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Agroforestry systems can play an important role in mitigating the effects of climate change given their capacity to increase tree diversity and to store more carbon than conventional farming. This study aims at assessing carbon stocks and the use of shade trees in different coffee growing systems in the Northeast Peruvian Amazon. Carbon stocks in trees were estimated by field-based measurements and allometric equations. Carbon stocks in dead wood, litter and soil (upper 60 cm) were determined using field sampling and laboratory analysis. The diversity analysis drew on the Shannon–Weiner diversity index, and focus groups were used to obtain information about the local use of shade trees. The total carbon stock in the polyculture-shaded coffee system was 189 t C/ha, while the Inga-shaded and unshaded systems totalled 146 and 113 t C/ha, respectively. The soil compartment contributed the largest carbon stock in the coffee growing systems and contained 67, 82 and 96% of the total carbon stock in the polyculture-shaded, Inga-shaded and unshaded coffee systems, respectively. The Shannon–Weiner index and tree species richness values were highest for the polyculture-shaded coffee system, with a total of 18 tree species identified as important sources of fodder, food, wood, firewood and medicine. Therefore, coffee agroforestry systems play a significant role in carbon storage, while promoting conservation of useful trees in agricultural landscapes in the Peruvian Amazon.
Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.
We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.
This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.
A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.
Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.
This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries.
Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models.
Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
Functional magnetic resonance imaging (fMRI) is a neuroimaging technique increasingly used for both patient care and clinical research. This techniche provides a space-time high-resolution able to detect small changes in regional brain activation.Ojbectives: the aim of this study was to compare patterns of regional brain activation in patients with eating disorders (ED) and healthy volunteers during emotional stimulation.
Materials and methods
A group of 13 young female ED outpatients was selected using DSM-IV criteria and 13 young healthy female volunteers with no significant differences in sociodemographic or environmental data. fMRI was used to examine the neural responses after visual stimulation with neutral and fearful images, taken from the IAPS (International Affective Picture System) and selected a region of interest (ROI) aproach to examine the function of the amygdala in emotional processing.Data processing and higher level analysis were carried out using FSL (fMRI's Software Library).
ED patients showed significantly greater rigth amygdala activation to the fearful images versus neutral images than healthy control subjects (p < 0.02)
A higher right amygdala response to processing of fearful stimuli was observed in ED patients compared to healthy volunteers. This emotional dysregulation in the affective response to unpleasant stimuli would correlate with a maladaptative response and therefore justify disruptive behaviours in this patients.
The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.
The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.
MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).
The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
The objective of this study was to examine the association of different personality traits on severity of addiction indexes and patterns of drug use level, in a sample of adolescent psychiatric patients with Substance Use Disorders (SUD), based on the dimensional model of Personality Psychopathology Five (PSY-5) of the MMPI-A.
The Teen Addiction Severity Index (T-ASI), the MMPI-A, and an inventory of drug use pattern were administered to 73 psychiatric patients (M=16.0, SD=1.18 years old; 51% male).
Rho Spearman correlations showed significant associations between Disconstraint (DISC) and T-ASI indexes of drug and social problems (rho= .342, p= .003, and rho= .320, p= .006) and also between DISC in relation to level of cannabis use and other drugs than cocaine and amphetamines (rho= .334, p= .004, and rho= .274, p= .023). The dimension of Psychoticism (PSYC) and Aggressiveness (AGGR) showed slight association with cannabis use (rho= .236, p= .045, and rho= .247, p= .035). The Negative emotionality (NEGE) and Introversion (INTR) showed a moderate association with the T-ASI index of psychiatric problems (rho= .265, p=0.023, and rho=.256, p= .029) but not with drug problems.
The DISC trait could represent a good indicator of risk for drug related problems. High scores in PSYC and AGGR are slightly associated to increase level of cannabis use. While psychiatric complaints are associated with NEGE and INTR traits.
Previously, we showed the usefulness of the REF scale to assess referential thinking (Rodríguez-Testal et al., 2001; 2009) although it isn’t specific for patients with psychotic disorders (Rodríguez-Testal et al., 2008).
This instrumental work aims to replicate the exploratory factor analysis about the Referential Thinking Scale (REF scale) already developed by Lenzenweger et al. (1997) to examine its multidimensionality.
Participants: The analyzed sample consisted of 193 participants (67.36% women, mean 28.36 years old, SD = 10.35), of whom 131 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language. This questionnaire consists of 34 items that assess the frequency of referential thinking on a dichotomic scale (true/false). We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation.
The principal-components factor analysis method led to 5 factors that explain 37.35% of variance for the rotated solution. Because of inter-factors correlations are small, we considered these factors as being independent. The five factors were labeled as: Laughter, Commentaries (it accounted for 8.92% of variance); Guilt (it accounted for 8.77% of variance); Causal Explanations (it accounted for 7.17% of variance); Songs, Newspapers, Books (it accounted for 6.44% of variance); and Attention, Appearance (it accounted for 6.04% of variance).
It's obtained the five factors isolated in previous studies (Lenzenweger et al., 1997; Rodríguez-Testal et al., 2001). However, the multidimensionality of the REF scale must be viewed with caution because of a small percentage of explained variance.
Improving adherence in mental patients, growing up insight and reducing stigmatization.
Giving simple and clear messages to families and patients for learning about symptoms and the management of daily difficulties.
Three were the main pillars of our work: patients’ opinion, professional knowledge and families contributions. First, patients were questioned about “What is for you mental illness?” “May you explain your illness?” and the answers were completed with a collage/picture. Those opinions were evaluated by the group and the therapist. We already made reunions with a mental patients association and family groups to expose their opinions and daily life difficulties.
Analyzing drawing-collage characteristics, medical histories and reflections from patients and families, we achieved an individual management for patients. Families could expose doubts and suggestions about patients care. We offered a multidisciplinary management to develop insight and adherence.
“The other shore of mental illness” is a book with a psicoeducative propose about useful concepts of mental illness. It emerges from the professional need to approach to the other shore, families and patients’ opinions and feelings.
Drawing has been used as worktherapy, becoming a benefit for diagnosis and evolution in mental illness. In this book we used them as a means in the improvement of insight and adherence.
The work with families, patients and caregivers let therapists to attend the real difficulties in their daily lives.
The book would be not only a vehicle to reduce stigma, but also a reflection on avoiding discriminatory politicals in mental patients assistance.
In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.
Descriptive ans cross-sectional.
Primary Health Care.
We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.
We conducted through a questionnaire that cointained the treatment and demographic characteristics.
We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.
In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
• To describe personality characteristics in personality disorders (PDs) patients with substance use disorders (SUDs) comorbidity.
• Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit who met DSM-IV criteria for PDs and had comorbidity with SUDs.
• To explore the psychometric characteristics we used the Temperament and Character Inventory-Revised (TCI-R).
• Overall, 32 subjects were assessed (72% males; mean age 38,4±7,3). Mean length of admission was 17,6 ± 7,5 days. Suicide attempt/ideation (50%) and behaviour disruption (19%) were main symptoms at admittance. Main drugs were alcohol (59,4%) and cocaine (15,6%); 24% had polydrug dependence (3 or more SUDs).
• TCI results showed a profile characterized by low self-directness (78,1%), low cooperativeness (46,9%) and high novelty seeking (31,3%).
• Sedative SUDs group (including alcohol, cannabis, and benzodiacepines SUDs) showed higher scores in asthenia (70,6 ± 2 vs. 57,52 ± 3,2; p=0,002), and locus of control (44,8 ± 4,1 vs. 31,4 ± 32,6; p=0,039) than stimulant SUDs group (including cocaine and amphetamine-like SUDs).
• Polydrug dependence group had higher scores in spiritual acceptance (63,6 ± 4,2 vs. 49,9 ± 2; p=0,003).
• The older group (38 thru highest) had higher scores in cooperativeness (44,8 ±3,2 vs. 35,7 ± 3,1; p=0,05) and compassion (47,9 ± 3,7 vs. 36,2 ± 3,8; p=0,03).
• We found a profile characterized by low scores in self-directness and cooperativeness as seen in previous surveys.
• The older patients seems attenuate some maladaptative personality characteristics.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.
Describe patterns of sexual behavior in patients diagnosed with transsexualism
Gender and Identity Disorder Unit (GIDU)
Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).
Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.
11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.
It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.
Previously (Rodríguez-Testal et al., 2001) we analysed the multidimensionality of Referential Thinking Scale, obtaining similar results to original research of Lenzenweger et al. (1997) but warning about the construction of subscales.
In this study we intended to analyse if the REF Scale is a good indicator to differentiate the two subtypes of paranoia “Bad Me” and “Poor Me” (Trower & Chadwick, 1995).
Participants: We analyzed data from a different sample of previous studies with 326 participants (64.11% women, mean age 30.8, SD = 10.84), of whom 212 were patients.
Design, materials and procedure: We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, of which we deleted two items because of psychometric criteria, resulting 32 dichotomic items. We used SPSS 15.0 to conduct a principal-components factor analysis with a varimax and oblimin rotation, retaining two factors.
Two factors explained 31.32% of the variance (rotated solution). We interpreted factor through factor loadings higher than .42. Factor 1 accounted for 18.28% of the variance and it's associated with referential laughter, commentaries and guilt. Factor 2 accounted for 13.05% of the variance and it's associated with referential concerns related to the media.
Since the inter-factor correlation is moderate (.44) and there are no relevant clinical differences about the content between the two factors, the REF scale is a one-dimensional measure. Therefore, two big factors don’t emerge from the REF scale related to referential concerns about laughter-commentaries and guilt that correspond to “Poor Me” and “Bad Me”, respectively.
In previous works we demonstrated the utility of the REF scale for the assessment referential thinking (Rodríguez-Testal et al., 2001) although it wasn't specific for patients with psychotic disorder (Rodríguez-Testal et al., 2008).
Objectives and hypotheses
We analyzed the psychometric properties of reliability and validity of the REF scale. We compared the differences in referential thinking between subjects with and without psychopathology. In the patient group we will not obtain differences in referential-thinking between diagnosis types of Axis I, Axis II, or patients with diagnoses on both axes.
Participants: 120 subjects, 70 patients attending a private center of clinic psychology, 64.3 % women, mean age = 35.21 (SD = 10.5) and 50 controls selected from the normal population, 54 % women, mean age = 33.48 (SD = 10.83).
It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.
We reached adequate internal consistency (Cronbach's alpha= .90, split-half reliability= .83 and .82). The test-restest reliability was significant (mean interval of 44 days). There are significant differences in referential thinking between subjects with and without psychopathology (t=3.8; p=.001). There are significant differences in referential thinking between types of diagnoses (F=3.99; p=.001).
The REF scale has adequate psychometric properties (reliability and validity). It discriminated between patients and no-patients, and between the different types of diagnoses, especially for those who suffer psychotic disorders.
We analyzed the association of age at onset of psychosis(AOP) with having a history of cannabis use in patients with a first episode of non-affective psychosis(FENAP) and investigated the impact on the AOP of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.
We recruited 112 consecutive patients with a FENAP. CIDI was used to assess drug use and to define the age at onset of heaviest use(AOHU) of a drug, as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOP was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOP of patients with and without a history of cannabis use, or associated cocaine use.
AOP was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOP: the earlier the AOHU the earlier the AOP. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first episode psychosis than the rest of the patients (sex-adjusted log rank χ2=23.43,df=1, p< 0.001). Their respective median AOP (25th, 75th percentiles) were 23.5 (21,28) and 33.5 years (27,45) (for log-transformed AOP, t=5.6, df=110, p< 0.001).
Our results are in favor of a catalytic role for cannabis use in onset of psychosis.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.
To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.
This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.
A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.
We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.
There is a significant incidence of psychiatric symptoms in patients with multiple sclerosis, the most common after receiving the diagnosis. We describe a man who was admitted for a first episode psychosis and a diagnosis of multiple sclerosis was made moreover.
A 24-year-old man was admitted with a paranoid delusion, auditory hallucinations with emotional response and the believe that their thoughts were being interfered. Blood test and cranial CT were normal. Risperidone was started. He developed ataxia and sensitive disturbances on the right arm. A cranial and spinal cord MRI revealed multiple T2 and FLAIR hyperintense lesions located in supra and infratentorial white matter, lesions in C3, and one lesion in right basal ganglia that enhanced with gadolinium. CSF analysis showed oligoclonals bands. Three years ago the patient had had transient sensitive symtoms. A diagnosis of relapsing-remitting multiple sclerosis was made and was started methyl-prednisolone intravenously. Risperidone was changed for amisulpride 800 mg/day because lack of response. He was discharged after 25 days. Six months later he has attenuated psychotic symptoms without news lesions in MRI. Glatiramer acetate has been started.
Results and conclusions
The most frequent disorder associated to multiple sclerosis is depression (prevalence of 20%). Psychosis is unusual, transient, sometimes as the onset relapse followed by remission. There's evidence of correlation between psychosis in multiple sclerosis and multiple lesions in temporal periventricular area. We suggest that in our case these two disorders are two separated entities since the enhanced lesion does not correpond with clinical findings.