Estudio de los perfiles clínicos de los pacientes con trastorno de la conducta alimentaria en dispositivos específicos / Study of the clinical profiles of patients with eating disorders in specific units

Objetivo. Descripción de perfiles clínicos de pacientes diagnosticados de Trastornos de la conducta alimentaria (TCA) que acuden a un dispositivo ambulatorio especializado para mayores de 18 años. Método. Se trata de un estudio observacional, transversal y descriptivo en el que con carácter retrospectivo se analizaron 101 historias clínicas de pacientes diagnosticados de TCA. Resultados. El perfil clínico observado fue que el 93,6% son mujeres, con una media de edad de 29,9 años. El 33% presentaban una evolución de entre 2 y 5 años. Existe un predominio de las formas purgativas. El 19,8% presentan problemas con sustancias de abuso y el 54,4% de la muestra presentan trastornos de ansiedad. Conclusiones. Las unidades específicas en el tratamiento de los TCA deben integrarse en un conjunto de recursos que permitan además del abordaje del TCA de la psicopatología comorbida y de la que dependerá el pronóstico y evolución de la enfermedad (AU)

Objective. The purpose of this study is to describe the clinical profiles of patients diagnosed of a specific Eating Behavior Disorder (EBD) who come to a specialized outpatient unit for patients over 18 years old with this disorder. Method. This is an observational, cross-sectional and descriptive study in which 101 medical records of patients with an eating disorder diagnosis have been analyzed retrospectively. Results. The clinical profiles observed showed 93.9%women, medium age 29.9%, in which 33% of the patients had an illness course of 2 to 5 years. Purgative forms were more frequently observed. A total of 19.8% had substance abuse disorders and 54.4% anxiety disorders. Conclusions. Specific units for Eating Disorders should be included in the combined resources that not only allow for treatment of the eating behavior disorders but also for their psychopathological comorbidities, the prognosis and evolution of the disease depending on the latter (AU)

Study of the clinical profiles of patients with eating disorders in specific units.

OBJECTIVE: The purpose of this study is to describe the clinical profiles of patients diagnosed of a specific Eating Behavior Disorder (EBD) who come to a specialized outpatient unit for patients over 18 years old with this disorder. METHOD: This is an observational, cross-sectional and descriptive study in which 101 medical records of patients with an eating disorder diagnosis have been analyzed retrospectively. RESULTS: The clinical profiles observed showed 93.9% women, medium age 29.9%, in which 33% of the patients had an illness course of 2 to 5 years. Purgative forms were more frequently observed. A total of 19.8% had substance abuse disorders and 54.4% anxiety disorders. CONCLUSIONS: Specific units for Eating Disorders should be included in the combined resources that not only allow for treatment of the eating behavior disorders but also for their psychopathological comorbidities, the prognosis and evolution of the disease depending on the latter.

Actualización en el tratamiento del trastorno por déficit de atención/hiperactividad / Update on Attention-deficit/hyperactive disorder treatment

Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos neuropsiquiátricos más frecuentes y mejor estudiados en la población infantil, y su relevancia aumenta al entender las interferencias que provoca sobre el desarrollo de quienes lo presentan. Objetivo. Actualizar las bases conceptuales y las evidencias del tratamiento del TDAH bajo el enfoque multimodal, es decir, la combinación del tratamiento psicofarmacológico y psicológico según los casos. Desarrollo. El TDAH debe entenderse como un proceso de larga evolución, por lo que se debe elaborar cuidadosamente su plan de tratamiento. Tiene que ser lo más completo posible y considerar la evidencia más reciente, las preferencias y preocupaciones de familiares y pacientes, y la psicoeducación. Los psicoestimulantes han sido los fármacos más estudiados y usados en el tratamiento del TDAH, con unas tasas de respuesta del 65-85% de los pacientes. La atomoxetina, un inhibidor de la recaptación noradrenérgica, es otra alternativa para el tratamiento del TDAH recientemente aprobada por la Food and rug Administration estadounidense y la Agencia Europea del Medicamento. Conclusiones. La planificación del tratamiento la decisión del fármaco que se debe utilizar tienen que individualizarse en cada paciente, atendiendo a los objetivos terapéuticos y, de manera relevante, ajustándose a la presencia de comorbilidades, muy frecuentes en este trastorno. En los pacientes no respondedores o resistentes a los tratamientos habituales, es más necesaria, si cabe, la evaluación minuciosa de la presencia de otros trastornos comórbidos que estén influyendo en la respuesta (AU)

Introduction. Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient’s every day life. Aim. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. Development. As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. Conclusions. The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient’s family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders’ patients (AU)

[Update on attention-deficit/hyperactive disorder treatment]. / Actualización en el tratamiento del trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient's every day life. AIM. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. DEVELOPMENT: As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. CONCLUSIONS: The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient's family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders' patients.

Depresión vascular con síntomas melancólicos: respuesta a terapia electroconvulsiva / Vascular depression with melancholic symptoms: response to electroconvulsive therapy

El concepto de depresión vascular hace referencia a casos de depresión de inicio tardío, con infartos cerebrales en técnicas de imagen y factores de riesgo cardiovascular, con déficit cognitivos y pobre respuesta a fármacos antidepresivos. Se presenta el caso de una mujer de 71 años, sin antecedentes psiquiátricos y con factores de riesgo vascular, que reingresa en una unidad de hospitalización psiquiátrica por depresión melancólica con síntomas psicóticos. La resonancia magnética de la paciente mostró un infarto lacunar subcortical y una ligera leucoaraiosis y presentó déficit cognitivos en las pruebas neuropsicológicas. En los ingresos previos fue refractaria a psicofármacos, respondiendo únicamente a terapia electroconvulsiva (TEC). En este ingreso se aplicó TEC, con remisión de la sintomatología, incluyéndose en programa de TEC de mantenimiento. El concepto de depresión vascular podría explicar las especiales características y evolución del caso

The concept of vascular depression includes cases of late-onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case

Vascular depression with melancholic symptoms: response to electroconvulsive therapy.

The concept of vascular depression includes cases of late- onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case.