¿Es hora de despertar a la Bella Durmiente? En 1980, la psiquiatría europea cayó en un profundo sueño / Is it time to awaken Sleeping Beauty? European psychiatry has been sleeping since 1980

En 1980, la publicación del Diagnostic and Statistical Manual of Mental Disorders (DSM-III) dio lugar a un callejón sin salida, el DSM-V. Siguiendo la alegoría del cuento de La Bella Durmiente, el DSM-III hechizó la psiquiatría europea, que cayó en un profundo sueño. En la actualidad, es hora de que despierte y cree un nuevo lenguaje psiquiátrico para la psicopatología descriptiva y la nosología psiquiátrica de acuerdo con los conocimientos del siglo xxi. Se revisan 4 temas. En primer lugar, la psicopatología descriptiva, incluidas a) la obra de Chaslin y la de Jaspers, y b) la transmisión de las ideas de Jaspers por parte de Schneider, que participó en las tentativas de Kraepelin de incorporar la neurociencia a la nosología psiquiátrica. En segundo lugar, los progresos de la psiquiatría estadounidense: a) la seudociencia del psicoanálisis, b) el bajo grado de experiencia diagnóstica antes de la publicación del DSM-III, c) la revolución neo-kraepeliniana, que dio lugar al DSM-III, d) el fracaso en mejorar las habilidades diagnósticas y e) la repetición del «mensaje» de Kraepelin («la neurociencia salvará la psiquiatría»). En tercer lugar, el DSM-III devastó la psiquiatría europea al echar por tierra: a) los libros de texto nacionales, lo que aumentó la coherencia pero arrinconó el pensamiento creativo en Europa, y b) la escala del sistema Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie, la tentativa más razonable de llegar a acuerdos diagnósticos empezando por los síntomas (primer nivel), en lugar de por los trastornos (segundo nivel). En cuarto lugar, Berrios ha desarrollado el concepto de Jaspers de que la psiquiatría es una ciencia híbrida y que los trastornos psiquiátricos son heterogéneos. Berrios explica que los signos y síntomas psiquiátricos son híbridos. Algunos síntomas corresponden al «espacio semántico» y la neurociencia no puede explicarlos (AU)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980, has led to a dead end, the DSM-V. Following the allegory of Sleeping Beauty, the DSM-III put European psychiatry to sleep; it now must wake up to create a 21st century psychiatric language for descriptive psychopathology and psychiatric nosology. Four topics are reviewed. First, the review of descriptive psychopathology focuses on: a) Chaslin's and Jaspers's books, and b) Schneider's transmittal of Jaspers's ideas and involvement with Kraepelin in incorporating neuroscience into psychiatric nosology. econd, US psychiatry's historic steps include: a) the pseudoscience of psychoanalysis, b) the low level of pre-DSM-III diagnostic expertise, c) the neo-Kraepelinian revolution which led to DSM-III, d) the failure to improve diagnostic skills, and e) the reprise of Kraepelin's marketing («neuroscience will save psychiatry»). Third, the DSM-III devastated European psychiatry by destroying: a) the national textbooks which increased consistency but eliminated creative European thinking; and b) the Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie, the most reasonable attempt to reach diagnostic agreement: start with symptoms/signs (first level) rather than disorders (second level). Fourth, Berrios elaborated upon Jaspers, who described psychiatry as a hybrid science and heterogeneous. Berrios affirmed that psychiatric symptoms/signs are hybrid. Some symptoms are in the «semantic space» and cannot be «explained» by neuroscience (AU)

Cardiovascular extracellular microRNAs: emerging diagnostic markers and mechanisms of cell-to-cell RNA communication.

Cardiovascular diseases are a leading cause of morbidity and mortality in Western societies. It is now well established that microRNAs (miRNAs) are determinant regulators in various medical conditions including cardiovascular diseases. The recent discovery that miRNAs, while associated with different carriers, can be exported out of the cell, has triggered a renewed interest to analyze the potential to use extracellular miRNAs as tools for diagnostic and therapeutic studies. Circulating miRNAs in biological fluids present a technological advantage compared to current diagnostic tools by virtue of their remarkable stability and relative ease of detection rendering them ideal tools for non-invasive and rapid diagnosis. Extracellular miRNAs also represent a novel form of inter-cellular communication by transferring genetic information from a donor cell to a recipient cell. This review briefly summarizes recent insights in the origin, function and diagnostic potential of extracellular miRNAs by focusing on a select number of cardiovascular diseases.

Diagnóstico prenatal de un hemangioma occipital de rápida involución / Prenatal diagnosis of a occipital rapidly involuting hemangioma

El hemangioma occipital es, tras los linfangiomas, el tipode tumoración más frecuente en cabeza y cuello. Su diagnósticoecográfico suele establecerse en el tercer trimestre o finalesdel segundo trimestre siendo útil la resonancia magnética(RM) prenatal para la confirmación del mismo. Posnatalmente,la gran mayoría de los casos regresan espontáneamente si bienpueden persistir y complicarse requiriendo exéresis quirúrgica.Presentamos el caso del hemangioma fetal de involuciónrápida (RICH, Rapidly Involuting Congenital Hemangioma) anivel occipital diagnosticado por ecografía en el tercer trimestrede gestación así como una revisión de la literaturadestacando los puntos clave para su diagnóstico diferencial,manejo prenatal, conducta obstétrica y tratamiento posnatal(AU)

Occipital hemangioma is one of the most frequentfetal head and neck tumors, second only to lymphangiomas.Diagnose is usually established in the third or inthe late second trimester of pregnancy. Prenatal MRIallowsdiagnosis confirmation. Vast majority of fetal hemangiomasregress spontaneously in the first year afterdelivery. However, persistence is a possibility, and theymight present complications, such as bleeding or ulcerations,in which case surgical treatment is warranted.We report a case of rapidly involuting congenitalhemangioma (RICH) in the occipital region of fetal craniumdiagnosed on a routine third timester fetal ultrasoundscan. We also present a review of available literature,outlining the key points to differential diagnosis,prenatal, obstetric and postnatal management(AU)

Variables psicológicas de riesgo de conducta antisocial adolescente / No disponible

La conducta antisocial se está convirtiendo en unproblema serio entre la infancia y la adolescencia. Losjóvenes con comportamiento antisocial presentan conductasagresivas repetitivas, vandalismos y rupturas conlas normas establecidas que impiden un desarrollosocial y de la personalidad adecuado.Existe un amplio consenso entre los investigadoresacerca de la naturaleza multicausal de la conducta antisocial.Aunque si bien es cierto que cualquier abordajepreventivo y/o de intervención de estas conductas enadolescentes debe centrarse en factores multidimensionales(biopsicosocial), en este artículo nos centraremosen la identificación de cuáles son las variables psicológicasde riesgo influyentes en el inicio y el mantenimiento de las mismas(AU)

The antisocial behavior is transforming into a seriousproblem between the childhood and the adolescence.The youths with antisocial behavior present aggressiverepetitive behaviors, vandalisms and ruptures with theestablished norms that impede a social development andan adapted personality.A wide consent exists among the investigators aboutthe nature multicausal of the antisocial behavior.Although it is certain that any preventive and/or interventionboarding of these behaviors in adolescentsshould be centered in a multidimensional factors (biopsycho-social). In this article we will center in the identificationof the psychological risk variables responsiblefor the beginning and the maintenance of the antisocialbehavior(AU)

Absceso como forma de presentación del carcinoma epidermoide primario de mama en una lactante. Revisión a propósito de un caso clínico / No disponible

Existen pocos casos descritos de absceso mamario comoforma de presentación del carcinoma epidermoide primario dela mama, y, menos aún, de carcinoma epidermoide de lamama durante la gestación. Generalmente, se considera queel potencial maligno del carcinoma epidermoide de mama esmayor que el de otras variedades anatomopatológicas de tumormamario así como también se le atribuye una mayoragresividad al cáncer de mama que aparece en la pacientegestante con respecto al que aparece fuera del periodo gestacional.Presentamos el caso de una paciente lactante diagnosticadade carcinoma epidermoide y llevamos a cabo una revisión delas características de esta variedad de neoplasia así como delas opciones de tratamiento que se han propuesto durante losúltimos años en relación a la misma(AU)

Few cases of breast primary squamous cell carcinoma(SCC) presenting as breast abscess have been reported and itis also less frequent the development of SCC during gestationalperiod. Malignant potential is generally considered to behigh in cases of SCC subtypes of breast cancer. On the otherside, breast cancer during lactation tends to behave aggressivelythan breast cancer in non- gestational patients.A case of SCC of the breast in a lactating woman is reported.We have reviewed literature for presenting features of thiskind of tumor and therapy options that have been suggestedduring last years(AU)

A study of genetic (CYP2D6 and ABCB1) and environmental (drug inhibitors and inducers) variables that may influence plasma risperidone levels.

Risperidone (R) is metabolized to 9-hydroxyrisperidone (9-OHR) by cytochrome P450 2D6 (CYP2D6). The main objective of this naturalistic study was to investigate the variables associated with two plasma ratios: the plasma R:9-OHR concentration ratio and the total concentration-to-dose (C:D) ratio. These ratios were studied as continuous measures by linear regression analyses and as three dichotomous variables in logistic regression analyses: R:9-OHR ratio >1 (indicative of lack of CYP2D6 activity), C:D ratio >14 (indicative of diminished R elimination), and C:D ratio <3.5 (indicative of increased R elimination). Plasma R levels; genotypes for CYP2D6, CYP3A5; and ABCB1 genes, and co-medication, including CYP inhibitors and CYP3A inducers, were studied in 277 patients. Almost all CYP2D6 poor metabolizers (PMs) had an inverted R:9-OHR ratio (>1). Having a CYP2D6 PM phenotype was strongly associated with a C:D ratio >14 (OR=8.2; 95% confidence interval [CI]=2.0-32.7), indicating diminished R elimination. CYP2D6 ultrarapid metabolizers (UMs) did not exhibit an increased R elimination. Some ABCB1 (or MDR1) variants were significantly associated with increased R:9-OHR ratios and decreased C:D ratios, but the results were neither consistent nor robust. Taking CYP inhibitors was significantly associated with a C:D ratio >14 (OR=3.8; CI=1.7-8.7) and with an inverted R:9-OHR ratio. Taking CYP3A inducers was significantly associated with a C:D ratio <3.5 (OR=41.8; CI=12.7-138), indicating increased R elimination. Female gender and old age appeared to be associated with a lower R elimination. Our study indicated that the CYP2D6 PM phenotype may have a major role in personalizing R doses, whereas the CYP3A5 PM phenotype probably has no role. CYP inducers and inhibitors appear to be relevant to R dosing. New studies are needed, particularly to further assess the role of the CYP2D6 UM phenotype and ABCB1 variants in R pharmacokinetics.