Early responses to deep brain stimulation in depression are modulated by anti-inflammatory drugs.

Deep brain stimulation (DBS) in the subgenual cingulated gyrus (SCG) is a promising new technique that may provide sustained remission in resistant major depressive disorder (MDD). Initial studies reported a significant early improvement in patients, followed by a decline within the first month of treatment, an unexpected phenomenon attributed to potential placebo effects or a physiological response to probe insertion that remains poorly understood. Here we characterized the behavioural antidepressant-like effect of DBS in the rat medial prefrontal cortex, focusing on modifications to rodent SCG correlate (prelimbic and infralimbic (IL) cortex). In addition, we evaluated the early outcome of DBS in the SCG of eight patients with resistant MDD involved in a clinical trial. We found similar antidepressant-like effects in rats implanted with electrodes, irrespective of whether they received electrical brain stimulation or not. This effect was due to regional inflammation, as it was temporally correlated with an increase of glial-fibrillary-acidic-protein immunoreactivity, and it was blocked by anti-inflammatory drugs. Indeed, inflammatory mediators and neuronal p11 expression also changed. Furthermore, a retrospective study indicated that the early response of MDD patients subjected to DBS was poorer when they received anti-inflammatory drugs. Our study demonstrates that electrode implantation up to the IL cortex is sufficient to produce an antidepressant-like effect of a similar magnitude to that observed in rats receiving brain stimulation. Moreover, both preclinical and clinical findings suggest that the use of anti-inflammatory drugs after electrode implantation may attenuate the early anti-depressive response in patients who are subjected to DBS.

Microstructural white-matter abnormalities associated with treatment resistance, severity and duration of illness in major depression.

BACKGROUND: Although white-matter abnormalities have been reported in middle-aged patients with major depressive disorder (MDD), few data are available on treatment-resistant MDD and the influence of relevant variables related to clinical burden of illness is far from being well established. METHOD: The present study examined white-matter microstructure in a sample of 52 patients with MDD in different stages (treatment-resistant/chronic MDD, n = 18; remitted-recurrent MDD, n = 15; first-episode MDD, n = 19) and 17 healthy controls, using diffusion tensor imaging with a tract-based spatial statistics approach. Groups were comparable in age and gender distribution, and results were corrected for familywise error (FWE) rate. RESULTS: Widespread significant reductions of fractional anisotropy (FA) - including the cingulum, corpus callosum, superior and inferior longitudinal fascicule - were evident in treatment-resistant/chronic MDD compared with first-episode MDD and controls (p < 0.05, FWE-corrected). Decreased FA was observed within the ventromedial prefrontal region in treatment-resistant/chronic MDD even when compared with the remitted-recurrent MDD group (p < 0.05, FWE-corrected). Longer duration of illness (ß = -0.49, p = 0.04) and higher depression severity (at a trend level: ß = -0.26, p = 0.06) predicted lower FA in linear multiple regression analysis at the whole-brain level. The number of previous episodes and severity of symptoms were significant predictors when focused on the ventromedial prefrontal area (ß = -0.28, p = 0.04; and ß = -0.29, p = 0.03, respectively). Medication effects were controlled for in the analyses and results remained unaltered. CONCLUSIONS: Our findings support the notion that disruptions of white-matter microstructure, particularly in fronto-limbic networks, are associated with resistance to treatment and higher current and past burden of depression.

Altered white matter volumes in first-episode depression: Evidence from cross-sectional and longitudinal voxel-based analyses.

BACKGROUND: Major depressive disorder (MDD) is accompanied by atypical brain structure affecting grey and white matter from the early stages. Neuroimaging studies of first-episode depression (FED) have provided evidence on this regard, but most of the studies are cross-sectional. The aim of this longitudinal study was to test potential changes in grey matter (GM) and white matter (WM) volumes in FED. METHODS: Thirty-three untreated FED patients (DSM-IV criteria) and 33 healthy controls (HC) underwent a 3T structural magnetic resonance imaging (sMRI) at baseline and after 2 years. Depressive symptoms were assessed at baseline and throughout the study with the 17-item Hamilton Depressive Rating Scale (HDRS-17). Recurrences of FED patients were also collected along the follow-up. To analyze GM and WM differences, whole-brain voxel-based morphometry (VBM, SPM12) was employed (FWE corrected). RESULTS: FED patients showed significant reductions compared to HC in WM volumes of prefrontal cortex (left anterior corona radiata). No differences were found in GM volumes. Full factorial longitudinal analysis of the whole sample revealed no significant effect in GM nor in WM, while the full factorial longitudinal analysis comparing recurrent and non-recurrent patients showed increments in WM volumes of left posterior corona radiata and right posterior thalamic radiation in the recurrent group. LIMITATIONS: Limited sample size, especially in the follow-up. CONCLUSIONS: The present findings provided some new evidence of the role of white matter alterations in the early stages of MDD and in the progression of the illness.

A double-blind, randomized, placebo-controlled trial of pindolol augmentation in depressive patients resistant to serotonin reuptake inhibitors. Grup de Recerca en Trastorns Afectius.

BACKGROUND: Pindolol has been reported to hasten the antidepressant action of selective serotonin reuptake inhibitors in open-label and placebo-controlled trials. Pilot studies also suggested that pindolol could augment the antidepressant response in unresponsive patients. We investigated whether the addition of pindolol can induce a rapid response in treatment-resistant patients. METHODS: After a single-blind lead-in placebo phase of 5 days to exclude placebo responders, 80 outpatients with major depression who did not respond to a minimum of 6 weeks of treatment with clomipramine hydrochloride, 150 mg/d; fluoxetine hydrochloride, 40 mg/d; fluvoxamine maleate, 200 mg/d; or paroxetine hydrochloride, 40 mg/d, were randomly assigned to additionally receive placebo (3 times daily) or pindolol (2.5 mg 3 times daily) for 10 days. The median number of ineffective treatments in the current episode was 2 (range, 1-4). Hamilton Rating Scale for Depression and Montgomery-Asberg Scale for Depression scores were used as primary measures of efficacy. RESULTS: At end point, the Hamilton and Montgomery-Asberg scores and change from baseline in Hamilton score were not significantly different in patients taking placebo or pindolol. The response rate was equal in both groups (12.5%). No differences in the clinical outcome were found when the various pretreatment subgroups were considered. At end point, the plasma concentration of pindolol was 9.9+/-5.1 ng/mL (mean +/- SD; n = 40). CONCLUSIONS: Although pindolol can accelerate the antidepressant action of selective serotonin reuptake inhibitors in previously untreated patients, it does not elicit a rapid clinical response in treatment-resistant patients within a 10-day period.

Volumetric MRI study of the habenula in first episode, recurrent and chronic major depression.

The habenula (Hb) can play an important role in major depressive disorder (MDD) as it is a key node between fronto-limbic areas and midbrain monoaminergic structures. In vivo neuroimaging studies have shown reductions in Hb volume in a post-mortem sample of patients with affective disorders but findings in unipolar MDD are not consistent. The current study aimed to investigate whether the Hb volume differed between patients with different stages of unipolar MDD and healthy subjects. We also explored differences in grey (GM) and white matter (WM) volumes and potential age and gender effects. High-resolution images were acquired using a 3T-scanner from 95 participants (21 with first-episode MDD; 20 with remitted-recurrent MDD; 20 with treatment-resistant/chronic MDD; and 34 healthy controls).Two researchers blinded to clinical data manually delineated habenular nuclei, with excellent inter-rater agreement. Multivariate analysis of covariance revealed a significant group-by-gender interaction (F9,258=2.22; p=0.02). Univariate effects emerged for Hb-WM volumes (F3,86=3.12; p=0.03) but not for total Hb volumes (F3,86=0.59; p=0.62) or Hb-GM volumes (F3,86=2.01; p=0.12). Women with a first-episode MDD had greater Hb-WM volumes than healthy controls and patients with treatment-resistant/chronic MDD (p<0.01). These findings remained unaltered when controlled for total intracranial volume or medication load. Our results do not support decreased total Hb volumes in unipolar MDD, in patients with first-episode or in patients with long-lasting recurrent or chronic depression. However, the increased Hb-WM volume we observed in women with a first-episode suggests involvement of Hb and its projections in early stages of the recovery process and in the course of MDD.

Primer ensayo clínico empleando la estimulación cerebral profunda en pacientes con esquizofrenia resistente / Deep brain stimulation in treatment resistant schizophrenia: A pilot randomized cross-over clinical trial

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Preclinical and clinical characterization of the selective 5-HT(1A) receptor antagonist DU-125530 for antidepressant treatment.

BACKGROUND AND PURPOSE: The antidepressant efficacy of selective 5-HT reuptake inhibitors (SSRI) and other 5-HT-enhancing drugs is compromised by a negative feedback mechanism involving 5-HT(1A) autoreceptor activation by the excess 5-HT produced by these drugs in the somatodendritic region of 5-HT neurones. 5-HT(1A) receptor antagonists augment antidepressant-like effects in rodents by preventing this negative feedback, and the mixed ß-adrenoceptor/5-HT(1A) receptor antagonist pindolol improves clinical antidepressant effects by preferentially interacting with 5-HT(1A) autoreceptors. However, it is unclear whether 5-HT(1A) receptor antagonists not discriminating between pre- and post-synaptic 5-HT(1A) receptors would be clinically effective. EXPERIMENTAL APPROACH: We characterized the pharmacological properties of the 5-HT(1A) receptor antagonist DU-125530 using receptor autoradiography, intracerebral microdialysis and electrophysiological recordings. Its capacity to accelerate/enhance the clinical effects of fluoxetine was assessed in a double-blind, randomized, 6 week placebo-controlled trial in 50 patients with major depression (clinicaltrials.gov identifier NCT01119430). KEY RESULTS: DU-125530 showed equal (low nM) potency to displace agonist and antagonist binding to pre- and post-synaptic 5-HT(1A) receptors in rat and human brain. It antagonized suppression of 5-hydroxytryptaminergic activity evoked by 8-OH-DPAT and SSRIs in vivo. DU-125530 augmented SSRI-induced increases in extracellular 5-HT as effectively as in mice lacking 5-HT(1A) receptors, indicating a silent, maximal occupancy of pre-synaptic 5-HT(1A) receptors at the dose used. However, DU-125530 addition to fluoxetine did not accelerate nor augment its antidepressant effects. CONCLUSIONS AND IMPLICATIONS: DU-125530 is an excellent pre- and post-synaptic 5-HT(1A) receptor antagonist. However, blockade of post-synaptic 5- HT(1A) receptors by DU-125530 cancels benefits obtained by enhancing pre-synaptic 5-hydroxytryptaminergic function.

Olanzapine orally-disintegrating tablet in severe psychotic agitation: a naturalistic study.

INTRODUCTION: This study was conducted to determine effectiveness and safety of olanzapine in patients with severe agitation. METHOD: A naturalistic, open-label study in 80 acutely agitated psychotic patients visited in our psychiatric emergency department. Patients received either a 20-mg olanzapine orally-disintegrating tablet or conventional treatment depending on attending psychiatrist's preference. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale (ACES) and pragmatic variables (second pharmacological intervention and need for physical restraints). RESULTS: 60 % patients completed a 6 hour trial. Both groups showed a significant reduction in mean PANSS-EC score. The olanzapine-treated group showed statistically significant improvements: PANSS-EC (F=122.9; df=2.4; p=0.000), ACES (F=68.2; df=2.8; p=0.000). Treatment was well-tolerated and no serious side-effects were observed. CONCLUSIONS: In this naturalistic study in patients with severe agitation, 20-mg oral olanzapine was effective, rapid and safe.

The clinical global impression scale for borderline personality disorder patients (CGI-BPD): a scale sensible to detect changes.

The CGI-BPD scale is an adaptation of the Clinical Global Impression (CGI) scale designed to assess severity and post-intervention changes in patients with Borderline Personality Disorder (BPD). It contains 10 items that score the nine relevant psychopathological domains of BPD, plus an additional global score. The CGI-BPD has two formats, the CGI-BPD-S, to evaluate the present severity, and the CGIBPD- I to evaluate improvement. To establish the psychometric properties of the CGI-BPD, the test was administered to 78 BPD patients, 11 men and 67 women, within the framework of a 4-month therapeutic intervention. The modified scale showed good validity and reliability (alpha 0.85 and 0.89; CCI: 0.86 and 0.78), adequate sensitivity to change, and a two-factor structure accounting for 67.4 % of total variance. While remaining simple to administer, the CGI-BPD may correct the excessive generalisation contained in its original version and is a useful tool to evaluate severity and change in BPD patients.

[A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. / Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas.

INTRODUCTION: Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. METHODS: A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. RESULTS: The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. CONCLUSIONS: A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

[Validation study of the Center for Epidemiological Studies-Depression of a Spanish population of patients with affective disorders]. / Estudio de validación del Center for Epidemiologic Studies-Depresion (CES-D) en una población española de pacientes con trastornos afectivos.

The Center for Epidemiologic Studies-Depression (CES-D) is a short self-rating scale composed of 20 items, designed to detect depressive symptomatology. It has demonstrated its sensibility in psychiatric patients and general population. The CES-D was administered to 99 patients, 33 men and 66 women with mean age of 44.14 years. The patients had been diagnosed of: Major Depressive Disorder (74%), Bipolar Disorder (10%), Adaptive Disorder with depressive mood (10%) and other mood disorders (6%) according to DSM-IIIR criteria. In order to study the validity and reliability of the CES-D, we administered the Hamilton Rating Depression Scale, the Beck Depression Inventory and analogical scales to all the patients. In the reliability analysis we obtain 0.9 alpha. The factor analysis show 4 factors who explain the 58.8% of the variance: "depresses Affect/Somatic", "Positive Affect", "Irritability/Hopelessness", "Interpersonal/Social". The scale shows a 0.95 sensibility and 0.91 specificity to depressive symptomatology detection (according to scores equal or over 9 on HRSD) taking as cutoff scores equal or over 16 on CES-D. Our results show that the CES-D is a sensitive and specify tool for depressive symptomatology detection in psychiatric population. The CES-D is easy to be completed and evaluated, therefore may be useful in epidemiologic studies in general populations.

[Olanzapine and cognitive-behavioural group therapy in borderline personality disorder]. / Olanzapina y terapia grupal cognitivo-conductual en trastorno límite de la personalidad.

INTRODUCTION: Borderline Personality Disorder (BPD) is considered one of the most difficult psychiatric conditions to treat, neither psychological nor pharmacological treatments have been shown to be particularly effective. We present a proposal for the treatment of patients diagnosed with BPD which uses an atypical neuroleptic, olanzapine, and cognitive-behavioural group therapy aimed at dealing with the following problems: Interpersonal Conflict, Affective Instability, Impulsiveness, and Confused Identity. METHODS: Six patients diagnosed with BPD using the International Personality Disorder Evaluation (IPDE) were treated during 6 months with olanzapine (at dosages of 5-20mg/day) and dialectical behaviour therapy, with weekly 2-hour sessions. RESULTS: All of these patients followed the programme during the first 2 months, and 3 of the 6 completed it, showing an improvement in their behavioural disorder, as indicated by a decrease in parasuicidal episodes (i.e. suicide attempts and self-mutilative acts) and fewer visits to the emergency department. One of the patients dropped out due to side effects. DISCUSSION: The possibility of using a combined therapeutic approach enables us to project controlled clinical trials over a longer period of time, thus making it possible to assess behavioural changes which are difficult to observe in conventional clinical trials.

Olanzapina bucodispersable en la agitación psicótica severa / Olanzapine orally-disintegrating tablet in severe psychotic agitation: a naturalistic study

Introducción. El objetivo de este estudio fue determinar la efectividad y seguridad de la olanzapina en pacientes con agitación severa. Método. Estudio naturalístico y abierto en 80 pacientes psicóticos con agitación psicomotriz severa que fueron atendidos en el servicio de urgencias de psiquiatría. Los pacientes recibieron 20 mg de olanzapina bucodispersable o el tratamiento convencional dependiendo de la preferencia del psiquiatra que los evaluó. La eficacia se determinó mediante los componentes de excitación de la escala de evaluación de los síntomas positivos y negativos (PANSS-EC), la escala de evaluación agitación-calma (ACES) y variables pragmáticas (necesidad de segunda intervención farmacológica y necesidad de contención física). Resultados. El 60% de los pacientes completaron el estudio de 6 h de duración. Ambos grupos mostraron una reducción significativa en la media de la puntuación PANSSEC. El grupo tratado con olanzapina mostró una mejoría estadísticamente significativa: PANSS-EC (F=122,9; gl=2,4; p=0,000), ACES (F=68,2; gl=2,8; p=0,000). El tratamiento fue bien tolerado y no se observaron efectos secundarios severos. Conclusiones. Según este estudio naturalístico en pacientes con agitación psicótica severa la administración de 20 mg de olanzapina oral fue efectiva, rápida y segura

Introduction. This study was conducted to determine effectiveness and safety of olanzapine in patients with severe agitation. Method. A naturalistic, open-label study in 80 acutely agitated psychotic patients visited in our psychiatric emergency department. Patients received either a 20-mg olanzapine orally-disintegrating tablet or conventional treatment depending on attending psychiatrist's preference. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation- Calmness Evaluation Scale (ACES) and pragmatic variables (second pharmacological intervention and need for physical restraints). Results: 60 % patients completed a 6 hour trial. Both groups showed a significant reduction in mean PANSS-EC score. The olanzapine-treated group showed statistically significant improvements: PANSS-EC (F=122.9; df=2.4; p=0.000), ACES (F=68.2; df=2.8; p=0.000). Treatment was well-tolerated and no serious side-effects were observed. Conclusions. In this naturalistic study in patients with severe agitation, 20-mg oral olanzapine was effective, rapid and safe

Impresión clínica global para pacientes con trastorno límite de la personalidad (ICG-TLP): una escala sensible al cambio / The clinical global impression scale for borderline personality disorder patients (CGI-BPD): a scale sensible to detect changes

La ICG-TLP es una adaptación de la escala de Impresión Clínica Global (ICG) diseñada con el objetivo de evaluar tanto la severidad como el cambio postintervención en pacientes diagnosticados de trastorno límite de la personalidad (TLP). Está compuesta por 10 ítems que puntúan los nueve dominios psicopatológicos relevantes del TLP y una puntuación global adicional. La ICG-TLP consta de dos formatos, la ICGTLP- S para evaluar la severidad actual y la ICG-TLP-M para evaluar la mejoría. Para establecer las propiedades psicométricas de la ICG-TLP ésta fue administrada a 78 pacientes (11 hombres y 67 mujeres) en el marco de una intervención terapéutica de 4 meses de duración. La ICG-TLP muestra buenas características de validez, fiabilidad (α de 0,85 y 0,89; CCI: 0,86 y 0,78), una adecuada sensibilidad al cambio y una estructura factorial de dos factores que explican el 67,4% de la varianza total. La ICG-TLP es una escala simple y fácil de administrar que corrige la excesiva generalización característica de su versión original y permite evaluar la severidad y el cambio en pacientes TLP

The CGI-BPD scale is an adaptation of the Clinical Global Impression (CGI) scale designed to assess severity and post-intervention changes in patients with Borderline Personality Disorder (BPD). It contains 10 items that score the nine relevant psychopathological domains of BPD, plus an additional global score. The CGI-BPD has two formats, the CGI-BPD-S, to evaluate the present severity, and the CGIBPD- I to evaluate improvement. To establish the psychometric properties of the CGI-BPD, the test was administered to 78 BPD patients, 11 men and 67 women, within the framework of a 4-month therapeutic intervention. The modified scale showed good validity and reliability (α 0.85 and 0.89; CCI: 0.86 and 0.78), adequate sensitivity to change, and a two-factor structure accounting for 67.4 % of total variance. While remaining simple to administer, the CGI-BPD may correct the excessive generalisation contained in its original version and is a useful tool to evaluate severity and change in BPD patients

Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas / A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department

Introducción. La agitación psicomotriz es una situación frecuente en urgencias de psiquiatría con una prevalencia aproximada del 10 %. No hay un consenso total respecto a su manejo; benzodiazepinas, antipsicóticos típicos y, más recientemente, los atípicos han demostrado una eficacia similar. El objetivo del presente estudio es describir las características epidemiológicas y el manejo clínico de los pacientes agitados en la práctica clínica en un servicio de urgencias psiquiátricas.Métodos. Estudio naturalístico de los episodios de agitación psicomotriz recogidos consecutivamente en un servicio de urgencias psiquiátricas. Se recogieron variables demográficas, clínicas y terapéuticas. Las variables de eficacia fueron determinadas mediante la escala Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) y la Agitation-Calmness Evaluation Scale (ACES). Se analizaron variables pragmáticas como la necesidad de sucesivas intervenciones farmacológicas o la necesidad de contención física.Resultados. Fueron incluidos 100 episodios de agitación psicomotriz. La edad media fue de 36,2 años y el 54% eran mujeres. Los diagnósticos más frecuentes fueron de trastorno psicótico (48 %) y de trastorno de la personalidad (24 %). El 39 % requirió contención física y el 52 % aceptó el tratamiento por vía oral. El haloperidol fue el fármaco más utilizado por vía oral y la olanzapina por vía intramuscular.Conclusiones. Una aproximación naturalística permite obtener datos de la práctica real en los servicios de urgencias psiquiátricas. Los estrictos diseños de investigación de los ensayos clínicos de eficacia implican sesgos de selección de la muestra y se suelen alejar de la realidad clínica. Los antipsicóticos atípicos se están convirtiendo en fármacos de primera línea en el tratamiento de la agitación

Introduction. Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in «real-life» in a psychiatric emergency service. Methods. A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. Results. The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. Conclusions. A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

Olanzapina y terapia grupal cognitivo-conductual en trastorno límite de la personalidad / Olanzapine and cognitive-behavioural group therapy in borderline personality disorder

Introducción: El Trastorno Límite de la Personalidad (TLP), es considerado como uno de los trastornos mentales más difíciles de abordar. Ni los tratamientos psicológicos ni los farmacológicos han demostrado ser suficientemente eficaces en esta patología. El objetivo de este trabajo es ensayar una propuesta de tratamiento combinado en pacientes diagnosticados de TLP utilizando un neuroléptico atípico, la olanzapina, y psicoterapia grupal cognitivo-conductual orientada a los siguientes objetivos específicos: conflictos interpersonales, labilidad afectiva, impulsividad, baja tolerancia a la frustración y confusión de la identidad. Material y métodos: Seis pacientes diagnosticados de TLP mediante la International Personality Dissorder Evaluation (IPDE) recibieron tratamiento con olanzapina a dosis de 5 a 20 mg/día y Terapia Conductual Dialéctica en sesiones semanales de dos horas de duración, durante seis meses. Resultados: Todos los pacientes siguieron el progra m a durante los dos primeros meses, tres de los seis pacientes finalizaron la terapia mostrando mejoría en los trastornos conductuales, lo cual se evidencia por una disminución del número de intentos de autolisis y la menor frecuencia de visitas a urgencias. Uno de los pacientes abandonó la terapia por efectos secundarios. Discusión: La posibilidad de utilizar una terapéutica combinada nos puede permitir plantear ensayos clínicos controlados, durante periodos prolongados de tiempo, valorando cambios conductuales difíciles de observar en los ensayos clínicos más convencionales (AU)