Responsabilidad profesional médica y suicidio: recomendaciones médico-legales / Medical professional responsibility and suicide: Medical-legal recommendations

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Leucopenia y neutropenia de rápida evolución inducidas por olanzapina / Leucopenia and neutropenia rapidly evolving induced by olanzapine

Algunos antipsicóticos se asocian a discrasias sanguíneas. El psicofármaco que más produce agranulocitosis es la clozapina (0,5-2% de los pacientes). La olanzapina es un antipsicótico de segunda generación con estructura química similar a la clozapina que tiene un riesgo de leucopenia/neutropenia de 1/10.000 pacientes tratados. Presentamos el caso de un paciente de 32 años sin antecedentes somáticos ni psiquiátricos, hospitalizado por un primer episodio psicótico. En la analítica previa al ingreso no había alteraciones en el hemograma (leucocitos totales 8,92x103/ul, neutrófilos totales 6,99x103/ul). A los tres días de haber iniciado tratamiento con olanzapina 20mg/día el recuento leucocitario había disminuido a 2,46x103/ul (neutrófilos totales 0,64x103/ ul). Tras sustituir la olanzapina, inicialmente por risperidona y posteriormente por zuclopentixol intramuscular, el recuento leucocitario fue aumentando progresivamente. A los doce días de la retirada, el hemograma se había normalizado (leucocitos totales 5,73x103/ul) (AU)

Some antipsychotics drugs are associated with blood dyscrasias. The psychotropic medication most frequently associated with agranulocytosis is clozapine (0,5-2% of patients). Olanzapine is a second-generation antipsychotic with a chemical structure similar to clozapine, with a risk of neutropenic reactions of 1/10.000 treated patients. We report the case of a 32-yearold man without medical or psychiatric records, who was admitted due to a first psychotic episode. In a blood test previous to hospitalization, complete blood cell count was normal (white blood cell count 8,92x103/ul, neutrophilic count 6,99x103/ul). Three days after initiation of olanzapine 20mg/day, WBC count had fallen to 2,46x103/ul (neutrophilic count 0,64x103/ul). After replacing olanzapine, initially for risperidone and later for intramuscular zuclopentixol, WBC count gradually increased. On the twelfth day of olanzapine withdrawal, complete blood cell count had normalized (WBC count 5,73x103/ul) (AU)

Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador / Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences

Objetivos. Describir la frecuencia de consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico (TCE) y valorar su relación con los trastornos neuropsiquiátricos, la funcionalidad y la sobrecarga del cuidador. Pacientes y métodos. Se valoraron 156 pacientes con historia de TCE moderado y grave. Se determinó el consumo previo de alcohol y tóxicos. A los informantes de los pacientes se les administró el inventario neuropsiquiátrico (NPI) y la escala de sobrecarga del cuidador de Zarit. La funcionalidad de los pacientes se valoró mediante la escala de puntuación de discapacidad (DRS) y la escala de coma de Glasgow extendida (GOSE). Resultados. Treinta y seis pacientes (23%) eran consumidores habituales de alcohol y otros tóxicos antes del traumatismo. Las alteraciones neuropsiquiátricas fueron más frecuentes y graves en el grupo de consumidores habituales, en especial la irritabilidad y la agitación-agresividad. Sus cuidadores percibieron una sobrecarga mayor. Después del TCE, 16 pacientes (44,4%) recayeron en el consumo. Tener una edad superior y vivir en pareja se asociaron a una mayor tasa de abstinencia. Conclusión. El antecedente de consumo de alcohol y tóxicos es frecuente en pacientes que han sufrido TCE y constituye un factor de riesgo para el desarrollo de alteraciones conductuales. Se necesitan intervenciones más activas encaminadas a la detección de estos casos y a la prevención de recaídas tras el traumatismo (AU)

Aims. To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. Patients and methods. 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). Results. 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. Conclusion. The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma (AU)

[Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences and caregiver burden]. / Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador

AIMS: To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. PATIENTS AND METHODS: 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). RESULTS: 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. CONCLUSION: The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma.