Radial diffusivity is the best global biomarker able to discriminate healthy elders, mild cognitive impairment, and Alzheimer's disease: A diagnostic study of DTI-derived data.

INTRODUCTION: For the past two decades, diffusion tensor imaging (DTI)-derived metrics allowed the characterization of Alzheimer's disease (AzD). Previous studies reported only a few parameters (most commonly fractional anisotropy, mean diffusivity, and axial and radial diffusivities measured at selected regions). We aimed to assess the diagnostic performance of 11 DTI-derived tensor metrics by using a global approach. MATERIALS AND METHODS: A prospective study performed in 34 subjects: 12 healthy elders, 11 mild cognitive impairment (MCI) patients, and 11 patients with AzD. Postprocessing of DTI magnetic resonance imaging allowed the calculation of 11 tensor metrics. Anisotropies included fractional (FA), and relative (RA). Diffusivities considered simple isotropic diffusion (p), simple anisotropic diffusion (q), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). Tensors included the diffusion tensor total magnitude (L); and the linear (Cl), planar (Cp), and spherical tensors (Cs). We performed a multivariate discriminant analysis and diagnostic tests assessment. RESULTS: RD was the only variable selected to assemble a predictive model: Wilks' λ = 0.581, χ2 (2) = 14.673, P = 0.001. The model's overall accuracy was 64.5%, with areas under the curve of 0.81, 0.73 and 0.66 to diagnose AzD, MCI, and healthy brains, respectively. CONCLUSIONS: Global DTI-derived RD alone can discriminate between healthy elders, MCI, and AzD patients. Although this study proves evidence of a potential biomarker, it does not provide clinical guidance yet. Additional studies comparing DTI metrics might determine their usefulness to monitor disease progression, measure outcome in drug trials, and even perform the screening of pre-AzD subjects.

Tratamiento psicológico grupal de sesión única para personas que sufren trastornos adaptativos. Programa y evaluación preliminar / No disponible

La elevada demanda de atención en salud mental en el Sistema Sanitario Público de Andalucía requiere idear e implementar propuestas asistenciales proporcionales a la gravedad de los trastornos, a la vez que ágiles y de calidad. Este trabajo presenta un programa de tratamiento psicológico grupal de sesión única para atender a personas que sufren trastornos adaptativos, así como los resultados de una evaluación preliminar de dicho programa. Los objetivos del programa son ayudar a la recuperación psicológica y emocional de los participantes y a la prevención de su recaída. Se ha aplicado a 40 personas, mujeres y varones, con edades comprendidas entre los 22 y 73 años, derivadas por sus médicos de atención primaria. La evaluación preliminar se realizó mediante un cuestionario de valoración y de satisfacción con el tratamiento de elaboración propia, indicadores asistenciales y la percepción de los profesionales que indicaron la derivación. A pesar del reducido número de pacientes que necesitaron una nueva derivación en los 12 meses siguientes, de las puntuaciones discretamente positivas obtenidas en el mencionado cuestionario y la percepción positiva de los médicos que indicaron la derivación, las limitaciones metodológicas de este estudio obligan a seguir valorando la oportunidad y utilidad del mismo en nuevos estudios controlados

The high demand for mental health care in the Public Health System of Andalusia requires to devise and implement care proposals proportional to the severity of the disorders, while being agile and of quality. This paper presents a single-session group psychological treatment program to assist people with adjustment disorders, as well as the results of its preliminary evaluation. The objectives of the program are to help the psychological and emotional recovery of the participants and to prevent their relapse. It has been applied to 40 people, women and men, aged between 22 and 73 years, derived by their family doctors. The preliminary evaluation was carried out through a questionnaire of assessment and satisfaction with de treatment of own elaboration, indicators of care and the perception of professionals who indicated the derivation. In spite of the small number of people who are referred back within 12 months after the treatment, the discreetly positive scores obtained in the questionnaire and the favorable perception of the doctors who referred patients, the methodological limitations of this study oblige to continue assessing the opportunity and utility of the same in new controlled studies

Diagnostic performance of regional DTI-derived tensor metrics in glioblastoma multiforme: simultaneous evaluation of p, q, L, Cl, Cp, Cs, RA, RD, AD, mean diffusivity and fractional anisotropy.

OBJECTIVES: Almost a dozen diffusion tensor-imaging (DTI) variables have been used to evaluate brain tumours with scarce information about their diagnostic ability. We aimed to perform a comprehensive evaluation of tensor metrics reported in the last decade. METHODS: Retrospective case control study performed in 14 patients with glioblastoma multiforme (GBM) and 28 controls. Conventional brain MR sequences and image postprocessing of DTI allowed the calculation of: MD, FA, p, q, L, Cl, Cp, Cs, RA, RD and AD, classified into five regions: normal appearance white matter (NAWM), immediate and distant oedema, enhancing rim and cystic cavity. ANOVA and AUROC analyses were performed. RESULTS: ANOVA depicted a significant difference among all metrics (p < 0.05). RA had the highest performance in the NAWM and cystic cavity; immediate and distant zones of oedema were best diagnosed by RD and Cp respectively; q was the best biomarker of the enhancing rim zone; p < 0.001 for all metrics. CONCLUSIONS: FA and MD, accepted biomarkers of brain injury, were surpassed by other metrics. RA, together with Cs, Cl and CP, might be the new leaders in the evaluation of brain tumours. DTI tensor metrics depict different clinical applicability at each tumour region.

Secondary MRI-findings, volumetric and spectroscopic measurements in mesial temporal sclerosis: a multivariate discriminant analysis.

INTRODUCTION: Primary- and secondary MR findings, volumetric measurements and MR spectroscopy data of each hippocampus represent more a dozen of variables that radiologists should consider in a quantitative MR report of temporal lobe epilepsy (TLE). There is a paucity of data about the significance of secondary MR findings simultaneously evaluated with volumetry and MR spectroscopy. We analyzed the influence of qualitative-secondary MR findings simultaneously with quantitative (volumetry and spectroscopy) data in MRI positive- and negative patients with mesial temporal sclerosis (MTS). METHODS: Analytic and transversal study of 59 patients with TLE and suspiciousness of MTS. 13 variables were analyzed for each hippocampus: age, gender, cerebral hemisphere, temporal lobe atrophy, choroidal fissure dilatation, mamillary body atrophy, collateral white matter atrophy, fornix asymmetry; Naa/Cr, Cho/Cr, mI/Cr, Naa/(Cr+Cho); and hippocampus volume (mm3). Multivariate discriminant analysis (DA) was performed with the aim to identify specific morphologic and metabolic attributes in hippocampi with and without MTS. RESULTS: Discriminant function significantly differentiated the hippocampi with- and without MTS (Wilks' λ = 0.211, χ2 (11) = 116.072, p = < .001. The model explained 79.03% of the variation in the grouping variable. The pooled within-groups correlations showed the highest influence of discriminating function for the secondary MR findings over metabolite indices and hippocampal volumes, the overall predictive accuracy was 93.9%. DISCUSSION: Due of the large number of variables (qualitative and quantitative) to which a radiologist is exposed in a conventional hippocampal MR-report, such evaluation might benefit from the use of predictive models generated by unconventional statistical methods, such as DA.

[Imaging anatomy of the cranial nerves using 3.0 Tesla MRI: a practical review for clinicians]. / Anatomía de los nervios craneales con resonancia magnética de 3.0 Tesla: una revisión práctica para clínicos.

Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves (CN). These nerves constitute a group of structures that have acquired during their phylogenetic development a high degree of specialization. There are 12 pairs of CN to which we use their specific name or number. The olfactory (I) and optic (II) pairs are not real nerves but tracts from the encephalon. The spinal nerve (XI) derives from superior cervical segment of the spine. The other 9 pairs of CN are related with the brain stem. Although the skull base foramina can be seen on computed tomography, the nerves themselves can only be visualized in detail on MR. That means, in order to see the different segments of nerves I to XII, the right sequences must be used. It is important to provide detailed clinical information to the radiologist so that a tailored MR study can be performed. In this review, the basic imaging anatomy of the 12 CN is discussed and illustrated briefly with an emphasis on more advanced extra-axial anatomy, illustrated with high-resolution MR images. Clinicians looking for complete anatomic descriptions and/or MR illustrations are advised to consult specialized textbooks considering it is not possible to describe all of the anatomy in one article. This manuscript is intended to be a practical review for clinicians.

3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands.

BACKGROUND: Computed-assisted three-dimensional data (3D) allows for an accurate evaluation of volumes compared with traditional measurements. AIMS: An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs) and PGs containing adenomas. DESIGN: Prospective, transverse, analytical study. MATERIALS AND METHODS: Forty-eight subjects underwent brain magnetic resonance imaging (MRI) with 3D sequencing for computer-aided volumetry. PG phantom volumes by both methods were compared. Using the best volumetric method, volumes of normal PGs and PGs with adenoma were compared. Statistical analysis used the Bland-Altman method, t-statistics, effect size and linear regression analysis. RESULTS: Method comparison between 3D volumetry and geometric volume revealed a lower bias and precision for 3D volumetry. A total of 27 patients exhibited normal PGs (mean age, 42.07 ± 16.17 years), although length, height, width, geometric volume and 3D volumetry were greater in women than in men. A total of 21 patients exhibited adenomas (mean age 39.62 ± 10.79 years), and length, height, width, geometric volume and 3D volumetry were greater in men than in women, with significant volumetric differences. Age did not influence pituitary volumes on linear regression analysis. CONCLUSIONS: Results from the present study showed that 3D volumetry was more accurate than the geometric method. In addition, the upper normal limits of PGs overlapped with lower volume limits during early stage microadenomas.

Entrenamiento en meditación en la Unidad de Salud Mental Comunitaria Oriente (Sevilla): fundamentos, programa y resultados clínicos y de satisfacción de las pacientes / Training in meditation in the Unit of Mental Community Health Orientates (Seville): foundations, program and clinical results and of satisfaction of the patients

En el presente artículo exponemos el programa, resultados clínicos y satisfacción de las asistentes a un grupo de meditación. El programa presentado es original y fruto de la experiencia profesional y personal de los autores. Ha ido dirigido a pacientes que acuden a nuestra unidad de salud mental y que se encuentran aquejados por sintomatología ansioso-depresiva. A pesar de la brevedad del programa, los resultados tanto en depresion y ansiedad han sido significativos a nivel estadístico y superiores al grupo control. Así mismo, las asistentes refieren gran satisfacción con la experiencia y mejorías en diversos aspectos personales (confianza en sí mismas, esperanza de mejoría, capacidad de afrontamiento, mayor comprensión sobre el origen de sus problemas, etc.). Los resultados nos animan a extender el uso de la meditación en nuestra práctica cotidiana(AU)

In the present article we expose the program, clinical results and satisfaction of the assistants to a group of meditation. The presented program is original and a fruit of the professional experience and personnel of the authors. It has gone directed to patients who come to our unit of mental health and who are afflicted by anxious-depressive symptomatology. In spite of the briefness of the program, the results so much in depression and anxiety have been significant to statistical level and superior to group control. Likewise, the assistants recount great satisfaction with the experience and improvements in diverse personal aspects (confidence in yes same, hope of improvement, capacity of confrontation, major comprehension on the origin of his problems, etc.). The results encourage us to extend the use of the meditation in our daily practice (AU)

In vivo 3T spectroscopic quantification of liver fat content in nonalcoholic fatty liver disease: Correlation with biochemical method and morphometry.

BACKGROUND & AIMS: The clinical application of liver fat quantification has increased in recent years, paralleling the epidemic increase in nonalcoholic fatty liver disease. The aim of this study was to perform a diagnostic evaluation of spectroscopy by comparing its measurement of total lipid content with that from liver biopsies and morphometry in normal subjects and patients with nonalcoholic fatty liver disease. METHODS: Patients with symptomatic cholelithiasis underwent 3T MR cholangiography with spectroscopic quantification of TLC. A laparoscopic cholecystectomy was performed on the day of admission, with liver samples taken during surgery. Microcolorimetric assessment quantified lipid content in liver samples and morphometric evaluation in stained slides. Statistical analysis included bivariate correlation, regression, and ROC analysis. RESULTS: The study was conducted in 18 patients, 5 men (mean age, 35.2+/-11.03 years; range, 27-54 years) and 13 women (mean age, 46.77+/-11.77 years; range, 21-61 years). Using a cut-off value >5% for fat content, 8 patients presented with steatosis and 10 patients presented with normal liver fat content. A significant correlation was observed between fat spectroscopy and lipid content (r=0.876, p<0.001). A lower and non-significant correlation was observed between lipid content and morphometry (r=0.190, p>0.05). CONCLUSIONS: The accuracy of spectroscopy in assessing fat concentration with a cut-off level of 7.48% was 100%. Spectroscopy showed a strong and significant correlation with lipid content. It may reliably replace liver biopsy for the assessment of liver fat content.

Imaging techniques for assessing hepatic fat content in nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD), an emerging clinical entity with worldwide recognition, is today the most common cause of abnormal liver function tests among adults in the United States. In Mexico City, its prevalence has been reported by our group to be around 14%, but its incidence is higher in the hispanic population in the United States (hispanic population 45%, white population 33%, black population 24%). The main issues in the diagnosis, follow-up, and management of NAFLD are our limited understanding of its pathophysiology and the difficulties involved in developing a noninvasive diagnostic method. Several imaging techniques can detect fatty infiltration of the liver, each with its own advantages and disadvantages. Ultrasound is still in the first option for diagnosis, but its accuracy depends on the operator and the patient's features. Computed tomography can detect hepatic fat content, but only at a threshold of 30%, and it involves ionizing radiation. Magnetic resonance (MR) spectroscopy is probably the most accurate and fastest method of detecting fat, but it is expensive and the necessary software is still not easily available in most MRI units. MR elastography, a new technique to detect liver stiffness, has not been demonstrated to detect NAFLD, and is still undergoing research in patients with hepatitis and cirrhosis. In conclusion, all these imaging tools are limited in their ability to detect coexisting inflammation and fibrosis. In this review, we discuss the radiological techniques currently used to detect hepatic fat content.

A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease.

PURPOSE: To determine prospectively the safety and efficacy of the blood-pool contrast agent gadofosveset trisodium in renal artery magnetic resonance angiography (MRA). MATERIALS AND METHODS: Gadofosveset (0.03 mmol/kg) was administered to adult patients with known or suspected renal arterial disease in a multi-center phase 3 single dose study. The drug binds reversibly to albumin, prolonging the blood residence time, and allowing collection of images in the first-pass and steady-state phases. The combination of these images was compared to non-contrast MRA, using catheter X-ray angiography (XRA) as the standard of reference (SOR). All MRA images were collected at 1.5 T in one imaging session for direct comparison, and XRA within 30 days. Sensitivity, specificity, and accuracy for diagnosing significant disease (stenosis > or =50%) were calculated for MRA using three independent blinded readers. Patient safety was monitored for 72-96 h. RESULTS: A total of 145 patients at 18 centers were enrolled and received gadofosveset; the 127 with complete efficacy data entered the primary efficacy analysis. Gadofosveset-enhanced MRA led to significant improvement (p<0.01) in sensitivity (+25%, +26%, +42%), specificity (+23%, +25%, +29%), and accuracy (+23%, +28%, +29%) over non-enhanced MRA for the three readers. The rate of uninterpretable examinations decreased from 30% to less than 2%. There were no serious adverse events, and the most common adverse events were nausea, pruritus, and headache (8% each). No significant trends in clinical chemistry parameters, nor significant changes in serum creatinine, were found following administration of gadofosveset. CONCLUSION: In patients with known or suspected renal arterial disease, multi-phase gadofosveset-enhanced MRA significantly improves sensitivity, specificity, and accuracy versus non-enhanced MRA. Gadofosveset was safe and well tolerated in this patient population.

Conceptos actuales en la radiología basada en evidencias: revisión / A review of current concepts in evidence-based radiology

La medicina basada en evidencias (MBE) se fundamenta en un descubrimiento sistemático, evaluación crítica y utilización de la investigación actual publicada en la literatura médica, para la toma de decisiones referentes al cuidado de un paciente individual o políticas de salud. En la radiología (incluyendo sus ramas diagnóstica y terapéutica), los principios y práctica de una MBE han recibido atención limitada. En esta breve revisión, presentamos algunos conceptos básicos de cómo implementar una radiología basada en evidencias y los conceptos y etapas de la MBE y el metaanálisis con enfoque en la radiología basada en evidencias. Se identifican las aplicaciones de ésta en la práctica, la educación y la investigación, y las habilidades requeridas. La aplicación de los principios de la MBE en el diagnóstico por imagen facilita la interpretación de los estudios y sustenta una evaluación bien dirigida. Esta revisión será útil para radiólogos en cualquier etapa de su entrenamiento o desarrollo profesional, con el fin de estimular una práctica radiológica basada en evidencias, especialmente en países en desarrollo.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough." Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Esclerosis temporal mesial en epilepsia del lóbulo temporal: evaluación cuantitativa con resonancia magnética 3.0 Tesla / Mesial temporal sclerosis in temporal lobe epilepsy: quantitative magnetic resonance imaging assesment with 3.0 Tesla

Se estima que hasta 70% de los pacientes con epilepsia del lóbulo temporal tienen una alteración morfológica del hipocampo, la esclerosis hipocampal mesial, también llamada esclerosis temporal mesial que se caracteriza por pérdida de neuronas y gliosis responsable del foco epiléptico. En la resonancia magnética convencional la esclerosis temporal mesial se define por la presencia de una atrofia del hipocampo más una señal hiperintensa en las secuencias con tiempo de repetición largo específicas para el hipocampo (FLAIR y T2 coronal). La resonancia magnética 3.0 Tesla permite actualmente estudiar la anatomía y fisiología cerebral o cambiar el mecanismo de adquisición de la imagen y los parámetros posproceso. La volumetría proporciona actualmente un volumen preciso y junto con la espectroscopia hace posible una evaluación cuantitativa del hipocampo. Ambas técnicas se suman a los hallazgos de la resonancia magnética convencional para identificar las lesiones cerebrales que participan en un foco epiléptico. Presentamos un caso de esclerosis temporal mesial con análisis cuantitativo del hipocampo y una breve revisión de la literatura.

Recent studies show that up to 70% of patients with temporal lobe epilepsy (TLE) have a hippocampal deficit known as temporal mesial sclerosis (TME) characterized by neuron loss and gliosis, and considered the main epileptogenic focus among this type of patients. The magnetic resonance imaging (MRI) features of TME include atrophy and hippocampus hyperintensitY in the long TR sequences (Flair and T2). The 3.0 Tesla MRI allows the study of the brain's anatomy and physiology using different sequences and post processing mechanisms. Volumetry can determine the accurate volume and, together with spectroscopy, makes possible a quantitative assessment of the hyppocampus. Both techniques help to locate cerebral areas with epileptogenic activity. We describe the imaging findings from spectroscopy and volumetry in a patient with TLE and briefly review the related literature.

Síndrome de Wallenberg: hallazgos en resonancia magnética con correlación clínica / Wallenberg syndrome: magnetic imaging findings and clinical correlation

El síndrome de Wallenberg es una de las entidades clínicas más frecuentemente reconocidas como parte de la patología vascular del tallo cerebral. En la actualidad puede ser identificada con rapidez gracias a las modernas técnicas en neuroimagen. Presentamos un paciente con cuadro clínico de miosis, disfonía, disfagia, seguido de ataxia. Se efectuó evaluación con resonancia magnética utilizando técnicas de difusión, coeficiente aparente de difusión, FLAIR (fast fluid-attenuated inversion recovery) y perfusión. Se describe la correlación clínica de los síntomas con la localización anatómica de la lesión, y se discuten los hallazgos de imagen. La descripción de este caso enfatiza la utilidad de la resonancia magnética para una adecuada evaluación y correlación clínica de los hallazgos en imagen con la exploración neurológica.

Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified by modern neuro-imaging techniques. We describe a patient complaining of miosis, dysphonia, and dysphagia followed by ataxia. An MRI evaluation was performed including diffusion-weighted imaging, apparent diffusion coefficient, T2-weighted images, fluid attenuated inversion recovery (FLAIR) and perfusion. A brief discussion of imaging findings is presented as well as a clinical correlation of the symptoms with the anatomic location of the lesion. This case report emphasizes the importance of imaging findings and their clinical correlation with neurological examination.

[Mesial temporal sclerosis in temporal lobe epilepsy: quantitative magnetic resonance imaging assesment with 3.0 Tesla]. / Esclerosis temporal mesial en epilepsia del lóbulo temporal: evaluación cuantitativa con resonancia magnética 3.0 Tesla.

Recent studies show that up to 70% of patients with temporal lobe epilepsy (TLE) have a hippocampal deficit known as temporal mesial sclerosis (TME) characterized by neuron loss and gliosis, and considered the main epileptogenic focus among this type of patients. The magnetic resonance imaging (MRI) features of TME include atrophy and hippocampus hyperintensitY in the long TR sequences (Flair and T2). The 3.0 Tesla MRI allows the study of the brain's anatomy and physiology using different sequences and post processing mechanisms. Volumetry can determine the accurate volume and, together with spectroscopy, makes possible a quantitative assessment of the hyppocampus. Both techniques help to locate cerebral areas with epileptogenic activity. We describe the imaging findings from spectroscopy and volumetry in a patient with TLE and briefly review the related literature.

[Wallenberg syndrome: magnetic imaging findings and clinical correlation]. / Síndrome de Wallenberg: hallazgos en resonancia magnética con correlación clínica.

Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified by modern neuro-imaging techniques. We describe a patient complaining of miosis, dysphonia, and dysphagia followed by ataxia. An MRI evaluation was performed including diffusion-weighted imaging, apparent diffusion coefficient, T2-weighted images, fluid attenuated inversion recovery (FLAIR) and perfusion. A brief discussion of imaging findings is presented as well as a clinical correlation of the symptoms with the anatomic location of the lesion. This case report emphasizes the importance of imaging findings and their clinical correlation with neurological examination.

[A review of current concepts in evidence-based radiology]. / Conceptos actuales en la radiología basada en evidencias. Revisión.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. " Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Subdural hematoma in a teenager related to roller-coaster ride.

Reports about neurological injury related to roller-coaster rides mostly involve adults; we present a case of subdural hematoma in a pediatric patient presented 14 days after a roller-coaster ride. These rides show extreme up-and-down, to-and-fro, and rotatory acceleration/deceleration forces that could produce tensile and shearing stresses with tearing of bridging cerebral veins resulting in subdural hemorrhage. Pediatricians should consider roller-coaster riding a modern cause of subdural hematoma, as well as a possible cause of unexplained neurologic events in otherwise healthy adolescents.

Tratamiento cognitivo conductual de un caso de trastorno delirante dismorfofóbico / Cognitive-behavioral treatment of a case of dismorphobic delusional disorder

Presentamos un caso de dismorfofobia delirante al que se aplica terapia cognitivoconductual (TCC) para modificar la creencia delirante y sus consecuencias emocionales y conductuales. La terapia incluyó: debate empírico, lógico y funcional, prueba de realidad y saciación. Las medidas de resultado fueron la PANSS, el grado de convicción en la creencia y escalas subjetivas de ansiedad y estado de ánimo. La convicción en la creencia desapareció y se produjo una notable mejoría en la perturbación emocional y en el funcionamiento social. Los cambios se mantuvieron 12, 24 y 36 meses después de finalizada la terapia. Se reflexiona sobre la necesidad de mantener tratamientos psicológicos a largo plazo en la psicosis (AU)

Tratamiento cognitivo-conductual de un paciente con diagnóstico de trastorno delirante / Cognitive-Behavioral treatment of a patient diagnosed of delusional disorder

Presentamos un caso con diagnóstico de trastorno delirante al que se aplica Terapia Cognitivo-Conductual (TCC) para la modificación de las creencias delirantes y sus consecuencias emocionales y conductuales. El procedimiento incluyó: debate empírico, lógico y funcional, comprobación de la realidad, saciación y solución elegante. Las medidas de resultado fueron la PANSS, medidas dimensionales del grado de convicción y preocupación en las creencias, la QLS y escalas subjetivas de ansiedad y de estado de ánimo. La convicción en las creencias permaneció inalterable, pero se produjeron nuevas reinterpretaciones delirantes de carácter más benigno; además , se apreció una notable mejoría en las perturbaciones emocionales asociadas y en el funcionamiento social, cambios mantenidos en seguimiento realizado 12 meses después de la terapia. Reflexionamos sobre la necesidad de tratamientos psicológicos de mantenimiento a largo plazo en el abordaje de la sintomatología psicótica (AU)

The paper presents the Cognitive-Behavioural Therapy used to modify the delusional beliefs and the emotional and functional consequences of a patient with a delusional disorder. The method included the following techniques: empirical, logical and functional discussion, verification of the reality, satiation and elegant solution. PANSS, dimensional measures of the extent of conviction, concerns about the beliefs, QLS and subjective scales of anxiety and mood were used as measures of the results. The conviction about the beliefs remained unalterable although new and more benign delusional reinterpretations were produced; there was also an improvement in the associated emotional disturbances and in the social functioning. These changes kept up stable in his 12 months follow up after the therapy. We reflect on the need of a long term psychological follow up for the intervention on the psychotic symptomatology (AU)

Alojamientos protegidos para enfermos mentales crónicos (1): perfil epidemiológico, síntomas, calidad de vida y autoestima en dos muestras de sujetos / Protected Housing for Chronic Mental Patients (1): Epidemiological profile. Symptoms, Quality of life and Self-esteem in two samples

En este estudio se comparan los síntomas psicopatológicos, la calidad de vida y la autoestima de dos muestras de pacientes mentales crónicos, unos que residen en alojamientos protegidos y otros en espera de hacerlo. También se precisa el perfil epidemiológico de los pacientes. Este tipo de alojamientos se presentan desde hace algunas décadas como la alternativa a los hospitales psiquiátricos tradicionales, que funcionaban en la práctica como recursos residenciales. Su utilidad ha sido considerada desde diferentes puntos de vista, a nivel clínico, asistencial, funcional y económico. A diferencia de los hallazgos de otros estudios, en el nuestro no se aprecia una mejor calidad de vida de los pacientes que viven en dichos alojamientos frente a los que no lo hacen. Tampoco están mejor psicopatológicamente ni tienen mayor autoestima. Se sugieren algunas modificaciones metodológicas en el diseño de futuros estudios que permitan controlar ciertas variables que pueden influir en los resultados (AU)

In this study the psychopathology symptoms, the quality of life and the self-esteem of two samples of patient mental chronic are compared, some housed in protected lodgings and others while waiting for making it. lt is also described the epidemic profile of the patients. This type of lodgings is presented for some decades like the alternative to the traditional psychiatric hospitals that worked in the practice as residential resources. Their utility has been considered from different points of view, at clinical, assistance, functional and economic level. Contrary to other discoveries, in our study a better quality of the patients' life is not appreciated that live in this lodgings in front of those that don't make it. Neither they are better psychopathologically neither they have bigger self-esteem. Methodological modifications are suggested in the design to control certain variables that can jnfluence in the results (AU)