Seguridad de risperidona en el embarazo. A propósito de un caso / Risperidone safety in pregnancy. A case report

El uso de la risperidona y de otros antipsicóticos durante la gestación se hace, en ocasiones, imprescindible a pesar de la imposibilidad de diseñar ensayos clínicos que refrenden la seguridad de los mismos. El informe de casos clínicos es un modo de constatar la ausencia de hallazgos clínicos al nacimiento, pero puede ser insuficiente. Se presenta el caso de una mujer que padece un trastorno esquizofreniforme y se mantiene en tratamiento con risperidona durante todo el embarazo, que culmina con el nacimiento de un niño sano. Se repasa la evidencia científica respecto a la seguridad de la risperidona en la gestación y se apunta la necesidad de realizar estudios de seguimiento a largo plazo para valorar correctamente el riesgo que se corre a la hora de prescribir antipsicóticos en el embarazo (AU)

The use of risperidone and other antipsychotic drugs during pregnancy is sometimes essential, although it is impossible to design clinical trials to demonstrate the safety of these kinds of drugs. The common method to communicate the absence of drug-related events is through case reports, even though they might be insufficient. This is a case report of a woman with a schizophreniform disorder who continued treatment with risperidone during all her pregnancy, and who gave birth to a healthy baby. The scientific evidence regarding risperidone safety during pregnancy is reviewed and the need to conduct follow up studies evaluating the consequences of using antipsychotic drugs in pregnant women is stated (AU)

Risperidone safety in pregnancy. A case report.

The use of risperidone and other antipsychotic drugs during pregnancy is sometimes essential, although it is impossible to design clinical trials to demonstrate the safety of these kinds of drugs. The common method to communicate the absence of drug-related events is through case reports, even though they might be insufficient. This is a case report of a woman with a schizophreniform disorder who continued treatment with risperidone during all her pregnancy, and who gave birth to a healthy baby. The scientific evidence regarding risperidone safety during pregnancy is reviewed and the need to conduct followup studies evaluating the consequences of using antipsychotic drugs in pregnant women is stated.

Eficacia del topiramato en niños y adolescentes con problemas en el control de los impulsos: resultados preliminares / Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results

Introducción. Si bien el topiramato en el terreno farmacológico ha mostrado probada eficacia en los trastornos del control de impulsos (TCI), este hecho no ha sido constatado con la misma evidencia en niños y adolescentes. Nuestro objetivo consiste en valorar la mejoría sintomática de diversos TCI en dichas edades tras la introducción del topiramato.Caso clínico. Once casos con TCI (criterios DSM-IV) fueron evaluados mediante la escala de impulsividad de Barrat (EIB) de forma basal y al mes y los 3 meses del inicio de tratamiento con topiramato.Resultados. Encontramos diferencias significativas en la subescala de impulsividad cognitiva (p = 0,040) y en la puntuación global de la EIB (p=0,043) entre la puntuación basal y al mes de tratamiento; a los 3 meses también la subescala de impulsividad motora mostró diferencias significativas con respecto a la basal (p=0,015).Conclusiones. Las reducciones significativas en la puntuación de la EIB en pacientes valorados en consulta de psiquiatría infantojuvenil por TCI bajo criterios consensuados hacen considerar el topiramato un fármaco eficaz en el control de la impulsividad asociada a diversos trastornos psiquiátricos también en niños y adolescentes. Son necesarios más estudios que incluyan un número mayor de casos y con grupo control para confirmar estos resultados

Introduction. Although in the pharmacological field topiramate has shown proved efficacy in impulsive behavioral disorders (IBD), this fact has not been demonstrated with the same evidence in children and adolescents. The aim of this study is to evaluate improvement of symptoms in different IBD in those ages after treatment with topiramate. ;;Clinical case. Eleven cases of IBD (DSM-IV criteria) were evaluated with the Barrat Impulsivity Scale (BIS), obtaining scores at zero, one and three months after starting treatment with topiramate. Results. We found significant differences in the cognitive impulsivity subscale (p=0.040) and total score of the BIS (p=0.043) when BIS scale was measured after one month of treatment; after three months of treatment, the motor impulsivity subscale also showed significant differences (p=0.015). Conclusions. The significant reductions at BIS scores in child and adolescents outpatients who have IBD make us consider topiramate as an effective pharmacological option for treatment of impulsivity in several psychiatric disorders, also in childhood and adolescence. More studies are needed to confirm these results, with bigger samples and control groups

[Efficacy of topiramate in children and adolescent with problems in impulse control: preliminary results]. / Eficacia del topiramato en niños y adolescentes con problemas en el control de los impulsos: resultados preliminares.

INTRODUCTION: Although in the pharmacological field topiramate has shown proved efficacy in impulsive behavioral disorders (IBD), this fact has not been demonstrated with the same evidence in children and adolescents. The aim of this study is to evaluate improvement of symptoms in different IBD in those ages after treatment with topiramate. CLINICAL CASE: Eleven cases of IBD (DSM-IV criteria) were evaluated with the Barrat Impulsivity Scale (BIS), obtaining scores at zero, one and three months after starting treatment with topiramate. RESULTS: We found significant differences in the cognitive impulsivity subscale (p=0.040) and total score of the BIS (p=0.043) when BIS scale was measured after one month of treatment; after three months of treatment, the motor impulsivity subscale also showed significant differences (p=0.015). CONCLUSIONS: The significant reductions at BIS scores in child and adolescents outpatients who have IBD make us consider topiramate as an effective pharmacological option for treatment of impulsivity in several psychiatric disorders, also in childhood and adolescence. More studies are needed to confirm these results, with bigger samples and control groups.

Revisión del concepto de parafrenia. A propósito de un caso / Review of the concept of paraphrenia. A case report

Presentamos el caso de una mujer de mediana edad que, sin antecedentes previos ni aparente desencadenante, sufre un cuadro alucinatorio y, sobre todo, delirante, de una gran riqueza, que ha evolucionado a la cronicidad y hacia su recaída con el abandono del tratamiento antipsicótico. Aprovechamos el caso clínico para revisar y discutir la validez del concepto de parafrenia, desde las características que le otorgaban los clásicos hasta lo reducido del concepto en la actualidad, así como las implicaciones de dicha restricción nosológica

We present the case of a middle-aged woman with no psychiatric history or apparent precipitating factors, who suffered from a hallucinatory and mostly delirious syndrome that developed into chronicity and relapse after interruption of antipsychotic treatment. The clinical features are used to discuss the validity of the concept of paraphrenia, ranging from the characteristics attributed by classical authors to the current simplified concept, as well as the implications of this nosologic restriction

Mycobacterium wolinskyi sp. nov. and Mycobacterium goodii sp. nov., two new rapidly growing species related to Mycobacterium smegmatis and associated with human wound infections: a cooperative study from the International Working Group on Mycobacterial Taxonomy.

Previous investigations demonstrated three taxonomic groups among 22 clinical isolates of Mycobacterium smegmatis. These studies were expanded to 71 clinical isolates, of which 35 (49%) (group 1) were identical to five ATCC reference strains including the type strain ATCC 19420T. Twenty-eight isolates (39%) were group 2, and eight isolates (11%) were group 3. Isolates of groups 2 and 3 were most often associated with post-traumatic or post-surgical wound infections including osteomyelitis, were susceptible to sulfamethoxazole, amikacin, imipenem and the tetracyclines, variably resistant to clarithromycin, and susceptible (group 1), intermediately resistant (group 2) or resistant (group 3) to tobramycin. The three groups were similar by routine biochemical and growth characteristics, but had different mycolic acid dimethoxy-4-coumarinylmethyl ester elution patterns by HPLC and different PCR-restriction enzyme patterns of a 439 bp fragment of the hsp-65 gene. Group 3 isolates differed from group 1 by 18 bp by 16S rRNA sequencing and exhibited < 25% homology by DNA-DNA hybridization, being most closely related to Mycobacterium mageritense. The 16S rRNA of group 1 and group 2 isolates differed by only 3 bp, but by DNA-DNA hybridization they exhibited only 40% homology. The following names are proposed: Mycobacterium goodii sp. nov. for group 2 isolates (type strain ATCC 700504T = MO69T), Mycobacterium wolinskyi sp. nov. for group 3 isolates (type strain ATCC 700010T = MO739T) and Mycobacterium smegmatis sensu stricto for group 1 isolates.