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Describe Attention Deficit Hyperactive Disorder's (ADHD) prevalence in Bipolar Disorders (BD) and relatives.
78 admissions for Bipolar Disorder (DSM-IV) in Impatient Psychiatric Unit, in Hospital Clínico Universitario of Valladolid (Spain). Only 36/78 patients participate in study. Demographic, social and clinical information were registered. ADHD symptomatology was evaluated from patient and descendant (Conners short version).
ADHD symptomatology suggestive in childhood/adolescence were detected in 13,9% (5/36). Conners score were negative (below 15) in all case.
ADHD symptomatology suggestive in their children were detected in 6,25% (n=3). Conner score were positive in 2,1%. Family psychiatry history in 72,2% (n=26), affective disorder in 60,52% (n=23). No family history with ADHD diagnosis. Only one case (2,8%) with symptomatology suggestive of ADHD in relatives.
The ADHD prevalence in our sample of BD and relatives weren’t higher than general population.
- Frontiers Between Attention Deficit Hyperactivity Disorder and Bipolar Disorder. Cathryn A. Galanter, MDa, Ellen Leibenluft, MD. Child Adolesc Psychiatric Clin N Am 17 (2008) 325-346.
- Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children.
UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.
Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.
Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.
Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.
47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.
19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.
Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.
10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.
Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.
Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.
Alexithymia is a term to describe a state of deficiency in understanding, processing, or describing emotions. It expresses the cognitive-emotional state of vulnerable subjects who prone to suffer from psychosomatic illnesses. It’s characterized by difficulties in relationship and emptiness of feelings. It has been incriminated in genesis and maintenance of various psychosomatic pathologies, included psoriasis. Psychological stress is important in onset and exacerbation of psoriasis. We assume hypothesis that emotions that cannot be expressed through the appropriate symbolic language will be expressed through a symbolic somatic symptom.
A case study of psoriasis in a woman of 27 years without a previous psychiatric history. She was treated jointly by the service of psychiatry and dermatology. Methodology: We performed a detailed history in the course of the disease, summarizing vital changes and outstanding events of her lifetime in the different vital areas (family, work, school and sex life).
From the comprehensive revision of the ailments and pathobiography we can establish a clear relationship between physical-psychological symptoms.
Skin is an envelope that represents the boundary line between body-psyche. Skin and psyche interact in many ways. The skin reacts to feelings and perceptions. Psychosomatic patients feel extreme anxiety when they have to cope with separation and merger situations. They experience these situations as if they were to lose their physical limit. Broadly speaking, because of their alexithymia, they cannot process a painful emotion properly, and though they will express it through somatisation disorders and the development of diseases. In the case of our patient, the skin verbalizes her emotional silence.
This pooled analysis compared the efficacy of venlafaxine extended-release (XR) versus placebo in the treatment of social anxiety disorder (SAD).
Data were pooled from 5 randomized studies of patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) SAD (N=1459) who were treated with venlafaxine XR 75 mg/d to 225 mg/d or placebo for 12 weeks (4 studies) or 28 weeks (1 study). Response and remission rates were calculated for the overall sample, as well as stratified by gender and level of physical symptom severity at baseline. Response was defined as a score of 1 or 2 on the Clinical Global Impressions–Improvement (CGI-I) scale. Remission was defined as a total score of <30 on the Leibowitz Social Anxiety Scale (LSAS).
At baseline the mean LSAS score was 88.1 and 86.6 for the venlafaxine and placebo arms, respectively. Overall response rates at week 12 were 55% for venlafaxine XR and 33% for placebo (P<0.0001); remission rates were 25% and 12%, respectively (P<0.0001). Among patients with less severe physical symptoms, response rates were 52% and 32% for venlafaxine XR and placebo, respectively (P<0.0001); remission rates were 27% and 14%, respectively (P<0.0001). Response rates among patients with more severe physical symptoms were 56% for venlafaxine XR and 33% for placebo (P<0.0001); remission rates were 24% and 11%, respectively (P<0.0001).
Venlafaxine XR is effective in the treatment of SAD, regardless of gender or severity of physical symptoms.
Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.
A prospective study in treatment-resistant schizophrenic patients was performed over 10 years to evaluate the therapeutic response to clozapine and the variables related to this treatment. Eighty schizophrenic and schizoaffective patients (according to Diagnostic and Statistical Manual [DSM]-IIIR criteria), considered as refractory (previously resistant to at least two different typical neuroleptics), were studied. The average dose of clozapine was 267 mg/d. The clinical variables considered were: Brief Psychiatric Rating Scale (BPRS), number of admissions before and after clozapine treatment and the Strauss-Carpenter scale as measures of efficacy; Premorbid Adjustment Scale (PAS), to assess personal and social adjustment before illness; Karolinska Personality Scale (KPS) to assess stable traits of personality; and the Simpson-Angus scale as a measure of extrapyramidal symptoms. Sixty percent of patients showed a significant improvement after clozapine treatment. Side-effects were mild and well tolerated, with no cases of haematological disturbance and only five withdrawals because of adverse events. The severity of the episode, according to BPRS score and anxiety as a personal trait, are related to good prognosis. Other relationships between improvement and clinical and demographic variables are discussed.
Despite the high prevalence of obsessive-compulsive symptoms located around 2-3% of the population, there continue to be cases where the characteristics of the patient or the circumstances of their environment, they fall short queries mental health or when they do not for the disorder itself, but for another reason obsessional symptoms worsen.
Expose using clinical case, the existence of patients with obsessive pathology whose characteristics do not seek mental health consultation, until this is associated with a new disease that interferes significantly in vital organization.
We report the case of a man of 88 years old, married at 60, was admitted to the psychiatric consultation at the request of his wife 29 years his junior, for behavioral disorders several years of evolution and history of obsessive symptoms compulsive, which did not interfere with their daily lives by the lack of insight and poor social environment
OCD is included in anxiety disorders.
It is characterized by the presence of obsessions and compulsions that interfere with personal, work and / or patient's social.
There are cases that own personality traits of the patient, this disorder is not diagnosed early and choose to go only when associated with worsening cognitive impairment rituals and interfere with family life.
Pathological gambling is often considered a behavioral addiction. Attentional bias (AB) refers to the observation that substance-related cues tend to grab the attention of experienced substance users. The Dot Probe Task has been used to assess AB in individuals with substance addiction, however it has never been used to assess AB in PG.
The aims of the present study are assessing potential AB in PG using Dot Probe Task with exposures time that assess attentional maintenance checking the possible correlation of PG severity with degree of attentional bias.
PG sample was 23 subjects and Non Gamblers group (NG) was 21 subjects. To asses the severity of gambling we use the South Oaks Gambling Screen. We can define two types of reaction times to assess the AB: a) Congruence time: time the subject takes to detect the point when it appears on the hemi-screen replacing the cue picture. b) Non-congruence time: idem when replacing the neutral picture. The difference between these times is the AB index.
The PG had a congruence time significantly lower than the non-congruence time which indicates the presence of AB in this group. There were also differences between AB index in PG and NG sample, validating the Dot Probe task to detect AB. Moreover, there weren’t relation between the severity of the game and AB.
The study shows the presence of AB in PG at level of maintenance of attention (disengagement) and the validity of Dot Probe Task to detect AB in PG.
The quality of the educational system of a country is not only an indicator of the levels of development and well made, but also to come. Not surprisingly, providing universal schooling is also capable of stimulating the development of children and youth, is a strategic objective of the first magnitude in the more advanced nations.
Our country is no stranger to this concern. It is for this reason that, in a recurrent way, the training of our young people, in particular, the problem of school failure are the subject of public debate.
School failure is considered now a major problem, especially in Spain (20-28%), where rates are above the European average and the OECD countries. The importance of this issue has led, in recent times, the emergence of numerous analyzes and various studies trying to determine the causes and to establish the true extent of the failure and dropout rates in our country.
This paper will describe possible factors for future preventive activities, influencing the increase in the rate of absenteeism / dropout: the appearance of breaking the educational link. Link or union that is fragmented by its components: the institution and the student.
There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.
To validate the self-administered PLE Scale.
Material and methods:
In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).
The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).
Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.
The general model of cognitive impairment of schizophrenic patient may be summarized as follows:first difficulty interpreting signals from other(predominantly negative symptoms),and on the other an emotionally intense overinterpretation of these(predominantly positive symptomatology). These patients have greater difficulty in understanding the mental states of those around. So cognitive rehabilitation aims to build the capacity of relevant attribute mental states to others and solve specific problems and difficulties of daily life. The aim of the study is to evaluate the correlation between the ability of understanding of mental states and the ability to interpret expressions Machiavellian(manipulative purposes)
Cross-sectional data were analyzed from a study with a sample of 43 patients diagnosed with schizophrenia compared to normal controls matched for age, sex and educational level. As scale measuring instruments used Mach-IV, self-administered questionnaires and a comprehensive neuropsychological battery to assess performance and the PANSS, SAPS and SANS scales
The path analysis were used to evaluate the effects of neuropsychological functions, functional ability and level of functioning in real life. After evaluating the following functions:physical distinction-mental distinction-reality appearance, identification of intent gaze, identifying emotions, ability to deceive, ability to understand the jokes, ability to understand stories, the study showed how schizophrenic patients showed poor workability, deception or strategic thinking ability and a poor ability to “take the place of another”
Cognitive rehabilitation works to help construct representations of others and of oneself and use them flexibly to guide social behavior by encouraging the underlying social interactions involving human capacity to perceive the intentions and dispositions of the other mental functions. In short, an improvement in the therapeutic field biopsychosocial
Pathological Gambling (PG) tends to be a heterogeneous disorder where patients differ with type and severity of gambling behaviour, psychiatric co-morbidity, family history, sex and age of onset. Age of disease onset in PG varies significantly, with many individuals having onset during childhood and adolescence and others in various stages of adulthood. Previous studies have demonstrated that age of onset is an important characteristic for a better understanding of the PG heterogeneity.
(1) To analyze differences in sociodemographic aspects between early-onset PG and non early-onset PG, (2) to study whether early-onset PG is associated with specific psychiatric diagnosis in axis I and II.
We used data from a large and nationally representative community sample of United States (US) adults, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We selected age 25 years as a threshold for early-onset PG.
Individuals with early-onset PG were more likely to be male, never married, and young and to have a lower education level and individual income than non early-onset PGs. Early-onset PG were less likely to have mood disorder (OR = 0.42 (0.19 − 0.94)) and had non-significant higher odds of having substance and anxiety disorders than non early-onset. The odds of having Cluster B disorder were significantly higher among early-onset PGs than non early-onset PGs (OR = 4.11 (1,77 − 9.55)).
Our findings support that subgroups of Pathological Gambling defined by onset age have phenotypic differences.
The HDP care structures are intermediate in nature providing an active heatlth care, multidimensional, structured and intensive medical care, aimed at patients with severe and complex system of partial hospitalization in pathology, as well as those patients who do not require, at a given time, income to total time, but are not subject to appropriate outpatient therapeutic gains.
- To analyze the profile of psychotic patients admitted to HDP.
- To know the effectiveness of the intervention in HDP on psychotic patients.
Material and Methods
Prospective naturalistic study of psychotic patients (F2X.XX) entering HDP for 24 months. As main outcome variables use: PANSS score, GAF score and CASH for insight. These scales are passed on valuation and the day of discharge device.
We identified 81 patients that have been hospitalized after an acute event (67, 82.7%). From the initial sample, 22 cases were first psychotic episodes (27.2%), 46 males (56.8%) and 35 women (43.2%), Discharge statistically significant improvement in PANSS score (p objective <0.001) in the GAF score (p> o, o, o, 1) and in CASH to awareness of illness score (p <0,0,0,1).
Intervention in day Hospital on psychotic patients improves psychotic symptoms, functionality and insight.
In the absence of biological measures, diagnostic long-term stability provides the best evidence of diagnostic validity.Therefore,the study of diagnostic stability in naturalistic conditions may reflect clinical validity and utility of current schizophrenia diagnostic criteria.
Describe the diagnostic evolution of schizophrenia in clinical settings.
We examined the stability of schizophrenia first diagnoses (n=26,163) in public mental health centers of Madrid (Spain).Probability of maintaining the diagnosis of schizophrenia was calculated considering the cumulative percentage of each diagnosis per month during 48 months after the initial diagnosis of schizophrenia.
65% of the subjects kept the diagnosis of schizophrenia in subsequent assessments (Figure 1). Patients who changed (35%) did so in the first 4-8 months. After that time gap the rates of each diagnostic category remained stable. Diagnostic shift from schizophrenia was more commonly toward the following diagnoses: personality disorders (F60), delusional disorders (F22), bipolar disorder (F31), persistent mood disorders (F34), acute and transient psychotic disorders (F23) or schizoaffective disorder (F25).
Once it is confirmed, clinical assessment repeatedly maintains the diagnosis of schizophrenia.The time lapse for its confirmation agrees with the current diagnostic criteria in DSM-IV. We will discuss the implications of these findings for the categorical versus dimensional debate in the diagnosis of schizophrenia.
Suicide is a public health problem of the first magnitude for both its costs and its implications for the population. The attention to suicide attempts is itself one of the first reasons for psychiatric consultation, if not the first, in hospitals. Among the risk factors for suicide is the presence of mental disorders on Axis I and II, and the existence of previous attempts.
Studying the behavior of some of the risk factors for suicide known (psychiatric history and previous attempts) in a sample from service Emergency Hospital Juan Ramón Jiménez
Performed a retrospective analysis (for a period of 6 months of 2013) of the risk factors associated with suicidal behavior of patients seen in the emergency department of our hospital for attempted suicide.
In an interim analysis found that up to 50% of patients treated for attempted suicide had made ??previous attempts. Most of them had any axis I disorder (> 75%) and were or had been in outpatient psychiatric follow. Extensive treatment with psychotropic drugs performed most (> 80%)
The high number of cases with previous attempts provides a clear example of the problem of suicidal behavior relapse. The importance of this is increased when you consider that most were receiving or had received psychiatric treatment, reflecting the limitations in our daily clinical practice we have to control this pubic health problem.
The psychological autopsy aims to reach an understanding on the psychological aspects of a specific death.
Interview of relatives and friends require sensitivity to their emotional condition. Since Edwin Shneidman started to use this method, one of the most important questions is when to arrange the interview.
To evaluate family and friends satisfaction with the interview, in order to determinate when is the best moment to settle the psychological interview.
We studied the results of 271 suicides psychological interviews, and analyzed two variables: the satisfaction (measured using rating scale from zero to ten) and the time passed since the suicide.
The overall satisfaction was high (8´75), and the average time that we lasted to carry out the interview was 8´54 months.
When we analyzed the satisfaction through the months, we did not find differences in the values of the rating scale.
Although the best time to contact friends and relatives has been established to be between 2 and 6 months after the suicide event, in our study we did not find any relation between the timing and the satisfaction.
The results of this study show that the fact of when is the best moment to settle the psychological autopsy interview is still unclear.
A better konwlodge about this could improve the satisfaction of relatives and friends with the psychologial autopsy.
According to the literature, consumption of cigarettes has been related to suicidal behavior. Furthermore, evidence suggests that increased consumption of cigarettes is associated with an increased risk of suicide.
- To verify the association between the consumption of cigarettes and completed suicide.
- To confirm a higher consumption of cigarettes in completed suicide versus controls.
Completed old suicide and controls were recruited through the Institute of Legal Medicine of the province of Seville, Spain. After the physical autopsy was conducted, family members were asked for a posterior interview following the Psychological Autopsy methodology.
There were 412 subjetcs collected for this study; 270 completed suicide and 142 controls.
Only one third of suicides did never smoke whether almost half of controls did so (27.5% vs. 47.2%; c2=23.73; df:3; p<0.0001). We did not find any difference between the quantity of cigarettes used by those subjects that smoke daily in suicides (53.2%) and controls (44.5%). However this lack of association may be due to the type of controls. Controls were in a substantial percentage cardiac sudden death subject and smoking tobacco has been largely associated with cardiovascular disorders.-Almost 50% of controls had never smoked (compared to 27% of suicides).
- There are fewer subjects that have never started smoking within the suicide subjects compared to controls.
- The number of cigarretes in those who smoke daily was not associated to any group. This results may be influenced by the characteristics of our control population.
When we want to approach eating disorders in infancy and childhood we can not forget the importance of relations with the relational patterns figures. The bond with the primary attachment figure is critical to the physical and emotional development. The “be fed” is a task essential to life, through it, it helps the child regulate their states, differ feelings / emotions. … to food and environment are created and entrenched relational patterns exist when feeding problems is essential to evaluate the interactive situation and the representational world of the attachment figure. Only then can we understand the disorder and help participants to solve (R. Feldman, Karen M., 2004).
In this paper the study of possible empathic failures in the original development of attachment in relation to disordered eating behavior is presented. To do this, we have taken a sample of 10 patients with DSM-IV criteria for an eating disorder diagnosis and valued the relationship with the attachment figure reference.
Try, therefore, to analyze the basic elements that come into play around the feeding in the first year of life: the child with its biological characteristics and temperament and adult relationship leading figure, which is the one with food to the child and gives.
There is no pharmacotherapy with specific indication for psychostimulant detoxification. Few studies have been made about pharmacological strategies in this dependence. In dual patients, literature about this remains limited.
Objectives and aims
To describe socio-demographic features, drug-related experiences, primary psychiatric disorders and therapeutical approaches in dual inpatients, and compare them with non dual inpatients.
We present a descriptive and cross-sectional study, based on the description of 300 admitted patients for psychostimulant detoxification from June 2008 to August 2011. Clinical and socio-demographic characteristics were registered using an ad-hoc questionnaire. Structured interviews based on SCID I, SCID II, ASI and CAADID were performed to screen psychiatric co-morbidity.
Almost 63% reached criteria for dual diagnosis (72.4% men, mean age 36 ± 7,8 years). The most common diagnostics were psychotic disorders (45.5%) in axis I and Cluster B personality disorders in axis II (31.8%). 44.7% were multiple-drug abusers. 57.9% of dual patients had been previously hospitalized in comparison with 28.1% of non dual patients, being this statistically significant. Dual patients used a higher number of pharmacological treatments at discharging from hospital (3,1 ± 1,5 vs 1,9 ± 1,4, p < 0.001). The most frequent approaches were antiepileptics (80,8%), antidepressant (67.7%), antipsychotics (51.3%), interdictors (16.9%), anxiolytics (12.8%) and opioid agonists (10.4%).
Dual patients admitted for a psychostimulant detoxification frequently reach criteria for psychotic disorders and cluster B personality disorders. They exhibit a severe condition, requiring numerous admissions and presenting higher prevalence of poly-drug abuse. Similarly, they need additional pharmacological strategies to complete detoxification.
We aim to determine risk and protective factors influencing relapse incidence in outpatient with schizophrenia.
A longitudinal, observational study was done with outpatients with schizophrenia (F20) or schizoaffective disorder (F25)(DMS-IV and ICD-10), without hospitalization during the previous 6 months. The patients were consecutively included into the study to received oral (O-A) or long-acting injectable (depot-A) antipsychotics. Clinical stage evolution, compliance, efficacy and safety assessments (including PANSS, CGI-SSI, hospitalization rates, and adverse events) were recorded before and after 6 and 12 months of treatment.
60 outpatients (aged 34.5±8.9, male 73%), 75% schizophrenia and 25% schizoaffective disorder diagnosis, 68.3% fewer than 15 years of schizophrenia evolution, 76.7% fewer than 5 times previous hospitalizations were treated with O-A (41.7%) or depot-A (58.3%) antipsychotics for at least one year. Depot-A treated patients showed a significant higher compliance compared to O-A patients during the all following time, lower PANSS (total, positive and negative) scores and CGI-SSI score (p<0.01), and a delayed relapse incidence and re-hospitalization to more than 1 year in the 48% of patients (relapse % depot/% oral) after 6 months 22.9%/52.0%, and after 12 months 48.6%/4.0%.
There were protective factors which delayed relapse incidence in schizophrenia: Use of sustained-release preparations, family support. There were risk factors for occurrence of relapse in schizophrenia: cocaine, heroin and alcohol consumption, absence of family support, greater severity of patients assessed through CGI-SI, male sex, age older than 25 years and long-term evolution of the disorder. Cannabis use did not affect the incidence of relapse.