[A case of obsessive symptoms in Huntington's disease]. / Un caso de síntomas obsesivos en la enfermedad de Huntington.

INTRODUCTION: Recently, some authors have postulated the existence of the so-called <>. This would include disorders that have the common point of the presence of repetitive thoughts and actions, which may either have a <> or <> nature. Certain neurological disorders with repetitive movements have also been grouped within this spectrum, including some forms of epilepsy, Parkinson's disease, Sydenham's Chorea or Huntington's disease. There is evidence that physiopathological connections may exist between some of these conditions. METHODS: A case of a patient with Huntington's Chorea with obsessive signs and symptoms is presented. The patient is a 50 year old male, diagnosed of Huntington's Chorea who is being treated with 25 mg/day of clozapine and 10 mg/day of clorazepate. The patient refused to eat certain foods for <>. He began to display other obsessive behaviors such as refusing to touch objects that might have been touched by others, and developed ritual checking methods. Treatment based on the administration of 40 mg/day of paroxetine was begun. With this treatment the compulsive symptoms have disappeared, as has the fear of choking. However, the choreic movements typical of his condition persist and the signs and symptoms associated with a process of dementia are becoming increasingly evident. CONCLUSIONS: It is concluded that the case described may well be a good example of obsessive spectrum, and that the underlying physio-pathology should be studied.

Tratamiento con gabapentina de los trastornos de la ansiedad / Treatment with gabapentin for anxiety disorders

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Un caso de síntomas obsesivos en la enfermedad de Huntington / A case of obsessive symptoms in Huntington's disease

Introducción. Recientemente, algunos autores han postulado la existencia del llamado "espectro obsesivo". En él se encontrarían trastornos que tendrían como punto en común la presencia de pensamientos o actos repetitivos, ya sean estos de tipo "compulsivo" o "impulsivo". Ciertos trastornos neurológicos con movimientos repetitivos se han incluido también dentro del espectro, como son algunas formas de epilepsia, la enfermedad de Parkinson, la corea de Sydenham o la enfermedad de Huntington. Existen indicios de que pudieran existir vínculos fisiopatológicos entre algunas de ellas. Métodos. Se presenta el caso de un paciente de corea de Huntington con sintomatología obsesiva. Se trata de un varón de 50 años, diagnosticado de corea de Huntington, y en tratamiento con clozapina 25 mg/día y clorazepato 10 mg/día. El paciente se negaba a tomar ciertos alimentos por "miedo a atragantarse". Comenzó a presentar comportamientos tales como evitar tocar objetos que pudieran haber tocado otras personas, además de rituales de comprobación. Se instauró un tratamiento de 40 mg/día de paroxetina. Con ello, la sintomatología compulsiva ha desaparecido, como también el miedo a atragantarse. Persisten, no obstante, los movimientos coreicos propios de su enfermedad y cada vez son más evidentes los signos y síntomas propios de un proceso demencial. Conclusiones. Se concluye que el caso reportado puede ser un buen ejemplo del espectro obsesivo, y se estudia la fisiopatología subyacente (AU)

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[Neurobiology of addiction to drugs of abuse]. / Neurobiologia de la adiccion a las drogas de abuso.

OBJECTIVE: In this review we study drug addiction from a neurobiological point of view, emphasizing the dopamine hypothesis. This is basic to explain how a genetic feature is related with an alteration of this neurotransmitter and can connect with environmental factors to develop the addiction problem. DEVELOPMENT: Toxic addiction is defined as the physical or psychophysiological dependence on a special chemical substance, whose suppression arouses deprivation symptoms in the person. The study of addiction to different drugs gives us a new approach for knowing the strengthening systems. Because even thought we do not know precisely the nervous mechanism of these substances that cause pleasure, we suppose that they are in the same place as rewarding and strengthening the behaviour mechanisms. In this way the dopamine hypothesis has been developed: in this hypothesis drug addiction is closely connected with a genetic upset of this neurotransmitter, so there is a defect in the reward system. This in turn stimulates the substance abuse that increases the brain s dopamine levels. CONCLUSION: Knowing the neurobiological mechanisms involved in addiction and its relation with dopamine and the reward system can help us understand that problem and aid the rational development of treatment

Influencia ponderal en el tratamiento a largoplazo con topiramato / Weight loss in long-term with topiramate

INTRODUCCIÓN: El objetivo de nuestro estudio es cuantificar la pérdida ponderal asociada al tratamiento a largo plazo con topiramato en pacientes con diferentes enfermedades neuropsiquiátricas y diversos grados de sobrepeso y obesidad. PACIENTES Y MÉTODOS: Se realiza un estudio observacional y prospectivo de 24 pacientes (19 mujeres y 5 varones) diagnosticados de diferentes enfermedades psiquiátricas y/o epilepsia y que asocian diversos grados de sobrepeso u obesidad.Se hace un seguimiento de dos años de duración, con revisiones periódicas cada tres meses el primer año y cada seis meses durante el segundo año. Se recogen las variaciones ponderales y se calcula el índice de masa corporal (IMC) en las diferentes visitas, al mismo tiempo que se evalúa su estado de ánimo, ansiedad, calidad de vida y calidad de sueño. RESULTADOS: En 23 de los 24 pacientes de la muestra se produjo un descenso del peso corporal al final del estudio. A lo largo del estudio el peso se redujo 9,5 kg de mediana (p < 0,01). Al mismo tiempo se observó una mejoría en el estado de ánimo, la ansiedad, la calidad de sueño y la calidad de vida a lo largo del estudio, siendo estadísticamente significativa en la dos últimas. DISCUSIÓN: En la actualidad el topiramato es una alternativa que podría ser beneficiosa para determinadas enfermedades neuropsiquiátricas que asocian sobrepeso u obesidad, con la doble ventaja de controlar la enfermedad neuropsiquiátrica al mismo tiempo que disminuye su peso corporal, con todos los beneficios que ello conlleva (AU)

Entrevistas, tests y cuestionarios de sueño aplicados a la realización de encuestas epidemiológicas / Interviews, tests and questionnaires of sleep disorders applied to epidemiological surveys

Se revisan diferentes métodos no instrumentales que han sido empleados en la evaluación epidemiológica del sueño (entrevistas, diarios de sueño y cuestionarios). Se hace un estudio más completo de estos últimos en la revisión con 1 figura, 2 tablas, y 86 referencias. La mayor parte de los mismos no han sido comparados con la polisomnografía, ni tampoco han sido objeto de una validación estadística ni epidemiológica suficiente. El Índice de Calidad de Sueño de Pittsburgh, y su versión española, es uno de los pocos instrumentos que han sido validados. Hay varios datos coincidentes entre los distintos trabajos: las quejas de mala calidad de sueño llegan a estar presentes en el 30 por ciento de las poblaciones evaluadas, pero la prevalencia de insomnio sólo es del 10 al 15 por ciento; la calidad de sueño es peor en ancianos y en mujeres; la duración media del sueño es cercana a las 7 horas y 30 minutos (AU)

Calidad de sueño en ancianos / Sleep quality in seniors

Los problemas del sueño son muy frecuentes en los ancianos, y el envejecimiento es un factor de riesgo para sufrir insomnio. A su vez, la mala calidad de sueño aumenta el riesgo de mortalidad en los ancianos. En el presente trabajo, hacemos público un estudio sobre la calidad de sueño de 55 sujetos mayores de 64 años, realizado con la versión española del Indice de Calidad de Sueño de Pittsburgh (PSQI). Encontramos que el deterioro del sueño es progresivo con el aumento de la edad, redundando sobre todo en una menor duración del sueño (AU)

El envejecimiento desde la perspectiva del análisis demográfico y social en psicogeriatría / Aging from the point of view of the demographic and social analysis in psychogerontology

Habiendo realizado nuestro país la transición demográfica y estando en una sociedad con estructura y requerimientos diferentes a la de las generaciones que nos han precedido, desde una perspectiva globalizadora y prospectiva se analizan diversas respuestas políticas ante el envejecimiento poblacional. España, con un índice de envejecimiento del 16,71 por ciento en 1999 (Estimación INE 1997), cuenta con 6.589.898 personas mayores de 65 años. Con una distribución estratográfica poblacional desigual, existen áreas peninsulares (cuencas del Duero y Ebro) que han cristalizado ya la estructura poblacional en un nuevo equilibrio. Dichas sociedades permiten anticipar y ensayar nuevos proyectos de planificación psicogeriátrica, que han de universalizarse en el ámbito de la Comunidad Europera del 2020 (AU)

[Evaluation of extrinsic sleep disorders in a population in Valladolid]. / Evaluación de las perturbaciones extrínsecas del sueño en la población de Valladolid.

OBJECTIVES: To study the prevalence of external sleep disturbances and their influence in sleep quality. DESIGN: Transversal descriptive study based on personal self-applied interview and the application of the Pittsburg Sleep Quality Index (PSQI) in 1053 persons selected among the over 18 year old population of the city of Valladolid between September 1997 and August 1998 in relation to different sociodemographics variables, life habits and psychiatric pathologies (anxiety and depression evaluated by Golberg Scale). RESULTS: Worsening of life quality and sleep efficiency was significantly associated to external disturbances such as coughing, going to the bathroom and nocturnal awakening and, less significantly, to pain sensation, having nightmares, dysthermic sensations and difficulty to breathing. Sleep external disturbances did not affect daytime activity but was associated to an increased hypnotic drug taking. INTERPRETATION: Sleep external disturbances are one of the most relevant and unknown variables associated to a decrease in sleep quality and, consequently, in life quality.

[The quality of sleep associated with polypharmacy]. / La calidad del sueño asociada a la polimedicación.

OBJECTIVE: Study of the association between multiple medication and the quality of sleep. DESIGN: Observational, cross-sectional study through two-stage sampling of 1053 people with a questionnaire and application of the Pittsburgh Sleep Quality Interview (PSQI). SETTING: Primary care. Population covered by health centres in the province of Valladolid. POPULATION: Adults over 18 who attended health centres in Valladolid province. RESULTS: As consumption of multiple drugs rose, there was significant deterioration in the overall quality of sleep and each of the following components: subjective quality, latency of sleep, duration of sleep, extrinsic disturbances and consumption of sleeping draughts. No differences were found for day-time repercussions. When psychiatric drug consumption was excluded from the study (to avoid the risk of bias in psychiatric illnesses), deterioration in the quality of sleep, on adding up the remaining therapeutic groups of drugs, was still found. CONCLUSIONS: The fact of consuming multiple drugs chronically may condition a deterioration in sleep quality, which will stimulate us to combat this symptom with more drugs and so further aggravate the problem. New prospective studies need to be undertaken to find out the reasons.

Vertical ring gastroplasty (VRG) in the treatment of the serious clinical obesity. Results and complications.

OBJECTIVE: The morbid obesity is a serious polysystematic disease to which it is necessary to offer a surgical solution when the conservative alternatives fail. METHODS: In a period of five years, 50 patients with vertical ring gastroplasty (VRG) have been evaluated and protocolized in the program of surgery of the morbid obesity, with an average weight of 134.3 kg corresponding to an overweight and body mass index (BMI) average respectively, of 69.7 kg and 49.8 kg/m2. RESULTS: The early morbidity has been scarce and the postoperative average stay of 7 days. The decrease of the percentage of weight, overweight and BMI was maximum 2 years later, with losses of 52 kg, with a percentage of loss of average overweight of 76.8% and a fall of 21 points in the BMI; however there was a partial recovery of the indexes in the following years. The accompanying pathology was solved in the period of studied time, although 84% of the patients referred vomits and practically 100% dietary limitations. CONCLUSIONS: The gastroplasty is a quick, simple technique and of scare morbimortality, although it is being subjected to criticism for the restrictions in the diet, quality of life and disruptions of the line of clamped. However, nowadays there is not a consensus on the ideal bariatric solution, and as a surgical alternative, the vertical gastroplasty can represent one of the techniques of choice for certain selected types of serious obesity.

[Historical study of delirium tremens in Spain in the second half of the 19th century]. / Estudio histórico del delirium tremens en España durante la segunda mitad del siglo XIX.

The authors, after a brief historical introduction, review the clinical contributions about Delirium Tremens during the second half of the XIXth century in 9 Saniard authors: J. Santamaría del Alba (1952), Inocente Escudero (1857), R. Sanfrutos (1858), Tomás Santero y Moreno (1867), Candela (1871), Robert (1871), José Armesto (1877), J. M. Castañeda (1879-1880), R. B. de la Roche (1881). It is appropriate to underline their tidying up and clinical interest, medical-pathological and general, their interest in the evolutionary course, their therapeutical empiricism and a certain indifference in framing this nosological entity in a doctrinal corpus more specific, except for Robert, who use the chloral hydrate only two after its introduction in medicine by Liebreich and De la Roche, who complains about absence of a monographic study and explains it according to the anatomic-clinical model of the General Pathology of his epoch, in a appropriate bibliographical context. Included are 12 tables and 27 bibliographical references.

[Historical study of seven cases of delirium tremens in Spain in the first half of the XIX century]. / Estudio histórico de siete casos de Delirium tremens en España durante la primera mitad del siglo XIX.

The authors in the introduction provide an schematic historical scope of reference about the spaniard and european psychiatry from the XVIIIe to the XIXe century. They described the first seven clinical cases of Delirium found by them and published by spaniard physicians in the first half of the XIXe century. They revised mainly the clinical sintomatology, course and evolution, and went into deep detail in the hygienic-dietetical and pharmacological therapeutics used in this period, specially several galenic preparations of opium, tartarus emeticus, cremor, etc. Serapio Escolar y Morales (1808-1874) described the first clinical case of Delirium Tremens in 1839 in a 28 year old man, raising the differential diagnosis between intermittent fever, epilepsy and meningitis, and proposed a useless antiflogistic treatment (bleeding, leeches, poultice) and opium. The second case was described by an anonymous author (J.M.S.Z.) in 1845 in a 42 year old man. Francisco Castellvi y Pallares (1812-1879), in 1845, published another case in a 34 year old male, with an adequate description of the natural history of the disease, healing in 19 days with high doses of watery opium extract. The fourth clinical case was described by R.C.B. in 1846 in a 60 year old man with "alcoholic chorea", "ataxis fever" being the only one with a mortal outcome, treated also with opiates which he did not agree with. The fifth and sixth cases were published by Uliberry in 1847 in two males, 38 and 36 years old respectively. The seventh and last case was described in 1848 by F. Paula Barea, having to highlight the nosological, nosographical and evolutive perspectives in 3 clinical periods and a fourth of convalescence, the treatment differences and the etiopathogenical considerations. Included are 9 tables, 2 graphics and 29 bibliographical references.

[Correlation between audiometric and electronystagmographic results in Menière's disease]. / Correlación entre los resultados audiométricos y electronistagmográficos en la enfermedad de Ménière.

Cochlear and vestibular functions of 30 patients suffering from Méniere's disease have been analyzed through audiometric and electronystagmographic studies. Auditive thresholds in low, medium and high frequencies have been correlated with the results of the caloric and pendular tests. Statistical analysis has demonstrated that there is no significant relationship between caloric and pendular reflectivity and hearing loss in the mentioned frequencies. In conclusion, in Méniere's disease hearing losses and vestibular alterations follow a different pathologic pattern.

[Parotid actinomycosis. Apropos of a case]. / Actinomicosis parotidea. A propósito de un caso.

The parotid Actinomycosis is a very uncommon infectious disease. In this article one case is presented discussing several aspects of its diagnosis and treatment.

[Sinusitis complications: presentation of 2 cases]. / Complicaciones de las sinusitis: presentación de dos casos.

Two cases of complications after acute sinusitis are presented. One case corresponds to an intracranial complication and the other to an orbital one. Several clinical considerations concerning their diagnosis and treatment are discussed.

[Clinical considerations concerning a new case of laryngeal chondroma]. / Consideraciones clínicas acerca de un nuevo caso de condroma laríngo.

A new case of a chondroma of the larynx is reported discussing the diagnosis and its treatment. Also a brief review of the literature is presented. Scattered calcification observed by CT is considered as a pathognomic finding. Finally, biopsy is the only method for establishing the positive diagnosis.