Actas Espanolas de Psiquiatria

Published by Elsevier Masson
Over the last 40 years, suicide attempts have become a health problem of epidemic proportions. In order to update preventive measures, we describe the variations observed in the epidemiologic pattern of patients who attempted suicide between 1969-96. A total of 1,150 suicide attempts seen in the Emergency Service of a General Hospital during this period was analyzed. The study protocol included: sociodemographic data, psychiatric antecedents and diagnosis, suicide behaviour and triggering life-events. Throughout the 27 years of the study the most relevant changes in the suicide-attempt population were: progressive levelling between males and females and an increase in antecedents and previous psychiatric treatments (11% vs 74%). The distribution of the psychiatric diagnoses changed in its relative frequency. A dramatic increase was observed in the number of patients who repeated the suicide attempt (22% vs 50%). Triggering life-events tended to vary in relation to sociological changes. Throughout the study period we observed a progressive increase of psychiatric diagnoses in suicidal patients. Therapeutic programs are needed to prevent repetition of suicide attempts, both during periods of psychopathologic exacerbation and during psychosocial adaptation crises triggered by life-events.
Obsessive compulsive disorder is a common disorder, but research on its clinical features is scarce. The goal of this study is to describe the clinical characteristics and demographic features of a large sample of patients with Obsessive compulsive disorder. The characteristics of 104 patients who sought psychiatric treatment and who were diagnosed as having Obsessive compulsive disorder were assessed by means of a structured questionnaire. The mean age of onset was 20 years and the mean time before soliciting treatment was 4 years. Most of the patients reported an insidious onset and related the onset to an stressful event. The most frequent obsessions were doubt, aggressiveness and contamination. Checking, need to ask and mental rituals were the most frequent compulsions. Cleaning and repetition compulsions were most frequent in women. Our results regarding age at onset of illness, way of onset or prevalence of certain obsessions and compulsions are similar to previous research. No agreement was obtained with previous research regarding the link between stress and illness onset, the course of the disorder or the time before treatment was sought. The differences with respect to previous studies could be accounted for the use of different instruments or criteria. The need for the development of instruments allowing to shed light on these discrepancies is stressed.
The short version of the Temperament and Character Inventory-Revised (TCI-R), the TCI-140, is presented. This study aimed: a) to obtain the psychometric properties of TCI-140; b) to analyze the relationship with the normal version of the TCI-R, and c) to study its convergent validity with the MMPI-2 PSY-5. The TCI-R and MMPI-2 PSY-5 scales were administered to a sample of consecutive psychiatric inpatients with differential Axis I and II diagnoses. It was found that the TCI-140 dimensions showed reliability coefficients ranging from 0.67 (Reward dependence [RD]) to 0.86 (Self-Transcendence [ST]) and the reliability coefficients of PSY-5 ranging from 0.68 (CON) to 0.86 (NE/NEU). Correlations for the dimensions with the TCI-R original 240-item version and TCI-R 140 item version ranged from 0.91 (Self-Directedness [SD]) to 0.97 (ST). The dimensions had a normal distribution. Correlations of TCI-140 scales with PSY-5 scales provided preliminary evidence supporting the convergent validity of the constructs. Then, Novelty Seeking (NS) was associated with low Constraint, Harm Avoidance (HA) was associated with low Aggressiveness and Positive Emotionality/ Extraversion, and also with high Negative Emotionality/Neuroticism, Reward Dependence (RD) was associated with high Positive Emotionality/Extraversion. Persistence (PS) was related to high aggressiveness, and Positive Emotionality/ Extraversion. On the other hand, SD was correlated with low Psychoticism, and Negative Emotionality/Neuroticism, and also with high Positive Emotionality/Extraversion. Cooperativeness (C) had a relationship to high constraint and low psychoticism. Finally ST was associated with high psychoticism and Positive Emotionality/Extraversion. The short Spanish version of TCI-R is a useful inventory for the evaluation of the principals dimensions of temperament and character.
The Child Behavior Checklist (CBCL/6-18) is the most commonly used parent-completed instrument that assesses child and adolescent psychopathology. It has been used in epidemiology and clinical studies. The last version contains DSM-oriented subscales. Investigate the psychometric properties of the CBCL/6-18 and develops a valid and reliable Mexican version. Psychologists and child psychiatrists adapted the Spanish version of CBCL/6-18, and a back translation was done by a native English speaker. Discrepancies in the adaptation were solved by consensus. The checklist was applied to children in the community and to outpatients from a psychiatric children hospital. Reliability was evaluated by estimating internal consistency (Cronbach's alpha) on all scales: retest at one week was evaluated with intraclass correlation coefficients (ICC). A ROC curve was performed to estimate a cut-off which correctly identified children from the clinically referred patients and children recruited in the community (non-referred). Mean differences for the groups were calculated with the Student's t test. The Mexican version of the CBCL/6-18 showed that the Cronbach's alpha coefficient was 0.90 for internalizing problems, 0.94 for externalizing problems and 0.97 for the total problem scale. The ICC was 0.97 for the total problem scale. Significant differences were found between the mean score in broad band, narrow and the new DSM/oriented scales. Conclusions: The Mexican version of CBCL/6-18 is a reliable and valid screening instrument for clinical and epidemiologic use.
This paper studies the introduction of the new physical therapies in the years prior to the Second Spanish Republic. It concludes that the physical treatments in force in the international literature were introduced early in Spain and were put into practice by the most important psychiatrists, although in few cases. Given the generalized criticism on the efficacy of psychiatry as a specialty, there was a general bias towards a positive evaluation of the efficacy of the physical therapies by the new generation of Spanish psychiatrists that did not occur in other countries of our setting. The psychiatrists who disagreed professionally with the above-psychiatrists opposed this tendency, there not being sufficient empirical support for the opinion of any group.
Suicide in Spain has increased in both genders and in different age groups. It is important to evaluate the tendencies of this phenomenon. This study describes suicide mortality in a limited and homogeneous population, which offers the possibility of collecting detailed data over a long time period (1936- 2000). Suicide cases were extracted from data in regional archives and from autopsy reports in the Olot court registry office. The suicide rate per 100,000 inhabitants was calculated by analyzing the number of suicides and inhabitants in 5-year groups. Suicide occurred more frequently in males and in the over 65-year old population. The suicide rate fluctuated during the period studied. Among males, the peak was 14.92 during 1961-1965 and lowered to 8.68 in 1996-2000. The suicide rate in females was always lower than for men, except during 1946-1950 (7.71 vs. 3.09) and 1976-80 (5.7 vs. 4.9). The most common methods used were hanging (52%) and shooting (18%). There was no difference in the methods among females. The demographic and methodological data reflect those obtained in similar studies. In the last 10 years of the study, Olot citizens did not have a higher risk of suicide than the population of the rest of Spain. This result should be interpreted considering the limits related to the methodology used in the data collection.
Comparative analysis by Spanish Regional Communities (RC) of indicators related to morbidity and staffing in psychiatric care hospital over a period of time (1980-2004) marked by the initiation and development of deinstitutionalization policies and handover of powers to RC. Longitudinal study. Descriptive analysis of variables, broken down by RC, related to psychiatric morbidity (ICD-9, codes 290-319) and indicators of hospital staffing over a 25-year period. DATABASE SOURCE: Hospital Morbidity Survey, 1980-2004 and Statistics for care facilities providing in-patient care regime, 1980-2004. Differences between Regional Communities are substantial in all the analyzed variables: discharges, total and average stay, total and initial consultations, rate of psychiatrists in hospital care, number of beds and psychiatric hospitals. For all the Regional Communities as a whole, an increase is observed in hospital discharges, decrease of total and mean stays, notable increase of consultations, little increase in psychiatric staff in hospital care and stagnation in the decline of psychiatric hospitals and beds in operation in psychiatric hospital during the last period of time series and low increase in beds for the hospitals that are not classified as a psychiatric hospital. We found evidence of qualitatively different care models between Regional Communities and substantial changes in major indicators over time series.
Sentences against psychiatrists dictated in appellate or higher courts of Spain in the period from 1992 to 2007 were analyzed. Decisions were gathered for 13 of the 17 autonomous communities and statistical analysis yielded the following results: in more than 50% of cases, the decision was unfavorable for the psychiatrist, but the damages never exceeded € 600,000. The most frequent condition in the series was personality disorders (48.9%). The most frequent reasons for seeking legal redress were monitoring errors and negligence; no cases were brought to trial for therapeutic errors. The patient died in 58.3% of cases. It is noteworthy that 10% of the sentences cited defects in patient information or informed consent. The psychiatric health care teams in both the public and private sector should maximize monitoring of institutionalized patients and optimize installations to provide special security measures for the patients.
Percentage distribution of men and women in relationship with productivity of the authors. M: men; W: women.
Percentage distribution of men and women in relationship with order of signing of the authors (% of number of authors). M: men; W: women.
Distribution of men and women in relationship to years of publications of the works (number of authors and number of signatures)
The governments and organizations responsible for scientific policies try to encourage equality of gender, among their priorities that of obtaining equal participation and full integration of women in all aspects of the scientific profession. The study analyzes the scientific production of women in the areas of Psychiatry by means of the bibliometric study of the papers published in ACTAS ESPANOLAS DE PSIQUIATRIA. A total of 458 papers published from 1999- 2006 period were downloaded from the Science Citation Index-Expanded database, these including original research papers, review articles and clinical cases. A bibliometric study broken down by gender was carried out to determine the existence or inequalities between men and women regarding scientific productivity, type of document, order of author signatures, on the institutional and geographical level. The papers were published by 1,194 different authors. The gender of 977 authors was identified, 587 (60.08%) men and 390 (39.92%) women. The percentage of women authorship has risen from 29.92% in 1999 to 38.86% in 2006. A total of 42.92% of authors having one published article were women, while (those with more than nine articles) only accounted for 33%. Bibliometric studies on scientific activity provide essential information to promote gender equality. An annual increase over 1% in the number of female authors in the journal has been observed, which if it continues will lead to a parity in coming years.
Comparison of treatment in the emergency ward between HW and non-HW
Heat waves have been related with lethal effects, especially in Europe during the intensely hot summer of 2003. However, besides increased deaths and ailments, there are no specific data on the psychiatric effects of heat waves. We have compared psychiatric emergencies in Barcelona during a 15-day heat waves period with the rest of the 2003 summer days. The main variables of the study were total emergencies, admissions, diagnoses, Severity of Psychiatric Illness scale (SPI), psychosocial variables, treatment rendered (including use of restraints), and referrals. No differences were found in the number of emergencies and admissions. During the heat wave, there were more patients with psychiatric backgrounds, more diagnoses of alcohol and drug abuse, but fewer anxiety disorders. The proportion of patients with mechanical restraint increased, but this only occurred in half of the cases in patients with drug or alcohol abuse. The item "dangerousness toward others" (part of the SPI scale) scored significantly higher during the heat waves. There were no significant increases or decreases in psychiatric emergencies or admissions. However, the heat wave was related to more violent behavior and higher drug and alcohol abuse. It should be noted that anxiety conditions and benzodiazepine prescriptions were lower during this period. These findings may be useful to implement medical-psychiatric preventive measures against the heat wave phenomenon.
Psychiatric research in Spain went through a notorious increase in quality and quantity of peer-reviewed papers during the last decade of the previous century, in parallel with other medical disciplines. Although there have been systematic studies of scientific production, they are inadequate from the perspective of the research groups and particularly from university departments. We considered this bibliometric study, in order to analyze the scientific production of the Department of Psychiatry and Forensic Medicine, at the Autonomous University of Barcelona, UAB [DPsML]. METHODOLOGY. In a cross-sectional survey of independent groups (n = 57, 54% men), indicators were applied to production, quality, visibility/distribution and sustained popularity. RESULTS. DPsML research groups, published 314 articles and/or reviews (216 international) between 2004 – 2009, reaching a total of 974 quotations in the period (16 quots./ basic researcher and 11.3 quots./clinical researcher). Contributions at the Thomson Scientific Index [TSI], come from clinical groups (56.48%), and basic groups: 43.52%. The basic groups showed on average impact factor of 5.12 and clinical groups of 2. CONCLUSIONS. DPsML published 11.84% of most cited papers in Spanish psychiatry, 20% in the field of drug addiction and 20.84% in the field of behavioral science,1 the inconsistent results with other bibliometric studies2 on the same researchers, shows the need for more tight and demanding indicators and mapping of production encompassing, both research groups as molar units (university departments). Key words: Bibliometrics, Scientific output, Impact index, Citation analysis, Psychiatry.
Introduction: The Strengths and Difficulties Questionnaire (SDQ) is one of the most frequently used screening test for children and adolescents mental health (MH). In 2006, the Spanish National Health Survey included the child’s MH section through the SDQ version for parents. Objective: To obtain reference values of the SDQparents Spanish version for the 4-15 year-old population living in Spain during 2006-2007. Methodology: From the Spanish National Health Survey-2006, measurements of central tendency, dispersion and percentiles scores were calculated for the “Total Difficulties Score” (TDS-SDQ) Index and for the five dimensions of the questionnaire. Results: A sample made up of 6266 children, ages 4 to 15 years, having national representativeness was obtained. Regarding the TDS-SDQ Index, scores were higher (worse MH) in boys than in girls (9.66 vs 9.04) and were higher in the younger age group in the total sample (9.90, 9.49 and 8.73) and also in boys. Girls scored higher than boys on the emotional symptoms and prosocial dimensions, and the scores were higher in older age group for the total sample. Regarding behavior problems, the younger age group scored higher in the total sample (2.19, 1.87 and 1.76) and by sex. Boys scored higher than girls on hyperactivity (4.51 vs. 3.92) and scores were lower in older ages in total sample (4.71, 4.19 and 3.82) and by sex. Peer problems dimension has no statistically significant differences by sex or age. Conclusions: The population values shown are informative and extend the knowledge and interpretation of the SDQ results.
A total of 215 schyzophrenic patients according to DSM-IV criteria in treatment on risperidone were included in an open label postmarketing surveillance 18 months study to evaluate safety and effectivity of the drug in preventing relapses. The Brief Psychiatric Rating Scale, Global Functional Assessment Scale and the Clinical Global Impression were used to assess. Safety was evaluated by the UKU subscale for neurological side effects. A 82.1% of the patients continued risperidone medication without relapse during the 18 month period. Risperidone was used at a mean dosage of 5.69 2.41 mg/d. Patients improved psychotic symptoms and global activity, and significant reductions were observed in mean total UKU subscale for neurological side effect score. 91.7% of the patients did not report any adverse event; only 2 (1.2%) patients dropt out because of intolerance.
Cognitive impairment is a syndrome with multiple causes, presenting frequently neuropsychiatric symptoms. In these cases, the psychiatrist role is essential, including both diagnosis and therapy.HIV-associated dementia usually includes psychiatric symptoms, even in the absence of neurological symptoms in initial stages. Moreover, the prolonged life span of patients with HIV leaves the possibility that prevalence or HIV-associated neurologic disease increases in coming years. We report a case of a HIV male with insidious cognitive impairment, making diagnosis difficult due to ambiguous symptoms. The patient begins with depressive symptoms and slightly develops cognitive impairment. The presence of cognitive impairment in a young person must alert us think about HIV pathology, because it is one of the leading causes of dementia in the young.
The therapeutic uses of melatonin in psychiatry are reviewed. Data source and search strategy: a 39 year period search covering a 39 year period (1966-2004) was carried out using Medline data base. The search strategy consisted in the combination of the key words ((mental disorders or psychiatry)) and ((melatonin and therapeutic use)). Two restrictive criteria were applied: a) selection of studies carried out in humans, and b) only randomized controlled trials were admitted 56 articles were found. Twelve were excluded because they were not directly related to the study aim. Melatonin was used in 44 articles related to different clinical conditions. It was used because of its hypnotic and/or resynchronizing actions in 93.2 % of the articles, while in 4.5 % of the articles melatonin was used due to its antioxidant properties. The main use of melatonin as a therapeutic agent in psychiatry is in sleep disorders and its use in other psychiatric is minor.
Psychotic-like experiences can be considered as a vulnerability marker for psychotic disorders. The psychometric assessment of the extended psychosis phenotype has advanced considerably in recent years, although it must continue to deepen the quality of self-reports available for its assessment in Spanish population. The main goal was to analyze the psychometric quality of the Community Assessment Psychic Experiences-42 (CAPE-42) in Spanish college students and patients with psychosis. The final sample was comprised of a total of 660 students (M = 20.3 years, SD = 2.6) and 97 patients with psychosis (M = 35.4 years, SD = 10.2). The goodness of fit indices resulting from the confirmatory factor analysis that tested the hypothesized three-dimensional model (Positive, Negative and Depressive) were not adequate. In contrast, the exploratory factor analysis yielded a three-dimensional solution. Internal consistency values for the three dimensions of the CAPE-42 ranged between 0.78 and 0.89 in the sample of students and between 0.84 and 0.93 in the patients with psychosis. The CAPE-42 scores correlated statistically significant with delusions and trait anxiety and state. These results show further evidence of validity of the CAPE-42 scores in samples of the Spanish population and support its use as a tool for the assessment of the extended psychosis phenotype.
Hidden psychiatric morbidity represents an important problem, one to two-thirds of serious cases receiving no treatment each year, often due to lack of awareness of illness. We present a case report of a patient diagnosed of schizophrenia whose first contact with the health system occurred at the age of 63 in extreme social circumstances.
There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period.
Background: Mental disorders in old age are a major public health problem. However, few epidemiological studies provide data on prevalence and risk factors of mental illness in older old population. The aim of this study is to assess the prevalence of common mental disorders and their associated factors in primary care patients over 75 years. Method: Cross-sectional epidemiologic study carried out in a sample of 426 older old patients who were attended at Primary Health Care settings, proportionally distributed for provinces and health centers. The Spanish version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used in order to diagnose the most common psychiatric disorders in this field. Results: Prevalence and comorbidity rates of affective, anxiety and somatoform disorders are high. 47.4% of the sample presented one or more psychiatric disorder. The most prevalent were affective (33.8%), somatoform (24.4%) and anxiety (14.3%) disorders. 6.3% had comorbidity between affective, anxiety and somatoform disorders. Perceived health status and physical illnesses were significantly associated with these mental disorders. Conclusions: Affective, anxiety and somatoform disorders are highly prevalent in older old population with high rates of comorbidity. Their detection and treatment should be considered a relevant issue in primary care.
To test the consistency of the proposed structure for the SCL-90R. 598 first appointments of a Mental Health Centre were evaluated. 352 of these patients completed the SCL-90-R during their first appointment and also 6 and 12 months later. The structure of this questionnaire from the first appointment as well as from follow-up observations is analysed separately in men and women by exploratory factor analysis. Moreover, confirmatory factor analysis have been applied in order to compare the relative adjustment with the data observed during the first appointment in the original model of Derogatis et al., as well as in 3 other factor models. Exploratory factor analysis rendered a different factor structure with all other contrasted models, that were rejected by confirmatory factor analysis as well, in men and women. Only a relative temporal stability in factor structure, different for men and women, was found. It seems that this tool may be rather more useful as a unitary measure for global distress. In addition, our results suggest that the factor structure of the SCL-90-R may vary in the same sample depending on the gender and also possibly varying throughout the time of observation. According to this, the benefit of the SCL-90-R for descriptive and monitoring studies throughout the time is questionable for this type of samples.
Medico-legal assessment of people who have suffered injuries in road traffic accidents must use Law 30/95 as a reference frame. Psychiatric and neuropsychological syndromes secondary to traumatic brain injury (TBI) are no exception and pose demanding challenges to physicians and psychologists. This paper analyzes descriptive and nosological difficulties face by psychiatrists and psychologists; their expert contribution includes translation of official diagnostic entities into categories published in the annex of Law 30/95. Our psychopathological repertoire was created in the 19th century and has hardly been revised since. The wide and varied types of neuropsychological impairments encountered in TBI have to be diagnosed within a very narrow range of DSM-IV and ICD-10 categories. The most common conflicts encountered in the medicolegal arena are revised: the differential diagnosis between dementia and combinations of organic personality disorder with cognitive impairment; differential diagnosis between spontaneous psychiatric illness (bipolar disorder, schizophrenia) and psychiatric syndromes secondary to brain injury (posttraumatic psychosis, organic bipolar disorder); differential diagnosis between concussional syndrome and organic personality disorder, cognitive impairment or organic affective disorder. Specific diagnostic guidelines are suggested for each of these clinical situations. Actas Esp Psiquiatr 2003;31(6):353-360
Delirium is associated with high morbidity and mortality. There are no available instruments validated for evaluation and follow-up of this syndrome in Columbia. An expert's panel adapted the Spanish DRSR- 98. In 110, randomly selected, medical-surgical hospitalized patients, 17 (15.5 %) of them with delirium diagnosed with DSM-IV-TR criteria, the inter-rater reliability, validity and sensitivity to clinical change of the new adaptation of the scale were measured. Internal consistency (Cronbach's alpha: 0.956), inter- rater reliability (ICC: 0.95) and validity (94.8 % under the ROC curve area) were very good. For the Cut-off score of 14 for the total scale score, sensitivity was 82.4% and specificity 97.8 %. The scale was sensitive to clinical change, with a mean difference of 12.9 (t: 4.071; p=0.007). The Colombian adaptation of the Spanish DRS-R-98 is sensitive, specific and reliable for assessment of delirium in hospitalized adults in medical surgical settings.
Objective: We have analyzed social and leadership abilities in children with ADHD and their relationship with execution of tasks involving sustained attention and inhibitory control. Patients and methods: A retrospective analysis of 170 patients with ADHD was performed. We evaluated leadership and social abilities, measured through the Behavior Assessment System for Children (BASC) and their relations with the results of different neuropsychological tests, including Wechsler scale for children (WISC-IV) and Conners' continuous performance (CPT II). Results: In the differential analysis between the IQ, results of the tests and their relation to BASC scores, a statistically significant relation was observed between attentional capacity expected according to the patient's intelligence and social skills scores (according to BASC filled out by mothers and teachers) and leadership (according to all informants) sections. Conclusions: Attentional difficulties are closely related to social competence in patients with ADHD, either by a direct cause-effect relationship or a shared dysexecutive substrate of this disorder.
Some psychopathological characteristics are frequently observed in women who have voluntarily aborted. However, some resistance currently remains to their recognition as a differentiated nosological category, known as Post-Abortion Syndrome (PAS). We tried to assign a diagnostic category to women with PAS by determining the extent by which they fulfilled the diagnostic criteria of international classifications. Criteria for Post-Traumatic Stress Disorder (PTSD) were met in the ten PAS cases studied. In addition, patients also showed other non-specific symptoms such as repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the "need to repair". PAS should be considered as an additional type of PTSD. It also has some specific characteristics that could help to understand the patient's life experience and to establish a psychotherapeutic intervention.
The present study was to assess the relationship between the Tridimensional Personality Questionnaire scores and the 5-HT activity in abstinent drug addicts. 16 men who satisfied the DSM-III-R/DSM-IV criteria for substance abuse disorder accomplished the Cloninger's Tridimensional Personality Questionnaire; their serotonergic activity was measured using the Fenfluramine Challenge Test. The Novelty Seeking is the only dimension showing a statistical difference versus a standard healthy sample, while harm avoidance and not the other dimensions was significantly correlated with the prolactin post-fenfluramine peak (r= 0.80, p<0.001). This work confirm that drug addicts are high Novelty Seekers and support the hypothesis that Harm Avoidance dimension correlate with serotonergic activity.
Objectives: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. Results: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. Conclusions: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.
Personality disorders in childhood sexual abuse victims: Cluster A
The main aim of the present study is to offer an updated review of the international studies published on personality disorders in child sexual abuse victims. The different papers were classified according to the most frequently found topics regarding this issue, with special focus on antisocial personality disorder and borderline personality disorder. The studies reviewed provide inconclusive results, which demonstrate the need for longitudinal studies that could test the directionality of the relationship between child sexual abuse, personality traits, and personality disorders. The concept of resilience is emphasized in order to explain the interindividual differences that are found in victims of the same traumatic event.
Zolpidem is an imidazopyridine, which acts at the benzodiacepine omega1 receptor subtype. Zolpidem was marketed as a short-acting hypnotic and it was assumed that had a lower potential for abuse than benzodiacepines. Since 1993, several cases of zolpidem dependence have been reported. We have observed three patients with abuse, dependence and withdrawal syndrome to zolpidem. Two of them had history of drugs abuse and all of them developed withdrawal symptoms when discontinuing it. In Spain, zolpidem may be sold without medical prescription like other non benzodiacepines hypnotics and it may be playing an important role in the increase of abuse cases. We think zolpidem should be considered as a benzodiacepine with the same control and regulation.
The article begin with a review of the high prevalence of concurrent mental illness and substance abuse disorders among general and clinical populations, highlighting the need for development of appropriate services to treat these persons. Several studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in substance abuse populations and vice versa. We review findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance abuse programs, and describe new programs that integrate both types of treatment at the clinical level. This is followed by a description of main difficulties to do with outcome and treatment retention. Finally, we review the effectiveness of several specific treatments programs within psychiatric care for patients who have a dual diagnosis of a severe personality disorder and a substance abuse disorder. Such programs include, brief integrated programs based on the disease-and-recovery model or on the cognitive-behavioral model, comprehensive integrated assertive programs and intensive partial hospitalization programs. We conclude, that although several program features appear to be associated with effectiveness, there is no clear evidence supporting an advantage of any type of program when co-occurring substance abuse with severe personality disorder. Implementation of new specialized services for dual disorders should be within the context of simple, well designed controlled studies.
A review was carried out into the literature of the last ten (Medline, IME, HealthSTAR, Cinahl) on the use of antipsychotic drugs in substance abusers. The use of these drugs is common in this population because of the high prevalence of psychotic pathologies among substance abusers and they are used in the treatment of situations derived from the consumption of certain substances and in secondary behavioural disorders following organic mental disorders or personality disorders. The special characteristics for the use of these drugs among addicts are reviewed as these patients tend to present adverse side-effects with greater frequency, for example, extrapyramidal symptoms and less compliance with treatment.
The aim of the present study was to identify possible risk and protective factors for the development of problems with the use of drugs in adolescents. A two years follow-up was carried out (from the 2nd to the 4th year of the Compulsory Secondary Education). Sociodemographic variables, general and eating psychopathology, family functioning and patterns of drugs use were assessed in 1,076 students. After controlling the effect of having problems with the use of drugs at the beginning, cigarettes smoking at the age of 13 years predicted the consumption of alcohol 2 years later and vice versa. Independently of the effect of this association, general psychopathology, body image dissatisfaction and self-harm at the beginning were risk factors for alcohol consumption 2 years later. Moreover, besides female gender and high academic achievements, normal family functioning was a protective factor against the fact of suffering problems with drugs later on. These present findings might have relevance in the development of preventive strategies for the use of drugs in adolescent population.
The aim of this study was to evaluate the efficacy of the treatment with antipsychotic olanzapine in cocaine abuse methadone patients. The decrease or interruption of cocaine consume as well as the possible pharmacokinetic interaction between olanzapine and methadone were studied. Patients (n= 21) include in a methadone maintenance program (14 months), with DSM-IV criteria for opioid and cocaine dependence and without schizophrenic diagnostic, were treated with olanzapine 5 to 10 mg/day. The therapeutic outcomes were assessed by personal interviews, cocaine consumption, changes of consumption patrons (via of administration) and secondary effects to olanzapine. Withdrawal symptoms were measured by means of the abbreviate version of the scale of Gossop. Cocaine used was measured by urine analysis (enzymoimmnuoassay). The possible pharmacokinetic interaction between olanzapine and methadone was measured in plasma before and during the treatment in 15 patients. Olanzapine combined with methadone in cocaine abusers was well tolerated in an important proportion of patients. Moreover the consumption of cocaine was decreased or stopped in 53,2% of the patients. In addition, no withdrawal syndrome was observed in any patients. Furthermore the ratios of methadone plasma levels did not change in relation to the dose before and during the treatment, suggesting a lack of pharmacokinetic interaction between methadone and olanzapine. In conclusion the results of this preliminary study, led us to advance that olanzapine could be a useful treatment for cocaine abuse at least in patients in a Methadone Maintenance Program, with the advantage of not to induce any pharmacokinetic interaction with methadone.
We have assessed the weight that Cloninger' dimensions play in the substance abuse disorder. Also, we have analysed the hypothetical self-independence of these dimensions and if there is some correlation between those and some demographic variables. 20 drug abstinents and 20 controls, all males, fulfilled the Tridimensional Personality Questionnaire. All the values on the Novelty Seeking (NS) subclass and the overall NS scale were higher in the abstinent group. The most meaningful differences were found on the excitable and extravagant subclass and the total NS scale. There was also a significant though smaller difference on the disorderly subclass. Only the Harm Avoidance (HA) subclass fatigability was significantly higher in the abstinent group. The value of persistence substantially low in the abstinent subjects was the most significant difference between groups when the Reward Dependence (RD) scale was considered. The correlation analysis demonstrated that the three dimensions were mutually independent in the controls. However, in the abstinent group NS correlated positively with HA and negatively with persistence. Any correlation was found between the dimensions and the demographic variables in both groups. A high sensation seeking behaviour and a low persistence seems to be the most prominent characteristic of our abstinent subjects. Both tendencies could explain in part their high substance seeking tendency and possibly the high rate of relapse found in similar populations. Finally, the Cloninger's hypothesis about the mutually independence of the dimensions seems to be fulfilled only in the control group.
Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.
180 psychotic patients with opiate dependence and abuse (ICD-10) were included in an open label study. The study objectives were to evaluate safety and efficacy of risperidone for a six month follow-up period. The total mean dose was 4.4 (SD: 2.4 mg/daily; range: 0.5-12 mg/daily). BPRS, CGI and DDS-SV were used to assess efficacy and UKU subscale for neurological side effects and spontaneous reports for safety. Risperidone treatment improved symptoms, disability of the included patients with a significant reduction in the mean total scores of BPRS, CGI and DDS-SV observed from the first month of treatment onwards. Risperidone also reduced illegal opiate abuse patients from 39% basedate to 18% at month 6. There was a significant reduction (p< 0.0001) in the total UKU subscale for neurological side effects scores from visit 1 onwards for studied sample. Risperidone was well tolerated by the study patients. From 165 elegible patients, just 10 (6.1%) discontinued treatment due to adverse reactions, 94% of the patients did not suffer any adverse event; the most frequent adverse events according spontaneous reports were extrapyramidal effects (3%) and anxiety (1.8%). Risperidone improved disability, psychotic symptoms and tolerability of these patients. Those results could mean an outstanding breakthrough in the treatment of these type of disorders and, if it is confirmed that risperidone can lead to abstinence, we would be before a new line of treatment for dual pathology.
Unlabelled: Chorea-acanthocytosis is an uncommon neurodegenerative disorder, usually with a low rate of progression. It is characterized by Huntington disease-like involuntary movements, cognitive decline, behavioral changes, seizures and polyneuropathy. Chorea-acanthocytosis belongs to the group of neuroacanthocytosis syndromes, a group of genetically defined diseases associated with progressive degeneration of the basal ganglia and peripheral red blood cell acanthocytes. The onset of the disease is variable in its manifestations and psychiatric symptoms may dominate the clinical picture. Case report: A 48-year-old woman with a history of seizures since age 35 developed behavioral and affective changes that led to her referral to our mental health unit. She had an unsteady gait, motor clumsiness, emotional instability and impulsivity. Personality changes related with medical illness were diagnosed despite a normal neurological survey. Subsequent development of choreic involuntary movements, evidence of striatal atrophy on MRI and detection of acanthocytes in a peripheral blood smear allowed diagnosis. The role of the basal ganglia in psychiatric manifestations and the pathophysiology of chorea-acanthocytosis are discussed.
Family influence and involvement in the obsessive- compulsive symptoms of their relatives are widely recognized in clinical practice although there is a very little research investigating those variables. The Family Accommodation (FAS) for obsessive-compulsive symptoms is an interview developed to evaluate those aspects of family interactions. The aim of this study is to present the Spanish translation, adaptation and validation of the FAS in a sample of Spanish adolescents. This is a 12 month follow-up study of 20 adolescents diagnosed of obsessive-compulsive disorder (OCD), and their families, who started treatment in a child and adolescent mental health outpatient unit. The reliability measurement of the scale obtains good values (Cronbach's alpha is 0.87, Guttman split-half is 0.81). Measurement of convergent validity has good correlation levels with other measures of OCD symptom severity, both at the onset of the treatment as well as at the 12 month follow-up. There are no significant differences in FAS scores between families whose mother and/or father exhibit OCD symptoms of their own and those without this condition. The results support the hypothesis that the evaluation interview of the Spanish adaptation of the family accommodation/involvement in OCD symptoms, as the original, is a reliable and valid measure of family participation in obsessive-compulsive symptoms of adolescent with OCD.
Although schizophrenia has a great impact on the health care, social and family levels, there is little epidemiological information on patients with schizophrenia, its diagnosis and treatment in Spain. The ACEE (Abordaje Clínico de la Esquizofrenia en España; Clinical Approach to Schizophrenia in Spain) study was designed with the primary objective of defining the management of schizophrenia in Spain from the perspective of current clinical practice. ACEE is a descriptive cross-sectional multicenter observational study with data collected in the setting of current clinical practice by means of a specifically designed questionnaire. A total of 1,937 patients have been studied (83% pertaining to the public sector and 17% to private one). Most subjects had paranoid schizophrenia in the stabilization phase, and did not work because of their illness. Most (96%) were receiving antipsychotic treatment and 55% also received some non-drug treatment. Negative symptoms were more frequent than positive symptoms (88% versus 63%). Significant differences were observed for type of patients and diagnostic procedures involved between the public and private health care sectors. The ACEE study shows that schizophrenic patients attending Spanish psychiatric centers are mainly single, non-working males who are living in their family setting. Treatment basically consists of antipsychotics combined with other drugs, and few complementary examinations are performed.
The aim of the present study was the development of a self-reported instrument in Spanish to assess attitudes towa rds change in eating disord e rs (AC TA ) and to analyze its reliability and validity. The questionnaire was elaborated following the transtheoretical approach of stages of changes, proposed by Prochaska and DiClemente and using the clinical records systematically registered regarding patients cognitions, behaviors and emotions related to the disorder. It was administered to 186 patients who where diagnosed an eating disorder according DSM-IV criteria. Subsequently, the process of refinement and validation of the scale was initiated. Moreover, a set of self-reported instruments was used to assess the eating disorder psychopathology: the Eating Attitudes Test (EAT), the Bulimic Investigatory Test Edinburgh (BITE), the Eating Disorders Inventory (EDI-2) and the Body Shape Questionnaire (BSQ). The final version consisted of 59 items divided into six subscales: precontemplation, contemplation, determination, action, maintenance and relapse. All of them s h owed an internal consistency over 0.70 which corresponded to the six factor obtained after the factorial analysis. Furthermore, the subscales were logically correlated to each other and to the questionnaires measuring eating psychopathology. The present results suggest that the ACTA be an easily administered, reliable and valid questionnaire, which could be used withinthe motivational approach. This could provide interesting information regarding the knowledge of the therapeutical process.
The aim of this paper is to present the bibliometric indicators of Actas Españolas de Psiquiatría that were obtained from the study "Potential impact factor of the Spanish medical journals in 2001", financed by the Spanish Ministerio de Educación, Cultura y Deporte. The citations made in Actas Españolas de Psiquiatría and its national and international impact factor and immediacy index have been obtained by the use of a methodology similar to the one used by the Institute for Scientific Information. The national indicators only take into account the citations made in 87 Spanish journals considered as sources, while those from the foreign source journals of Science Citation Index have been added to the previously cited ones. Actas Españolas de Psiquiatría has obtained a national impact factor of 0.315 and an international impact factor of 0.395, which places it as a leader in the Spanish psychiatric journals.
Borderline personality disorder (BPD) is usually treated with a combination of antipsychotic and anticonvulsant drugs although only limited efficacy is obtained in many patients. A major problem in the treatment of BPD is the lack of compliance derived form the pathological impulsivity of BPD patients. Twelve severe BPD patients refractory to previous treatment with drug combinations for three months were treated with intramuscular long-acting risperidone for a six-month period. Clinical changes were rated with the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale, anxiety and aggression scales. Functional improvement was evaluated with the Global Assessment of Functioning (GAF). Six-month treatment with IM risperidone was associated with significant improvement of CGI (t: 5.7 - 4.0; p<0.01) and of GAF (t: -4.5; gl: 10; p<0.01). Clinical improvement was robust after the first month of treatment. No relevant extrapiramidal side effects were reported with the exception of mild psychomotor slowing which requires dose adjustments in four patients. Treatment with i.m. long acting risperidone during six months was associated with significant clinical and functional improvement and excellent tolerability in a group of BPD patients refractory to previous treatment. The results indicate that the effect of IM risperidone in BPD should be further investigated in large placebo-controlled trials.
Our aim was to evaluate treatment safety, tolerability, efficacy and compliance of long-acting injectable risperidone (LAIR) as maintenance treatment in a bipolar and schizoaffective inpatients sample with torpid course due to poor compliance to oral therapy. 22 inpatients, 14 with a diagnosis of bipolar disorder and 8 with a diagnosis of schizoaffective disorder, were included in this study. They were treated with LAIR, 1 dose every 14 days, and were evaluated for 40 weeks with the Young Mania Rating Scale (YMRS), Hamilton Scale for Depression (HAM-D), UKU-Side Effect Rating Scale and Clinical Global Impression Severity of Illness scales (CGI). Average YMRS scores were reduced significantly from 10.5 at baseline interview to 2.5 at week 40 (p < 0.001). HAM-D and UKU scales did not reach a statistically significant reduction. CGI-S scores were reduced from 3.8 at baseline to 1.5 at week 40 (p < 0.001). LAIR could be an effective maintenance therapy for bipolar and schizoaffective patients with poor compliance to oral treatment.
The introduction of long-acting injectable atypical antipsychotics has ensured adherence to treatment in patients with low awareness of the disorder, with an acceptable rate of side effects. In the case of long acting olanzapine injection in particular, has particular relevance the existence of a special side-effect called post-injection syndrome. This rare side effect consisting in the presence of symptoms of olanzapine overdose after intramuscular administration of medication has led to restrictions on the use of the drug and the need for patient observation for three hours after each injection. We report a case of postinjection syndrome, to our knowledge, the first in Spain since the commercialization of Zypadhera. As in most cases described in the literature have symptoms of overdosage of olanzapine (dysarthria, sedation, fatigue, etc.) that are selflimiting without any therapeutic measure and are accompanied by supratherapeutic plasma levels of olanzapine.
In spite of the guidelines and consensus on its indications and application, electroconvulsive therapy (ECT) continues to be one of the therapeutic procedures with less knowledge on its mechanism of action. It is interesting to evaluate the way in which the factors that modulate the convulsant activity can be modified by this therapy and its relation with the therapeutic effect. The aim of the present article is to review, in the context of neurobiological theories, the bibliography regarding the electrophysiological mechanisms of action of ECT, mainly the anticonvulsant hypothesis. Having better knowledge about these mechanisms can achieve an improvement in the clinical practice and provide a starting point to search for alternative treatments based on the same physical bases. After doing a study of all the papers and reference books, those works which, according to their methodology and design, provide relevant scientific information with regard to the principal topic of this review and that have been published between 1993 and 2007 were selected. In order to provide better consistency to the text, a series of articles prior to 1993 that were considered important within the setting studied have been included, since they establish the theoretical bases of ECT and have been frequently mentioned after their sublication. The scientific evidence obtained is systematized into three sections: basic concepts, neurophysiological hypotheses and electrophysiological findings.
Schizophrenic treatment was developed during the second half of the last century, mainly within the context of the development of antipsychotic drugs. Even though there has been significant progress due to the availability and use of multiple drugs, these can still be classified into three basic groups of antipsychotic drugs (atypical antipsychotics, typical antipsychotics and dopamine partial agonist antipsychotics). Their primary antipsychotic mechanism is still the action on the dopamine systems. Many of the second-generation antipsychotics are believed to offer advantages over first-generation agents in the treatment for schizophrenia. However, the drug properties that provide the different therapeutic effects from those of the first generation are not clear and some adverse effects may still affect the patient's health and quality of life. Furthermore, the efficacy of the antipsychotics is limited. This has led to the use of adjuvant medications to strengthen the treatment effects. On the other hand, work is being done on the development of new research lines to develop new non-dopaminergic antipsychotic drugs, with not very successful results. The aim of this paper is to make a brief review on the current therapeutic armamentarium for schizophrenia, the strategies to develop drugs, and theories of mechanisms of action of antipsychotics. Emphasis is placed on the new therapeutic targets for the development of future treatments.
The knowledge of the therapeutic efficacy of the electroconvulsive therapy (ECT) dates back to the fourties. Since then important investigation efforts have been carried out, to analyze the mechanism of action by which the ECT achieves its therapeutic effect. The present work reviews the different hypothesis that have been related to the mechanism of action or the ECT, as well as the large neurophysiological findings, believed to be involved in its therapeutic effect.
The doctors don't have reliable instruments in order to detect the painful experience in a patient with intention of deceiving. The objective of this investigation is the development of an instrument that helps the doctors on that task. The investigation is based on that the pain is not possible to evoke. A patient that doesn't feel pain, really, will introduce the modifications characteristic of all memory when requests you that he/she describe the pain that says feel. The will of deceit will also distort their description. A discriminant analysis will detect the difference between the description of a pain that is not present and another that yes it are, and between the sincere descriptions of the deceiving one. The descriptions of the pain carried out by two different samples of nursing students have been studied with a list of pair of antonym adjectives (Osgood's semantic differential). A subgroup of the first sample described a pain that they suffered in the same moment of description, and the other subgroup described a suffering pain some days before. In the other sample, a subgroup made a sincere description of their pain and other subgroup described the pain with will of deceiving the interviewer. The investigation has provided two discriminant models. A discriminant model differentiates between a present and another remembered pain (sensibility: 0.75; specificity: 0.85; kappa reliability: 0.60; p < 0.000000001; probability of success p: 89%). The other discriminant model differentiates between a description of a pain with will of deceiving and another pain described sincerely (sensibility: 0.94; specificity: 0.95; kappa reliability: 0.89; p < 0.000000001; probability of success p: 97%). The results of this investigation seem to demonstrate that it is possible to discriminate between the descriptions of real pains and the suspicious pains of not being real, and that also one is able to discriminate between pains described with will of deceit and pains described sincerely. These discriminant models allows to classify the description of the subjects in four groups: "liars", "sincere", "magnifiers", and "psychogenic". However, it is necessary still carry out more effort of investigation so that these results could be replied in patients that suffer pain.
Objectives: Community psychiatry has mainly relied upon intermediate long term care services while there is a large gap between patient's needs and availability of acute care services. Taking this into consideration, the main aim of this paper is to review the evidence supporting the efficacy and feasibility of implementing the new models of care developed to fulfil the gap in the provision of community and hospital care for acute and severely ill patients. Finally the paper will propose a "care balanced approach" to integrate the key elements of the new alternatives of acute community and hospital care in the mental health system. Material and method: A review of the current literature was used to identify the key components of acute care for psychiatric illness. For this purpose Medline (1966-2010), EMBASE (1980-2010), and PsycINFO (1985-2010) databases were reviewed using key terms relating to assertive outreach, home treatment/crisis resolution, psychiatric acute day care, deinstitutionalization, Mental Health Service Models. Results: Three main types of acute care have been identified: Acute Continuous Day Care (ACDC) -day hospitals -, Assertive Outreach Care (AOC) -Assertive Community and Assertive Outreach teams-, and Home Acute Care (HAC) -Crisis resolution, Home treatment teams-. The feasibility of these alternatives is supported by available evidence. Although these acute care alternatives may be complementary and could be combined for achieving a greater positive impact on the clinical and social recovery of the patients, there are usually implemented independently. Conclusions: An integrative acute care subsystem combining these three strategies in a balanced care system should be formally incorporated to the advanced community model in mental health care.
Top-cited authors
Alfonso Gutierrez-Zotes
  • Pere Mata Institute
Julio Bobes
  • University of Oviedo
Joaquin Valero
  • Pere Mata Institute
Carmen Bayon
  • Hospital Universitario La Paz
Robert Cloninger
  • Washington University in St. Louis