Use of Paliperidone Palmitate Throughout a Schizoaffective Disorder Patient's Gestation Period.

Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. Case report: An analysis is made of the safety and tolerability of paliperidone palmitate treatment throughout the gestation period in a 34-year-old patient diagnosed with schizoaffective disorder. Discussion: Paliperidone palmitate treatment throughout the gestation period was safe and well tolerated by both mother and foetus, there being no malformations or other perinatal complications in the newborn to date.

Psicopatología general en tabaquismo / General psychopathology in cigarette smoking

Se realizó un programa para deshabituación tabáquica en el medio laboral. Los grupos de tratamiento fueron asignados según la elección voluntaria del los pacientes. El protocolo de valoración consistió en entrevistas clínicas y cuestionarios (EDI-2, SCL-90-R) constituyéndose dos grupos de estudio según presentaran diagnóstico de enfermedad mental (n = 17) o no (n = 25). Los enfermos con patología psiquiátrica mostraron mayores niveles de ineficacia (0,008), perfeccionismo (0,0001), conciencia interoceptiva (0,0001), impulsividad (0,002) e inseguridad social (0,003), ansiedad (0,001) y GSI (0,01). Los pacientes con dependencia de tabaco que solicitan abandonar el hábito tabáquico tienen una alta prevalencia de comorbilidad psiquiátrica y muestran mayores niveles de psicopatología general y disfunciones alimentarias. Recomendamos realizar estudios longitudinales y con mayor número de pacientes para confirmar estos datos y conocer la evolución de dichos pacientes a lo largo del proceso de tratamiento

A nicotine deshabituation program is done in a place of work. Two study groups were assignated about the patient’s voluntary election of treatment. The protocol was composed of a clinic interview and tests (EDI-2, SCL-90). Two study groups were constituted depending on suffered mental disorder (n = 17) or not (n = 25). Patients with mental disorder had highest score in ineffectiveness (0.008), perfectionism (0.0001), interoceptive awareness (0.0001) impulsivity (0.002) and social insecurity (0.003), anxiety (0.001) and GSI (0.01). Patients with nicotine addiction who ask for give up smoking show a high prevalence of psychiatry comorbility and highest score in general psycopathology and eating disturbances. We recommend realizing longitudinal studies with a bigger number of patients to confirm these data and knowing these patient’s evolution in the treatment

Efficacy of bupropion in the treatment of pemoline dependence.

We present the case of a woman who requested psychiatric evaluation because she had been taking pemoline for six months at a dose between 100-150 mg/day, and was finding it difficult to discontinue taking this substance. Initiation of 300 mg/day of bupropion solved the patient's dependence problem. We propose using antidepressants such as bupropion for the treatment of addictive behaviors due to central nervous system stimulants.

[Psychological features and Doppler-Duplex in erectile disfunction]. / Aspectos psicológicos y Doppler-Duplex dinámico en disfunción eréctil.

OBJECTIVES: To establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injec tion and psychological features in patients suffering from erectile dysfunction. METHODS: Forty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultra sonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed an penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90). RESULTS: 29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5 cm/s and penile tumescence grade III) and were classified as good responders with probably psy chogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vas cular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. Th more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography. CONCLUSIONS: Psychological features and dysfunctional personality traits accompany psychogenic and organic erectile dys function, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an usefu method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort an dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.

[History of sexual abuse in patients with bulimia nervosa: its influence on clinical status]. / Antecedentes de abusos sexuales en pacientes con bulimia nerviosa: su influencia en el estado clínico.

INTRODUCTION: Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. METHODS: Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. RESULTS: Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. CONCLUSIONS: The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.

Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES).

BACKGROUND: The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. METHODS: A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. RECOMMENDATIONS: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

[Factors associated with poor response after surgery in morbid obesity]. / Factores asociados a mala respuesta tras cirugía en obesidad mórbida.

The eating behavior, the psychopathological status, and the personality were analyzed in a group of patients with morbid obesity, 18 months after surgery, isolating psychopathological factors associated with a poor response.

Psychopathological differences between morbidly obese binge eaters and non-binge eaters after bariatric surgery.

AIMS: To determine the psychological characteristics of a group of morbidly obese patients with binge eating disorders and to investigate whether the psychopathological status of binge eaters is different from that of other morbidly obese patients. METHODS: We used the Binge Eating Scale, the Three-Factor Eating Questionnaire and the Millon Clinical Multiaxial Inventory-II (MCMI-II) to interview 140 morbidly obese patients 18 months after bariatric surgery (vertical banded gastroplasty), and compared the results obtained in binge eaters (n = 25) and non-binge eaters (n = 115). RESULTS: The binge eaters had more eating disturbances (more binge eating, less restriction, more disinhibition, more hunger) and psychopathological characteristics (passive-aggressive traits, aggressive-sadistic traits, manic disorders, alcohol dependence and major depression) than the non-binge eaters. They were also younger and achieved a lower percentage of weight loss. CONCLUSIONS: After bariatric surgery, our obese binge eaters reported significantly more psychiatric symptoms, especially those relating to eating disorders, depression, alcohol dependence and personality disturbances. Their weight loss was less satisfactory, and they sought bariatric surgery at a younger age.

[Psychopathology of bulimia nervosa: a multidimensional model]. / Psicopatología de la bulimia nerviosa: un modelo multidimensional1

INTRODUCTION: In recent years, a number of studies have been carried out with the intention of isolating clinical dimensions in the psychopathology of bulimia nervosa. Although borderline personality has been considered a core element of the bulimic psychopathology by most of the authors, it has not been incorporated into any of these models. In this context, the present study was aimed at testing the consistence of the more complex model proposed until now, including in the analysis borderline personality as a clinical variable. SAMPLE AND METHODS: A group of 66 female patients fulfilling DSM-IV criteria for bulimia nervosa were assessed using a set of clinical instruments. The isolated items were processed using factor analysis techniques. RESULTS: Five basic dimensions of bulimia nervosa were obtained: 1. body disatisfaction; 2. restrictive eating behaviors; 3. purging behaviors; 4. emotional instability; and 5. disocial behavior. CONCLUSIONS: Our results support the idea that bulimia nervosa is a multidimensional condition. In our model, the dimension emotional instability incorporated borderline features, which tended to be strongly associated to self-defeating behaviors and depressive symptoms.

Estudio de la personalidad en una Unidad de Hospitalización breve psiquiátrica / Study of the personality in a brief-stay Psychiatric Unit

Objetivo: Pretendemos examinar el papel que los trastornos de la personalidad desempeñan en las características clínicas de pacientes ingresados en una unidad psiquiátrica corta estancia. Material y métodos: Estudio retrospectivo de 91 pacientes, mediante una entrevista realizada por personal sanitario clínico, ingresados entre noviembre de 1999 y febrero de 2000; donde se evaluó 3 tipos de variables (socio-demográficas, clínicas, y análisis de la personalidad). Resultados: Predominio del estado civil soltero, así como de la existencia de antecedentes personales psiquiátricos; siendo el motivo de ingreso más frecuente el trastorno de conducta. Se observó en la distribución de los trastornos de personalidad un predominio del trastorno esquizoide y anancástico. Discusión: Necesidad de lograr un acuerdo mayor entre médicos en el diagnóstico de presunción de trastorno de personalidad, así como una mayor probabilidad de este diagnóstico cuando existe comorbilidad con el eje I, o un mayor desajuste social (AU)

Aspectos clínicos de la folie à trois: a propósito de un caso / Clinical perspective in the folie à trois: a case report

El trastorno psicótico inducido es un cuadro clínico poco frecuente. Describimos un caso en el que están implicados tres miembros de una misma familia. Se analizan los factores etiológicos, la dinámica familiar y el entorno social en las psicosis inducidas (AU)

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Edidemiología del gesto autolítico en el hospital general / Epidemiology of the attempted suicide in the general hospital

Analizamos los datos sociodemográficos y clínicos de los pacientes atendidos por gesto autolítico en el servicio de Interconsulta Psiquiátrica de un Hospital General. Describimos los siguientes resultados: carácter de la demanda, diagnósticos psiquiátricos más frecuentes, así como el servicio médico que solicita dicha valoración. Hemos encontrado diferencias significativas en cuanto a la urgencia de la petición de la interconsulta, el diagnóstico clínico y el servicio que la solicita (AU)