although occupational exposure to n-hexane induces neurotoxic effects in the central and peripheral nervous systems, the mechanisms of its neurotoxicity remain unclear. n-Hexane is metabolized to 2,5-hexanedione (2,5-HD), which is the neurotoxic agent and the indicator chosen for the biological monitoring of exposed workers. It has been previously reported that chronic exposure to 2,5-HD impairs the glutamate-nitric oxide-cyclic GMP pathway at the level of activation of soluble guanylate cyclase (sGC) enzyme by nitric oxide (NO), both in cultured neurons and in the cerebellum of rats in vivo. The aim of this study was to assess whether the activation of sGC by NO is also altered in lymphocytes from rats treated with 2,5-HD and/or workers chronically exposed to n-hexane. Lymphocytes were isolated from male Wistar rats treated with 2,5-HD in drinking water, and from blood samples from shoe-factory workers environmentally and chronically exposed to n-hexane. Urine samples were also collected from workers at the end of the shift in order to measure the urinary levels of 2,5-HD. Activation of sGC by NO was significantly higher (p<0.05) in lymphocytes from rats treated with 2,5-HD than in control rats. In isolated lymphocytes from exposed workers the activation of sGC by NO also increases (p<0.05) in contrast to the controls. The results presented here indicate that the activation of lymphocytes could be an indicator of the toxicity produced by being exposed to n-hexane, since the effects observed in workers chronically exposed to n-hexane are similar to those found in rats chronically treated with 2,5-HD in drinking water.

Validez del trastorno autodestructivo de la personalidad DSM-III-R / Validity of DSM-III-R self-defeating personality disorder

Introducción: El trastorno autodestructivo de personalidad se introdujo en el DSM-III-R como una categoría propuesta para estudio adicional, siendo retirada de la cuarta edición del DSM debido a las dudas en torno a su validez. Objetivos: El objetivo de esta revisión es examinar la justificación de dicha decisión. Se presenta y discute la historia del trastorno, así como las bases para su inclusión como una categoría provisional del DSM-III-R. También se exponen los resultados de un estudio llevado a cabo por nuestro equipo con el objetivo de verificar la existencia del trastorno. Sujetos y métodos: Tras la evaluación de una muestra aleatoria de 200 pacientes psiquiátricos atendidos en un centro de salud mental, se seleccionaron 15 casos con sospecha clínica de rasgos autodestructivos para ser evaluados por un panel de expertos, mediante la historia clínica y la información aportada por el Personality Assessment Schedule(PAS). Resultados: Se identificaron dos casos, ambos comórbidos con el trastorno de personalidad dependiente. Seis sujetos más fueron diagnosticados como casos subumbral de acuerdo con los criterios DSM, presentando todos ellos comorbilidad en el eje 11. Conclusión: El trastorno "autodestructivo de personalidad parece existir; probablemente con una baja prevalencia y una alta comorbilidad, pero es necesario llevar acabo una mayor investigación para clarificar estos aspectos

lntroduction: Self-defeating Personality Disorder was introduced in DSM-III-R classificationas a category in need offurther study and then removedfrom DSM-IV edition because of its doubt ul validity. Objectives: The aim of this review is to examine the justification of such a decision. The history of the disorder as well as the bases for its inclusion as a provisional categoryin DSM-III-R are presented and discussed. Then, the results of a study carried outby our team with the aim of verifying the existence of the disorder are presented. Subjects and method: 15 patients with clinical suspicion of self-defeating traits were selected from a random sample of two hundred psychiatric outpatients and the information obtained from Personality Assessment Schedule (PAS) and clinical interview was assessed by a panel of experts. Results: Two cases were identified, both comorbid with Dependent Personality Disordel: Six more subjects were diagnosed as subthreshold cases according to DSM criteria. All of them presented other comorbidities. Conclusion: Self-defeating Personality Disorder seems to exist, though probably with a low prevalence and a high comorbidity, but further research is necessary to clarify these aspects

Homicidio-suicidio en el anciano: ¿por qué el cuidador mata a su pareja con enfermedad de Alzheimer y después se suicida? / Homicide-suicide in the elderly: why do caragivers kill partners with Alzheimer's disease and then kill themselves?

Las consecuencias negativas para los cuidadores de los familiares con demencia son bien conocidas. Sin embargo, existe poca información sobre la violencia familiar que implica a los cuidadores, habitualmente esposos, que matan al paciente y, en ocasiones, después se suicidan o lo intentan. En este artículo se hace una revisión sobre este tema. Y se encuentra que la depresión es una característica nuclear del anciano agresor y que generalmente es el varón

The negative consequences of caring for relatives with dementia have been well documented. However, data are lacking about violence involving caregivers, usually spouses, who kill the patient and sometimes attempt or commit suicide. In the present article we review this topic, in which depression in the perpetrator, usually a man, plays an important role

Abuso de anabolizantes / Abuse of anabolic steroids

Los esteroides anabolizantes se utilizan en la actualidad como drogas de abuso. Se ha descrito un patrón de consumo adictivo y sintomatología por abstinencia. La administración prolongada de dosis altas se ha asociado con patología orgánica y trastornos psiquiátricos. En este artículo hacemos una revisión del tema

Anabolic steroids are currently used as drugs of abuse. An addictive pattern of consumption and withdrawal symptoms has been described. Prolonged administration of high doses is associated with organic disease and psychiatric disorders. The present article provides a review of the subject

Trastorno depresivo de la personalidad y alteraciones del estado de ánimo / Depressive personality disorder and mood disorders

INTRODUCCIÓN: El trastorno depresivo de la personalidad (TDP) está incluido en el apéndice B del DSM-IV a la espera de que estudios futuros puedan aclarar si se trata de una categoría diagnóstica independiente de otros trastornos de los ejes I y II. En este artículo se presentan nuevos datos sobre su relación con el trastorno depresivo mayor y la distimia. PACIENTES Y MÉTODO: En una muestra aleatoria de atención primaria, se evalúa si los pacientes presentan un trastorno depresivo de la personalidad según los criterios del DSM-IV, un trastorno depresivo mayor o un trastorno distímico, así como los antecedentes personales y familiares de los pacientes con trastornos afectivos. RESULTADOS: Se obtiene una muestra de 657 pacientes, de los cuales el 3,6 por ciento (n = 24) cumple criterios diagnósticos de trastorno depresivo de la personalidad. En el momento de la exploración, el 37,5 por ciento de los pacientes con trastorno depresivo de la personalidad son diagnosticados también de distimia y el 20,8 por ciento de trastorno depresivo mayor. Una tercera parte de los casos diagnosticados de trastorno depresivo de la personalidad nunca han presentado un trastorno del estado de ánimo. Los antecedentes familiares afectivos son más frecuentes en los pacientes diagnosticados de trastorno depresivo de la personalidad. CONCLUSIONES: El trastorno depresivo de la personalidad, a pesar del solapamiento conceptual y empírico existente, puede ser distinguido clínicamente de otros trastornos afectivos del eje I. Estudios futuros deberán informar acerca del curso y pronóstico de este trastorno y de su relación con otros trastornos del eje II (AU)

Chronic exposure to 2,5-hexanedione impairs the glutamate-nitric oxide-cyclic GMP pathway in cerebellar neurons in culture and in rat brain in vivo.

2,5-Hexanedione is a neurotoxic metabolite of hexane. The mechanisms of its neurotoxicity remain unclear. We assessed whether chronic exposure to 2,5-hexanedione affects the glutamate-nitric oxide-cGMP pathway in primary cultures of cerebellar neurons and/or in the cerebellum of rats. Chronic exposure of cultured cerebellar neurons to 2,5-hexanedione (200 microM) reduced by approximately 50% NMDA-induced formation of cGMP. Activation of soluble guanylate cyclase by nitric oxide was reduced by 46%. This treatment reduced the content of neuronal nitric oxide synthase and soluble guanylate cyclase in neurons by 23 and 20%, respectively. In the cerebellum of rats chronically exposed to 2,5-hexanedione (in the drinking water) NMDA-induced formation of cGMP was reduced by 55% as determined by in vivo brain microdialysis. Activation of soluble guanylate cyclase by nitric oxide was reduced by 65%. The content of neuronal nitric oxide synthase and of soluble guanylate cyclase was reduced by 25 and 21%, respectively, in the cerebellum of these rats. The effects are the same in both systems, indicating that cultured neurons are a good model to study the mechanisms of neurotoxicity of 2,5-hexanedione. These results indicate that chronic exposure to 2,5-hexanedione affects the glutamate-nitric oxide-cGMP pathway at different steps both in cultured neurons and in cerebellum of the animal in vivo. The alteration of this pathway may contribute to the neurotoxic effects of 2,5-hexanedione.

Trastorno depresivo de la personalidad / Depressive personality disorder

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Aluminium impairs the glutamate-nitric oxide-cGMP pathway in cultured neurons and in rat brain in vivo: molecular mechanisms and implications for neuropathology.

Aluminium (Al) is a neurotoxicant and appears as a possible etiological factor in Alzheimer's disease and other neurological disorders. The mechanisms of Al neurotoxicity are presently unclear but evidence has emerged suggesting that Al accumulation in the brain can alter neuronal signal transduction pathways associated with glutamate receptors. In cerebellar neurons in culture, long term-exposure to Al added 'in vitro' impaired the glutamate-nitric oxide (NO)-cyclic GMP (cGMP) pathway, reducing glutamate-induced activation of NO synthase and NO-induced activation of the cGMP generating enzyme, guanylate cyclase. Prenatal exposure to Al also affected strongly the function of the glutamate-NO-cGMP pathway. In cultured neurons from rats prenatally exposed to Al, we found reduced content of NO synthase and of guanylate cyclase, and a dramatic decrease in the ability of glutamate to increase cGMP formation. Activation of the glutamate-NO-cGMP pathway was also strongly impaired in cerebellum of rats chronically treated with Al, as assessed by in vivo brain microdialysis in freely moving rats. These findings suggest that the impairment of the Glu-NO-cGMP pathway in the brain may be responsible for some of the neurological alterations induced by Al.

Role of nitric oxide and cyclic GMP in glutamate-induced neuronal death.

Glutamate is the main excitatory neurotransmitter in mammals. However, excessive activation of glutamate receptors is neurotoxic, leading to neuronal degeneration and death. In many systems, including primary cultures of cerebellar neurons, glutamate neurotoxicity is mainly mediated by excessive activation of NMDA receptors, leading to increased intracellular calcium which binds to calmodulin and activates neuronal nitric oxide synthase (NOS), increasing nitric oxide (NO) which in turn activates guanylate cyclase and increases cGMP. Inhibition of NOS prevents glutamate neurotoxicity, indicating that NO mediates glutamate-induced neuronal death in this system. NO generating agents such as SNAP also induce neuronal death. Compounds that can act as "scavengers" of NO such as Croman 6 (CR-6) prevent glutamate neurotoxicity. The role of cGMP in the mediation of glutamate neurotoxicity remains controversial. Some reports indicate that cGMP mediates glutamate neurotoxicity while others indicate that cGMP is neuroprotective. We have studied the role of cGMP in the mediation of glutamate and NO neurotoxicity in cerebellar neurons. Inhibition of soluble guanylate cyclase prevents glutamate and NO neurotoxicity. There is a good correlation between inhibition of cGMP formation and neuroprotection. Moreover 8-Br-cGMP, a cell permeable analog of cGMP, induced neuronal death. These results indicate that increased intracellular cGMP is involved in the mechanism of neurotoxicity. Inhibitors of phosphodiesterase increased extracellular but not intracellular cGMP and prevented glutamate neurotoxicity. Addition of cGMP to the medium also prevented glutamate neurotoxicity. These results are compatible with a neurotoxic effect of increased intracellular cGMP and a neuroprotective effect of increased extracellular cGMP.

[Evaluation of psychiatric training in Spain: results of a questionnaire]. / Evaluación de la formación de psiquiatría en España: resultados de una encuesta.

INTRODUCTION: In this paper, a collective of Psychiatry Residents from Valencia surveys the degree of achievement and satisfaction with the Spanish programme. METHOD: Every resident received an enquiry and a letter with instructions to fill it. Colleagues who did not answer back, were contacted and sent a new enquiry. RESULTS: We received a total of 142 enquiries from 52 institutions (80% of the total). The results are distributed in supervision, theoretical training, research, rotatories, assistential pressure, staff-resident ratio, training out of the programme and satisfaction. CONCLUSIONS: This work show that the programme is not being carried out properly. There are still some deficiencies in many rotatories, even though they have been improved. In spite of it, the level of satisfaction with the residence is acceptable.

[Preparation of a SCID-II-based diagnostic tool for personality disorders. Spanish version. Translation and adaptation]. / Elaboración de un instrumento para el diagnóstico de los trastornos de personalidad basado en el SCID-II: Versión española. Traducción y adaptación.

We carried out the translation and adaptation into Spanish of the original version of the SCID-II (Semistructured Clinical Interview for Diagnosis in Axis II according to DSM-III-R). In the questionnaire we modified the formulation of some items: the questions were changed into assertions and the answer scale was broadened into seven options. In the interview, questions and operative formulations which did not appear in the English version were created. Four trained psychiatrist interviewed in pairs a sample of 60 patients who has previously filled in the questionnaire. The reliability between interviewers oscilates between K = 0.37 for the Schizotypical Personality Disorder and K = 1 for the Avoidant Personality Disorder. The overall agreement (presence or absence of diagnosis) is K = 0.85. With the questionnaire we established 257 diagnoses whereas with the interview we diagnosed 35 cases.