Modelo biopsicosocial en el manejo del trastorno por estrés postraumático en inmigrantes: "Centro de tratamiento de personas sometidas a tortura de Oregón". ¿Se necesitan centros específicos en nuestro país? / No disponible

La inmigración es un proceso en auge y los inmigrantes una población potencialmente de riesgo, ya que parte de ellos han estado expuestos a situaciones traumáticas, por lo que debemos de estar familiarizados con el diagnóstico y tratamiento del trastorno por estrés postraumático (TPET). Desde 1977 existe en Estados Unidos un Programa de Psiquiatría Transcultural y un Centro dedicado al tratamiento de refugiados de países donde ha existido violencia política. Basándonos en su experiencia, que contrastamos durante una estancia de 3 meses durante el período de formación MIR, hemos revisado las características diagnósticas del TPET, el funcionamiento del Centro y sus enfoques terapéuticos. Las manifestaciones del TPET varían en el tiempo y con las circunstancias sociolaborales y familia-res del paciente, por lo que un modelo biopsicosocial es recomendable en el tratamiento de estos pacientes (AU)

The migrant population in Spain is increasing rapidly. Potentially, migrants constitute population at risk because some of them may have been exposed to traumatic situations. Therefore, we should become familiar with the diag-nosis and treatment of post-traumatic stress disorder (PTSD) in this po-pulation. Since 1977, the Intercultural Psychiatric Program and the Torture Treatment Center of Oregon, USA, specializes in the treatment of refugees from countries that have suffered poli-tical violence. Based on their experience, which the senior author observed for 3 months during his MIR training, we reviewed the diagnostic characteristics of PTSD and the Center’s structure and therapeutic approaches. The ma-nifestation of PTSD varies over time, and depends on the social, familial and working status of the patient. Therefore, a biopsychosocial model is recommended for the treatment of these patients and a similar model is proposed for treatment of PTSD among the migrant population in Spain (AU)

Reacción exantematosa inducida por ziprasidona / Ziprasidone-induced exanthematous reaction

Introducción: Los fármacos antipsicóticos causan reacciones adversas de tipo cutáneo, aproximadamente, al 5% de los individuos a quienes se prescriben. Descripción del Caso: Paciente de 44 años diagnosticada de trastorno bipolar tipo I, que ingresó en el hospital por presentar descompensación de su psicopatología. Tres días después del incremento de ziprasidona a 120 mg/día, presentó lesiones dérmicas maculopapulosas en el tronco y las extremidades superiores, de forma simétrica, que se acompañaban de intenso prurito y febrícula de 37,5 °C. Se suspendió la ziprasidona y tuvo una recuperación completa de las lesiones tras 5 días. Discusión: Ya que las reacciones adversas de tipo cutáneo producidas por psicofármacos son comunes y potencialmente serias, el psiquiatra debe estar familiarizado con ellas (AU)

Introduction: Antipsychotic agents are known to cause adverse cutaneous reactions in approximately 5% of individuals prescribed these drugs. Case report: The patient was 44-year-old woman diagnosed with bipolar disorder type I, who was admitted to hospital for decompensation of her psychopathology. Three days after the dose of ziprasidone was increased to 120 mg/day, the patient developed macules and papules on the trunk and symmetrically distributed on the upper limbs, accompanied by intense pruritus. Her temperature was 37.5 °C. Ziprasidone was suspended, with complete disappearance of the lesions after 5 days. Discussion: Since adverse cutaneous reactions to psychotropic medications are common and potentially serious, psychiatrists should be well versed in these events (AU)

Topiramate as a treatment for pain in multisomatoform disorder patients: an open trial.

Multisomatoform disorder (MSD), defined as 3 or more medically unexplained, currently distressing physical symptoms in addition to a long (> or =2 years) history of somatization, is a prevalent and disabling disorder in which few pharmacological trials have been referred to in the literature. Thirty-five MSD patients from the Somatoform Disorders Unit of the Miguel Servet University Hospital, Zaragoza, Spain, with pain of more than 3 months as the main symptom, were treated with topiramate in doses ranging from 300-400 mg/day. Patients were assessed at baseline and at one and six-months follow-up with the McGill Pain Questionnaire (MPQ), Pain Visual Analogue Scale (PVAS), Clinical Global Impresión (CGI), Global Assessment Functioning (GAF) and Hospital Anxiety Depression Scale (HADS). Eight patients (22.8%) dropped from the study, 3 due to side-effects and the other 5 because of lack of efficacy. All the outcome measures showed significant improvements at one-month except the ratings on the Hospital Anxiety Depression Scale. At six-months follow-up, clinician-rated assessments (CGI and GAF) still showed significant differences with baseline but less significant than at one-month follow-up. However, patient-rated assessments (MPQ and PVAS) did not present significant differences with baseline. Despite limitations of the study, topiramate seems to be effective in treating multisomatoform disorder patients with pain as the main symptom and a controlled randomized trial in these patients appears warranted. A possible "decay effect" in patient-rated assessments with any drug in somatoform disorder patients is discussed.

Assessment of a pilot course on the management of somatization disorder for family doctors.

Somatization disorder (SD) patients are difficult to treat and produce negative feelings in health professionals. Smith et al.'s guidelines have demonstrated cost-effectiveness in the treatment of these patients, but family doctors consider it difficult to put these into practice in the long term. The objective of this paper is to design and assess a pilot course, based on Smith's norms, to train general practitioners for the everyday management of SD patients in primary care. We have designed a 20-h practical course, using role-playing and video recording with standardized patients, and focusing on micro-skills recommended by the literature on the subject. Assessment of the efficacy of the course is made by evaluation of baseline and post course video recordings by researchers unaware of the order of the interviews. The comparison of baseline and post course assessments demonstrated a significant improvement in several key skills (giving a name to the illness, explaining the psychological and biological basis of the disease, and emphasizing stress reduction) but no change on others (explaining that SD is a well-known disorder, empowering the patient, not blaming the patient for his or her illness, and instilling hope). Finally, other skills such as assessing the patient's opinion of the illness, recognizing the reality of symptoms and informing that there is no life risk, were correctly done from the beginning and, therefore, showed no change. We found that training may facilitate the development of certain skills. However, some doctors' abilities might also require the use of techniques such as Balint groups to modify negative emotions, such as anger and fear, toward these patients.

Salud mental en inmigrantes: el nuevo desafío / Mental health in inmigrants

No disponible

Macroglosia y lesión papular en la lengua secundaria a mirtazapina / Macroglossia and tongue papular injury due to mirtazapine treatment

No disponible