Violence in mental disorders and community sample: an evolutionary model related with dominance in social relationships.

The major risk determinants of violence are to be young and male, to have low socioeconomic status and suffering substance abuse. This is true whether it occurs in the context of a concurrent mental illness or not; i.e., mental disorders are neither necessary, nor sufficient causes for violence. Intense motivation is a facilitating factor for violence in clinical and non clinical samples. This explains why 'normal' people, are implicated in planned violence at higher rates than mentally ill (e.g. in criminal acts against property). However mentally ill patients are more easily implicated in impulsive violence or in violence without obvious cause due to veiled motivation fuelled by unidentified symptoms. Subjective or real awareness of competitive disadvantage increases motivation for violence (e.g. paranoid, narcissistic symptoms, etc.). Many psychiatric disorders as antisocial disorder, borderline, schizophrenia, have most of the factors that facilitate the appearance of violence. Antisocial disorder is a good model to study determinants of violence in normal samples as it is present in young males that do not have any psychotic symptom, have stable symptomatology, self control under scrutiny, and their motivations are similar to normal samples. Our evolutionary model suggests that there is a non random association of genetic factors (genes, pseudogenes, promoting areas, etc.), that is, a genetic cluster (cluster DO), whose phylogenetic function is to motivate to be the dominant in social relationships. To be the dominant is a major psychological feature present in many social groups of animals, included primates. DO cluster have sense from an evolutionary viewpoint: when expressed in no pathological way it increases inclusive fitness (transmission of the genes of a person genotype whether by oneself or by relatives reproduction). Features of cluster DO in humans are expressed differently according to sex, age, moral education, level of intelligence, etc. Cluster DO has higher phenotypical expression in males and young people. Primary antisocial personality disorder and other related disorders (cluster B personality disorders, disocial, defiant disorder, etc.), are a pathological manifestation of this cluster DO. Some other genetic clusters that causes the genetic liability to some disorders (e.g. attention deficit disorder) are non random associated with cluster DO, thus explaining clinical comorbidity. According to our model, motivation for dominance usually prevails over motivation for material benefit or antinormative behaviour, this explains some incongruent behaviour in antisocial patients not elucidated by other models. Along with the primary expressed feature of dominance of cluster DO there are other secondary features that have been identified by psychobiological studies: novelty seeking, intolerance for frustration, impulsiveness, fearless, aggressiveness, higher threshold for activation of the sympathetic system, lack of empathy, egoism, non acceptance of rules, defiant and rebellious behaviour, manipulation in social interactions, selfishness and deficits in altruism or in social co-operation.

Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

[GEITDAH consensus on attention deficit hyperactivity disorder]. / Consenso del GEITDAH sobre el trastorno por deficit de atencion/hiperactividad.

In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects.

[Drugs for attention deficit hyperactivity disorder]. / Farmacos para el trastorno por deficit de atencion/hiperactividad.

Quantitative studies have highlighted differences in several drugs approved for use in Spain in the treatment of attention deficit hyperactivity disorder. No clear differences are observed, however, in the case of qualitative studies. The number of patients needed to be treated in order for one to reach complete remission (NNT) of methylphenidate (MTF) is from 2.2 to 5, and the effect size (ES) is 0.9. Atomoxetine has an NNT of 4 and an ES of 0.7. The advantages of immediate-release MTF (IR-MTF) over the extended-release version (ER-MTF) lie in its low cost, its flexibility and the better results obtained in quantitative studies. In contrast, ER-MTF offers a lower risk of abuse, needs to be taken fewer times with less need for third parties to control administration, and there is a lower risk of stigmatisation. Combination or changes of IR-MTF and ER-MTF and the combination of MTF with atomoxetine are sometimes necessary to adjust the weekday or weekend doses. Starting treatment with IR-MTF and then maintaining or changing to ER-MTF offers certain advantages as regards safety, dose adjustments and dosage. Atomoxetine is the best alternative if there is a background of adverse events with low or moderate doses of stimulants, or lack of response to high doses of stimulants. In cases of notable comorbid anxiety, both MTF and atomoxetine have the same level of indication. If there is a risk of substance abuse, both atomoxetine and ER-MTF are the preferred treatment. For the other indications, MTF is the preferred treatment.

Aripiprazol en el autismo: seguridad y tolerancia / Aripiprazole in autism: safety and tolerability

El objetivo de este estudio es hacer una revisión sobre la eficacia y seguridad de aripiprazol en el tratamiento de los síntomas de irritabilidad asociados al trastorno autista. También se revisa la mejoría en otros síntomas de la escala Aberrant Behavior Checklist (ABC). Para ello hemos revisado tres estudios. Dos son aleatorizados, doble ciego y multicéntricos, 8 semanas de duración, que evaluaban la eficacia de aripiprazol a dosis fijas (5mg/d, 10mg/d, 15mg/d) y a dosis flexibles (2-15mg/d) comparados con placebo. El tercer estudio fue un análisis post hoc de los dos anteriores y evaluó el efecto del aripiprazol en los 58 ítems de la escala ABC. Los resultados fueron significativos con aripiprazol en comparación con placebo en los siguientes ítems de la escala ABC y con todas las dosis de aripiprazol usadas: cambios rápidos de humor, gritos, patadas, movimientos repetitivos, bullicioso, constantemente corre o salta y tiende a ser excesivamente activos. Con la dosis de 15 mg /d se obtuvieron resultados significativos en un mayor número de items

The aim of this study is to do a review on the efficacy and security of aripiprazole in the treatment of symptoms of irritability associated with autistic disorder. Improvements in other symptoms included on the Aberrant Behavior Checklist (ABC) are revised as well. In order to do this we have reviewed three studies. The first two are 8-week, randomized, double-blind, multicenter trials to evaluate the efficacy of both aripiprazole fixed doses (5 mg/d, 10mg/d, 15mg/d) and flexible doses (2-15mg/d) versus a placebo. The third study was a post hoc analysis of the two former, and it evaluated the effect of aripiprazol on the 58 items the ABC scale. The results were significant with aripiprazole versus a placebo on the following ABC scale items and with all aripiprazole doses used: mood changes quickly, cries/screams, stamps feet, repetitive movement, boisterous, constantly runs or jumps, and tends to be excessively active. Furthermore with the 15mg/d dose significant results were obtained for a greater number of items

[Swallowing phobia: symptoms, diagnosis and treatment]. / Fobia a tragar: clínica, diagnóstico y tratamiento.

INTRODUCTION: Choking phobia (or swallowing phobia) is characterized by a fear of swallowing foods, liquids or pills, sometimes after an episode of choking on food. METHODS: Forty-one case reports on swallowing phobia from 1978 to 2005 were studied. Clinical and therapeutic variables of the disorder were studied. RESULTS: It appears to occur more often in females (two-thirds of the cases) and has a high comorbidity with anxiety disorders (panic disorder, 41 %; obsessive conditions, 22 %, and separation anxiety, 15 %). Life-events and eating traumatic antecedents are frequently present (44% and 56% cases, respectively). Cognitive-behavioral treatments have been of proven efficacy, as well as anti-panic drugs (alprazolam, lorazepam, bromazepan, imipramine, clomipramine, fluoxetine, paroxetine) with a remission rate of 58.5%. Gender and treatment differences are also analyzed.

Mirtazapine versus paroxetine in panic disorder: an open study.

Introduction Open studies suggest that mirtazapine has efficacy in panic disorder treatment. We designed an open study that evaluates changes induced by mirtazapine compared with paroxetine in panic disorder. Methodology Patients 18-65 years old consecutively referred to a psychiatry liaison service with panic disorder (DSM-IV criteria) were offered either mirtazapine or paroxetine treatment. Results There were statistically significant reductions from baseline to week 3 and from week 3 to 8 for mirtazapine and paroxetine groups for: number of panic attacks, Beck Anxiety or Depression Inventory (BAI, BDI) Clinical Global Impresion (CGI) of panic disorder severity and CGI of panic disorder response (these variables were evaluated by the patient, the clinician or a blind evaluator). Responders at week 3 (BAI decrease of 50%) were 83% for the mirtazapine group and 84% for the paroxetine group. Responders at week 8 (number of panic attacks equal to 0) were 77% for the mirtazapine group and 73% for the paroxetine group Statistically significant differences between mirtazapine and paroxetine were found for number of panic attacks at weeks 3 and 8 and BAI at week 3, suggesting a faster response for mirtazapine. Responders at week 8 maintained a no recurrence figure of 95% at follow-up 6 months later. Panic disorder either with or without comorbid depression improved in both groups of treatment. Discussion Our study supports the hypothesis that mirtazapine has efficacy in the treatment of panic disorder either with or without comorbid depression.

[Treatment of Tourette syndrome and its comorbidity: experience with 17 cases]. / Tratamiento del síndrome de Tourette y su comorbilidad: presentación de 17 casos.

INTRODUCTION: Clinical characteristics and comorbid disorders of Tourette syndrome (TS) are reviewed along with a presentation of our experience with 17 cases. MATERIAL AND METHODS: We carried out a retrospective study of pediatric patients with TS admitted from 1998 to 2004 in Fundación Hospital Alcorcón. RESULTS: Seventeen patients were obtained, 16 of whom were men and there was only 1 woman. Present age ranged from 7 to 17 years old. Most frequent comorbid disorders were attention deficit disorder (ADD) in 9 patients, (53%), obsessive-compulsive disorder in 8 (48%) and anxiety in 7 (41%). Learning disorders were found in 7 patients (41%), 5 of whom have concurrent ADD and 1 severe obsessive compulsive disorder. Psychopharmacological treatment was withdrew in the 2 cases treated with halloperidol due to the presence of severe extrapyramidal symptoms (EPS) and in 3 of the 7 cases treated with pimozide (one of them was withdrawn due to EPS). No EPS was found with atypical neuroleptics, but sedation and weight gain was common. Methylphenidate was administered to 7 patients without an increase in tics. CONCLUSIONS: In our sample the most common comorbid disorders were ADD, obsessive-compulsive disorders, anxiety and learning disorders. Atypical neuroleptics were better tolerated than classic ones, although the incidence of side effects is elevated. Methylphenidate was not associated with tic worsening.

[Compulsive buying: a new disorder?]. / Compra compulsiva: un nuevo trastorno?

Despite its high frequency and its severe financial, social and personal complications, compulsive buying is rarely described in the psychiatric literature. We reviewed all the published papers on this syndrome to describe its clinical features, epidemiology and response to drug or psychological treatment. Psychiatric comorbidity is also reviewed and nosologic implications are analyzed.

[Olanzapine in Tourette's syndrome: a report of three cases]. / Tres casos de síndrome de Gilles de la Tourette tratados con olanzapina.

We report three cases of Tourette syndrome, that were antipsychotic-naive or non-respondent to other drugs. They were treated with low doses of olanzapine (2.5 mg to 10 mg daily). They reached an important reduction in tic symptoms and social adaptation. The only side effects were mild sedation and weight gain.

[Efficacy of gabapentin in a sample of bipolar patients]. / Eficacia de gabapentina en una muestra de trastornos bipolares.

INTRODUCTION: Field studies support the idea of gabapentin being helpful in the maintenance, and in the treatment of some symptoms in bipolar patients. Our study evaluates relapse rates previous and after gabapentin administration in severe bipolar patients. METHODOLOGY: Gapabentine was administered to all consecutive bipolar patients from a relapse prevention program who could not be given lithium, valproic acid or carbamacepin because of his current medical condition or his past history of secondary effects or lack of response to those treatments. Number and severity of relapses were evaluated before and after gabapentin administration. RESULTS: Seven patients were included in the study. Medium maintenance period with gabapentine was 9 months. In the gabapentin period, relapses per month increased from 0.18 in the previous three years to 0.29. This may be due because six patients interrupted abruptly previous treatment in less than 1 week. Relapses severity, evaluated by measuring length and number of hospitalisations, and number of interviews by month, was similar to the three previous years, and better than the period from the beginning of the condition. Clinical Global Impression evaluated gabapentin as similar to previous mood stabilizers in five patients and better in two. Irritability and dysphoria improved in all the patients. CONCLUSION: Although gabapentin may be helpful in some patients, a clinical essay that shows its efficacy as add-on treatment is need.

[Assessment of Machiavellian intelligence in antisocial disorder with the MACH-IV Scale]. / Valoración de la Inteligencia maquiavélica en el trastorno antisocial mediante la Escala MACH-IV.

INTRODUCTION: The objective is to evaluate the presence of Machiavellian intelligence with the MACH-IV Scale in antisocial patients versus community controls. MATERIAL AND METHODS: Categorical diagnosis and dimensional evaluation program according to IPDE were obtained from 26 controls from the community and 40 patients from a methadone program. Both groups were evaluated on cooperation with TCI and on Machiavellian intelligence with MACH-IV. RESULTS: Higher figures in MACH-IV Global Score, Tactics subscale (to manipulate others), Visions subscale (interpretations on Machiavellian behavior of others) were found in the 20 antisocial patients compared with the 26 community controls achieving statistical significance. No statistical differences were found for Morality subscale scores (abstract morality) between groups. Dimensional evaluation of antisocial disorder according to IPDE shows statistically significant positive correlations for Tactics subscale, Visions subscale and Global Score of MACH-IV scale, but no statistically significant correlation was found for Morality subscale. There is a statistically significant negative correlation between MACH-IV Tactics subscale and TIC altruism subscale. CONCLUSIONS: Antisocial patients have the same level of abstract moral attitudes as controls but are prone to use Machiavellian intelligence to interpret the actions of others, rationalize their own conduct and manipulate the behavior of others to get a benefit. These data support the hypothesis that many of the features of the antisocial syndrome may be explained by an abnormal development of an innate predisposition to be dominant in social relationships.

[Antisocial personality disorder evaluation with the prisoner's dilemma]. / Evaluación del trastorno antisocial de personalidad con el dilema del prisionero.

INTRODUCTION: The aim of this study is to evaluate cooperation problems in antisocial disorder with the prisoner's dilemma game, which, in mathematical game theory, is the paradigm of the <> games (mutual benefit from cooperation). METHODS: We have designed a computer version of the prisoner's dilemma (CDT-BD) that confronts the patient to a simulation of a reciprocal exchange situation. IPDE provided us a categorical and dimensional evaluation of 26 controls from the community and 40 methadone patients. Only methadone patients obtained an antisocial diagnosis: 20 in the category of positive antisocial and 10 in the probable antisocial category. Patients also fullfilled TCI and MACH-IV. RESULTS: CDT-BD is, according to the parent's opinion (mothers), a good correlation of real life behavior. CDT-BD shows a statistically significant poorer cooperation of antisocial patients this is catego rical evaluation (ve rsus in controls) and in dimensional evaluation true both for variables that measure non-cooperation due to the patient's initiative and those as a response to the computer provocation. This may be due to a tendency of antisocials to use interchange situations <> strategies (you win what the other player loses) instead of non-zero games strategies. Non-cooperative responses are correlated to high scores on the MACH-IV scale (manipulative behavior and cognition) and revengeful in Treatment and Character Inventory (TCI). CONCLUSIONS: CDT-BD allows us to generate and test new hypotheses on the causes of the cooperation problems in antisocial patients using game theory paradigms.

Fármacos para el trastorno por déficit de atención/hiperactividad / Drugs for attention deficit hyperactivity disorder

Se encuentran diferencias entre los diversos fármacos aprobados en España para el trastorno por déficit de atención/hiperactividad en estudios de tipo cuantitativo. No hay claras diferencias en estudios de tipo cualitativo. El número de pacientes a tratar para que uno alcance remisión completa (NNT) del metilfenidato (MTF) es de 2,2 a 5, y el tamaño del efecto (TE), de 0,9. La atomoxetina tiene un NNT de 4 y un TE de 0,7. Las ventajas del MTF de liberación inmediata (MTF-LI) respecto al de liberación prolongada (MTF-LP) residen en su bajo coste, su flexibilidad y mejores resultados en estudios cuantitativos. Por contra, el MTF-LP presenta un menor riesgo de abuso, precisa un menor número de tomas, una menor necesidad de terceros para el control de éstas y un menor riesgo de estigmatización. La combinación o cambio de MTF-LI y MTF-LP y la combinación de MTF con atomoxetina son en ocasiones necesarias para ajustar la posología de día laborable o de fin de semana. Iniciar el tratamiento con MTF-LI para luego mantener o cambiar a MTF-LP aporta ciertas ventajas en seguridad, ajuste de dosis y posología. La atomoxetina es la mejor alternativa si hay antecedente de eventos adversos con estimulantes en dosis bajas o moderadas, o falta de respuesta a los estimulantes en dosis altas. En caso de ansiedad comórbida importante, tanto el MTF como la atomoxetina tienen igual nivel de indicación. Si hay riesgo de abuso de sustancias, tanto la atomoxetina como el MTF-LP son de primera elección. Para el resto de indicaciones, el MTF constituye la primera elección (AU)

Quantitative studies have highlighted differences in several drugs approved for use in Spain in the treatment of attention deficit hyperactivity disorder. No clear differences are observed, however, in the case of qualitative studies. The number of patients needed to be treated in order for one to reach complete remission (NNT) of methylphenidate (MTF) is from 2.2 to 5, and the effect size (ES) is 0.9. Atomoxetine has an NNT of 4 and an ES of 0.7. The advantages of immediate-release MTF (IR-MTF) over the extended-release version (ER-MTF) lie in its low cost, its flexibility and the better results obtained in quantitative studies. In contrast, ER-MTF offers a lower risk of abuse, needs to be taken fewer times with less need for third parties to control administration, and there is a lower risk of stigmatisation. Combination or changes of IR-MTF and ER-MTF and the combination of MTF with atomoxetine are sometimes necessary to adjust the weekday or weekend doses. Starting treatment with IR-MTF and then maintaining or changing to ER-MTF offers certain advantages as regards safety, dose adjustments and dosage. Atomoxetine is the best alternative if there is a background of adverse events with low or moderate doses of stimulants, or lack of response to high doses of stimulants. In cases of notable comorbid anxiety, both MTF and atomoxetine have the same level of indication. If there is a risk of substance abuse, both atomoxetine and ER-MTF are the preferred treatment. For the other indications, MTF is the preferred treatment (AU)

Aditivos y trastorno del déficit de atención. Actualización / Additives and upheaval of the attention deficit. Update

En 1975 se abrió el debate sobre si el consumo de ciertos aditivos podría aumentar la hiperactividad o tener efectos perniciosos en la atención, conducta y aprendizaje, ya en población normal, ya en pacientes con trastorno por hiperactividad. Si bien los resultados han sido negativos durante decenios de investigación, desde el 2004 se ha reabierto el debate con más fuerza gracias a un nuevo metanálisis y a dos investigaciones cuyos últimos resultados se publican en septiembre del 2007. Estos artículos aportan datos positivos sobre un efecto neurobiológico leve de estos aditivos en población normal y según metanálisis también en TDA. Este efecto neurobiológico implicaría al menos un aumento de la hiperactividad. Los estudios necesitan ser replicados por otros equipos de investigadores y afinar problemas metodológicos pero por el momento cambian nuestra perspectiva sobre la influencia de estos aditivos en la hiperactividad y sobre sus efectos neurobiológicos (AU)

Artificial food colours and other food additives (AFCA) have long been suggested to affect behaviour in children.. The main putative effect of food additives is to produce overactive, impulsive, and inattentive behaviour. Despite the failure of early studies along 30 years to identify the range of proposed adverse affects, a recent meta-analysis4 of double-blinded, placebo-controlled trials and two new researches has shown a significant effect of food additives on the behaviour of children with ADHD. This effect should be to increase hyperactivity. Although these studies need to be replicated, have changed our view point about this issue (AU)

Revisión crítica de la eficacia y seguridad de atomoxetina / Efficacy and safety of atomoxetine: A critical review

La atomoxetina es un fármaco que inhibe la recaptación de noradrenalina, y que se está estudiando para el tratamiento del trastorno de déficit de atención con hiperactividad (TDAH) en España. Se han publicado con este ármaco en países anglosajones, diversos estudios pre- y post-comercialización, tanto abiertos como aleatorizados, doble ciego y controlados con placebo, en niños y adolescentes y en adultos. Señalamos sus propiedades farmacológicas y sus indicaciones, así como los datos publicados sobre su eficacia en TDAH y trastornos comórbidos, y revisamos críticamente su perfil de efectos adversos y las últimas cuestiones sobre su seguridad (AU)

Atomoxetine is a drug that inhibits the noradrenaline reuptake and that is being studied for treatment of attention- deficit/hyperactivity disorder (ADHD) in Spain. So far, a variety of pre- and post-marketing, open-label and randomised, double-blind, placebo-controlled trials have been published, in children and adolescents and in adults. Its pharmacological properties and indications, and published evidences on efficacy on ADHD and comorbid disorders are presented, and its adverse effects profile and last safety concerns are critically reviewed (AU)

Aspectos evolucionistas de los trastornos afectivos, revisión crítica y propuesta de un nuevo modelo / Evolutionary aspects of affective disorders, critical review and proposal of a new model

La psicopatología evolucionista enfoca la psicopatología bajo el prisma de la teoría de la evolución, generando nuevas hipótesis etiológicas de los trastornos mentales. Para la psicopatología evolucionista las emociones son sistemas de respuesta o formas especiales de funcionamiento prefijados genéticamente, producto de la evolución, que nos permiten adaptarnos al ambiente, a sus amenazas y oportunidades, y que ejercen su función mediante una serie de cambios coordinados a nivel fisiológico, cognitivo y conductual. Existen varios modelos evolucionistas que intentan explicar la función adaptativa de la depresión: reacción ante la pérdida de jerarquía en la lucha social, escenificación de la sumisión o rendición, forma de lograr el cambio de motivación al no lograr un objetivo, función de búsqueda de apoyo social, paralelismos con la fase de desesperación del experimento de separación de crías de monos de sus madres, hibernación, etc.Nuestro modelo intenta explicar la depresión, los estados maníacos, hipomaníacos y otros estados afectivos. A nuestro juicio la mayoría de los trastornos afectivos son procesos patológicos (y no adaptativos) que surgen de un mecanismo desencadenante innato (MDI) que inicialmente sí es adaptativo, pero se ha alterado, y cuya función es regular el nivel de energía y actividad a partir de la intensidad y duración de luz (MDI-A). Este MDI-A desencadena respuestas vegetativas, endocrinas y conductuales presentes tanto en humanos como en animales filogenéticamente más antiguos. Más recientemente en la filogenia se han acoplado a este MDI-A otros mecanismos (MDI-AA). En el hombre los desencadenantes de los MDI-AA son de índole social y se han añadido nuevas respuestas (como el humor) a las respuestas más antiguas del MDI-A

Evolutionary psychopathology incorporates psychiatry into biology via theory of evolution, generating new etiological hypothesis for mental disorders. For evolutionary psychopathology emotions are a response system or a genetically programmed, specialized state of functioning, formed by natural selection, that allows us to adapt to the environment, increasing the ability to cope with threats and opportunities. Emotions exert their function by coordinated physiological, psychological and behavioral changes. Many functions have been suggested for low mood or depression, including communicating a need for help, signaling yielding in a hierarchy conflict, fostering disengagement for commitments to unreachable goals, regulating patterns of investment, parallelism with despair phase of separation from mother situation in monkeys, hibernation, etc. ;;Despite other evolutionary models, our model not only tries to explain depression but mania, hypomania and other affective disorders as well. For us, most affective disorders are pathological states (and not adaptive ones), due to dysfunction of an innate precipitating mechanism (IPM). IPM function is to regulate energy and activity levels according to intensity and duration of light (namely IPM-A). This IPM-A is responsible for vegetative, endocrine and behavioral responses that are present in humans and more ancient phylogenetic animals. More recently in the phylogeny, other mechanisms (IPM-AA) have coupled to this IPM-A. In the human being, the precipitating factors of IPM-AA are predominately social. IPM-AA add new responses (such as mood) to the older responses of IPM-A

Fobia a tragar: clínica, diagnóstico y tratamiento / Swallowing phobia: symptoms, diagnosis and treatment

Introducción. La fobia a tragar (o a atragantarse) se caracteriza por miedo a atragantarse al ingerir comida, líquidos o pastillas, a veces tras un episodio de atragantamiento con comida. Métodos. Se han analizado las publicaciones entre 1978 y 2005 en las que se recogían 41 casos con fobia a tragar. Se estudiaron las variables clínicas y terapéuticas del trastorno. Resultados. Parece suceder más en mujeres (dos tercios de los casos) y tiene una alta comorbilidad con trastornos de ansiedad (pánico, 41 %; patología obsesiva, 22 %, y ansiedad de separación, 15 %). Con frecuencia existen antecedentes traumáticos en la ingesta o sucesos vitales (56 y 44%, respectivamente). Se han mostrado eficaces los tratamientos cognitivo- conductuales, así como fármacos antipánico (alprazolam, lorazepam, bromazepam, imipramina, clomipramina, fluoxetina, paroxetina) con una tasa de remisiones completas del 58,5 %. Estudiamos las diferencias por sexo y por tratamientos utilizados

Introduction. Choking phobia (or swallowing phobia) is characterized by a fear of swallowing foods, liquids or pills, sometimes after an episode of choking on food. Methods. Forty-one case reports on swallowing phobia from 1978 to 2005 were studied. Clinical and therapeutic variables of the disorder were studied. Results. It appears to occur more often in females (twothirds of the cases) and has a high comorbidity with anxiety disorders (panic disorder, 41 %; obsessive conditions, 22 %, and separation anxiety, 15 %). Life-events and eating traumatic antecedents are frequently present (44% and 56% cases, respectively). Cognitive-behavioral treatments have been of proven efficacy, as well as anti-panic drugs (alprazolam, lorazepam, bromazepan, imipramine, clomipramine, fluoxetine, paroxetine) with a remission rate of 58.5%. Gender and treatment differences are also analyzed

El uso de los nuevos antipsicóticos atípicos en el síndrome de Gilles de la Tourette / Use of atypical antipsychotics in Tourette´s syndrome

El síndrome de GiIles de la Tourette (SGT) es un trastorno neuropsiquiátrico con tics motores y vocales crónicos y una elevada comorbilidad y síntomas secundarios. Se han venido usando agonistas alfa-2 (clonidina) o antipsicóticos clásicos (haloperidol, pimocida) con buena eficacia pero mala tolerancia (Efectos adversos). Revisamos la literatura existente sobre eficacia y tolerancia de los nuevos antipsicóticos (clozapina, risperidona, olanzapina, quetiapina, amisulpride, ziprasidona) en esta patología

Tourette's syndrome is a neuropsychiatric disorder characterized by chronic motor and vocal tics and a high comorbidity and associated symptoms. Usually, alpha-2 agonists (clonidine) or typical antipsychotics (haloperidol, pimozide) have been used with a good efficacy but they are poorly tolerated (adverse effects). We review here the existing evidences on efficacy and tolerance for the new antipsychotics (clozapine, risperidone, olanzapine, quetiapine, amisulpride, ziprasidoné) on this disorder