[Present status of psychosurgery in Spain]. / Estado actual de la psicocirugía en España.

In order to know the present activity of psychosurgery in Spain, and the opinion of neurosurgeons relative to it, a survey was designed and applied to all active neurosurgeons in our country. We obtained data from at least one neurosurgeon from the 74 neurosurgical centers in Spain (response rate= 100%). Only 6 neurosurgeons performed psychosurgical interventions. In total, 121 psychosurgeries were performed between 1999 and 2003, 75.7% of them in private centers. The most frequent indication is obsessive-compulsive disorder and the most frequent technique is anterior capsulotomy, although techniques and indications differ among the practising neurosurgeons. Those not performing them cite lack of patient referral (54.4%) or unexperience (36.8%) as the causes. A suspected lack of efficacy or the possible adverse effects are seldom expressed. The possibility of using deep brain stimulation for psychiatric indications, as well as the experience of some neurosurgeons and the favorable opinion of the rest, might increase the number of operations in our country.

[Efficacy of electroconvulsive therapy: a systematic review of scientific evidences]. / Eficacia de la terapia electroconvulsiva: revisión sistemática de las evidencias científicas.

We carried out a systematic study of bibliographical review of scientific evidence provided by clinical trials that assessed the short, medium and long-term efficacy of electroconvulsive therapy (ECT) from 1965 until June 2003. The studies with the following features have been excluded: a) those in which ECT is not the aim of the research; b) those that do not compare ECT with another different treatment; c) those in which the aim of the research is not to evaluate the efficacy of ECT, and d) those in which the studies are not randomized clinical trials. We have used the biomedical databases Medline, Psyclit, IME and Cochrane. On applying the corresponding search strategies on every bibliographical repertory, a total amount of 916 studies were found, which were reduced to 62 after having applied the specified exclusion criteria. The scientific evidence obtained, which compare the efficacy of ECT exclusively in depression, schizophrenia, mania and Parkinson disease, are systematized.

[Akathisia due to risperidone withdrawal: two clinical cases]. / Acatisia por retirada de risperidona: dos observaciones clínicas.

Akathisia due to withdrawal or disruption of antipsychotic treatment is a rare and scarcely elucidated presentation of extrapyramidalism which can also occur after other drug withdrawal. After having reviewed biomedical data basis IME and the latest seven years of MEDLINE and EMBASE, we only found one case, which was published in 1997, of persistent akathisia after risperidone withdrawal, but it had started under treatment with haloperidol. We next present the clinical observation of other two patients who developed akathisia after risperidone withdrawal. In one of them, akathisia started within the first days of treatment at hig-medium doses and got worse after withdrawal; in the other case, akathisia immediately started just after withdrawal of a nine-month treatment with risperidone at low doses.

Acatisia por retirada de risperidona: dos observaciones clínicas / Akathisia due to risperidone withdrawal: two clinical cases

La acatisia por retirada o discontinuación de tratamiento antipsicótico es una presentación rara y poco elucidada de extrapiramidalismo que también puede ocurrir tras la retirada de otros fármacos. Tras revisar las bases de datos biomédicas IME y los últimos siete años de MEDLINE y EMBASE sólo hemos hallado un caso publicado en 1997 de acatisia persistente tras la retirada de risperidona, pero que empezó bajo tratamiento con haloperidol. A continuación presentamos la observación clínica de otros dos pacientes que desarrollaron acatisia tras la supresión de risperidona: en un caso la acatisia había comenzado durante los primeros días del tratamiento con dosis altas-medias y se agravó tras la supresión; en el otro comenzó inmediatamente sólo tras la supresión de un tratamiento de nueve meses de dosis bajas de risperidona (AU)

[Variability in attitudes and use conditions of electroconvulsive therapy. Results of a preliminary study]. / Variabilidad en actitudes y condiciones de utilización de la terapia electroconvulsiva. Resultados de un estudio preliminar.

OBJECTIVE: Presenting the results of a pilot study on attitudes and use of ECT in Spain which was administrated to volunteers during a national congress of psychiatry. MATERIAL AND METHODS: A cross survey on a sample of psychiatrists (N= 125) which is not representative enough who attended the congress. A descriptive analysis of the outcomes is made. RESULTS AND CONCLUSIONS: There is a statistically significant association depending whether ECT is used in the work place or not. When it is used, there are 100% favorable attitudes. On the other hand, only 36% attitudes are favorable when ECT is not used in the work place. It is typically applied within a period of 8-10 treatment sessions, with a mean frequency of three times a week, performed by psychiatrists who treat with this technique less than 10 patients per year and using facilities within 1 to 5 years old. Maintenance ECT is unusual and it is only performed in monthly or fortnightly sessions. The commonest anesthetic agents are Propofol and Thiopental but this is unknown by 27.6% of the practitioners. The outcomes are contrasted with the consolidated guidelines on clinical practice of ECT.

[Determination in blood and urine of the recent non-therapeutic consumption of psychotropic substances in patients being admitted to the psychiatric unit of a general hospital in Valencia]. / Determinación en sangre y orina del consumo reciente no terapéutico de sustancias psicotropas en los pacientes que ingresan en la unidad de psiquiatría de un hospital general de Valencia.

BACKGROUND: An increasing trend in the consumption of psychoactive substances has been observed in psychiatric patients who are hospitalised. The aim of this research is to establish the prevalence and the characteristics of the recent and non-therapeutic consumption of these substances, by detecting their presence in the blood and urine of psychiatric patients admitted to hospital, the influence of such consumption on the clinical manifestations of the mental disorders and to recommend criteria for such a phenomenon. METHOD: Detection of cannabis, amphetamines, opiates and cocaine, using the ADX system, and in blood through the REA system for alcohol detection, in patients admitted to the Psychiatric Unit of the General University Hospital in Valencia, during the first six months of 1995. The diagnoses were based on the CIE-10 in its research version, and the influence of the consumption of substances detected in the clinical manifestations of the disorders was determined by the majority decision taken be three experienced psychiatrists. RESULTS: the prevalence detected in the consumption of psychotropic substances is high (almost one third of those admitted), and consumption played a part in the admission of most of these patients (nearly 89%), aggravating the mental disorder problem when they were admitted. The variables that were most often associated with the consumption detected, where males hospitalised as a result of a brush with the law. CONCLUSIONS: A routine determining of the presence or absence of substances liable to abuse is recommended in patients admitted to psychiatric institutions.

[Therapeutic guidelines in chronic fatigue syndrome]. / Orientaciones terapéuticas en el síndrome de fatiga crónica.

The treatment of CFS is not definitive up till now and it is limited both by ignorance of its causes and by different applicable operative case definitions. It has been etiopathologically related to infectious agents, neuromuscular illnesses, neuro-endocrinous-immunologic alterations and to different psychiatric disorders, particularly depressive disorders. Consequently, a great variety of therapeutic strategies have been tried, most of them with insufficient results. Among the medicamentous ones: immunity activator agents such as recombinant interleukin-2, nonspecific immunitary modulators such as seric gamma globulin, antivirus drugs such as acyclovir, muscular relaxants such as ciclobenzaprine, H2 receptor blockers and steroid and nonsteroid anti-inflammatory drugs such as ibuprofen, naproxen and fulbiprofen. Better results seem to have been obtained with antidepressants, and amfebutamone and serotonin-reuptake selective inhibitors are specially promising. Among the nonmedicamentous strategies, cognitive behavioural treatment can be effective and the so called "psychiatric management of the patient with CFS" has been proposed as a global, pragmatic, individualized, comprehensive approach which must be completed with other interdisciplinary interventions on the patient and his environment.

[Psychiatry periodicals in Spain up to 1931]. / Las revistas sobre psiquiatría en España hasta el año 1931.

The development of psychiatry, as it happens with other medical specialties, has been linked to that of the journals dedicated to it. They are a good exponent of its state of growing or consolidation. The first psychiatric journal in Spain appeared in 1865 and 27 years later the next one was founded. None of the three journals which existed in the 19th century continued at the beginning of the 20th century. During the first three decades of this century, nine specialized journals were founded, among which the "Revista Frenopática Española" in the first place, and the "Archivos de Neurobiología" afterwards, were the most outstanding in our country and the "Revista Frenopática Española" was that of the greatest international projection. Although the importance of a constellation of prestigious journals which were not dedicated to psychiatry was decisive for the development of this discipline in our country, the professionals organized themselves in the monographic journals about this subject, linked to mental hospitals.

[Prolific psychiatric authors of the 1st 3d of the century in Spain]. / Los autores psiquiátricos prolíficos del primer tercio de siglo en España.

The 45 main authors of articles on psychiatry from 1901 to 1931 are studied together using a repertory of the author as a source. It contains the psychiatric production in 32 important Spanish medical journals in that time. The following variables have been considered for the collective biographical analysis of the authors: year and place of birth, universities where they studied, institutions for their professional practising, cities for their professional residence, medical specialty, professional position, number of original articles on the subjects of psychiatry published and contained in the reference repertory, productivity index and signatures per work index. We can say that 0.2 of the prolific authors were born from 1880 to 1889 and 0.2888 of them were from Madrid and Barcelona. In those cities, 0.3334 of them studied Medicine and 0.6444 of them lived there; 0.6 of them worked in hospitals and 0.2222 of them worked in madhouses. Most of them were neuropsychiatrists. The occasional producers were 0.6908 of them and the reports with only one signer were 0.9492 of the total. Abdón Sánchez Herrero was the greatest producer on the specialty with 348 articles.