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Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.
The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.
Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.
Restricting Anorexia Nervosa (RAN, n = 21)
Binging-Purging Anorexia Nervosa (BPAN, n = 29)
Bulimia Nervosa (BN, n = 34)
Control (C, n = 52)
RAN, BPAN, BN > C
Checking subscale (MOCQ)
BPAN, BN > C
RAN, BPAN, BN > C
Harm avoidance (TCI-R)
BPAN, BN > C
Anticipatory worry vs optimism (TCI-R)
RAN, BPAN, BN > C
Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.
The aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.
The revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.
Diagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table).
BPAN, BN > C
RAN > C
C > RAN, BPAN, BN
In concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.
To compare the efficacy and safety of the intramuscular formulations of ziprasidone and haloperidol in treating agitation in schizophrenic patients attended in an emergency room.
Consecutive patients were alternatively assigned to receive 20 mg of IM ziprasidone or 10 mg of IM haloperidol. Efficacy measures were improvement in Behavioral Activity Rating Scale (BARS), in the sum of five items of the Positive and Negative Syndrome Scale that focused on agitation (PANSS-A) and scores on the Clinical Global Impression improvement scale (CGI-I), obtained 45 minutes and 2 hours after the IM medication. Tolerability assessments included changes in ECG, monitoring of vital signs and register of adverse events.
Finally 18 patients (13 men, mean age 40.8 ±10.2) were included in the analysis of data. At arrival in the emergency room, there were no differences between ziprasidone (Z) and haloperidol (H) groups in age, mean QTc length, mean BARS and mean PANSS-A scores. Analyzing the global sample there was an improvement in agitation scores. No significant differences were found between the groups in change of BARS and PANSS-A scores, in CGI-I scores or in the variation of the length of QTc interval at two hours. No serious adverse events were reported.
In spite of the small sample size, both treatments ziprasidone IM and haloperidol IM seems to be similarly effective for the management of psychotic agitation in the emergency room. Both were well tolerated. Lengthening of QTc interval due to ziprasidone IM had not been found in our sample.
Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.
We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).
115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.
61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.
Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).
Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.
The concurrence of psychoactive substance use and schizophrenia is important in its effect on therapeutic responses and patient prognosis. The prevalence of these disorders depends on the methodology used:retrospective studies and those in which drug consumption information was not collected in a structured way present a prevalence of disorders due to substance use between 3-22%.When this information is gathered systematically, the prevalence goes up to 30-50%. Between the variables that predict a high risk of disorders due to substance use we found: young adult male, first hospital admittance at a young age, greater frequency of hospital re-admittance, better previous social adaptation to the disease and higher frequency of violent and impulsive behaviour.We try to determine the association of sociodemographic variables and the prevalence of disorders due to substance use.
331 schizophrenic patients admitted to the Psychiatric Ward of Conxo Hospital.Among these subjects, determination was made of the existence of comorbid disorders due to substance use.A descriptive analysis was carried out based on categorical variables using SPSS.
23 patients presented comorbidity(7%).The overall sample of schizophrenic subjects consisted of 93% males, however, the subjects with comorbidity were 100% male.With respect to marital status, there were a greater proportion of single patients with comorbidity(95%).There was a higher proportion of institutionalized patients in the group with comorbidity and a lower level of education. The comorbid group included more subjects who were unemployed.
schizophrenic patients with comorbidity are single men with poor social capacity.It´s important that we collet the drug consumption information by structured way.
Auditory and musical hallucinations have been reported in patients as an adverse effect of the use of opioids. Hearing loss, old age, and female gender are considered risk factors in the development of musical hallucinations. The aim of this report is to describe a case of a patient with auditory and musical hallucinations and to discuss the role of an opioid –tramadol- in the origin of those.
An 80 years old woman experiencing auditory hallucinations was referred to our hospital from an emergency room. The patient had bilateral mild hearing loss and was receiving tramadol 112.5 mg/daily during the last year for cervical pain. In the last ten months, she had been gradually noticing the voice of her dead husband coming from under her pillow, as well as intermittently hearing popular songs being played inside her head. The patient had good insight on both types of abnormal perceptions, which were reported as increasingly unpleasant through time.
Tramadol was discontinued and pimocide (range 1-4 mg/day) and loracepam (2.5 mg/day) were introduced, achieving the improvement of the hallucinations and the anxiety associated with them.
The outcome of this case supports the hypotheses that Opioids could induce musical hallucinations. Hearing impairment, old age, and gender could be underlying risk factors on the development of musical hallucinations.
In 1916 Wimmer described psychogenic psychosis as a psychosis secondary to mental trauma.
Currently, psychogenic psychosis is included among acute and transient psychotic disorders (F23) in the ICD-10 and among the brief psychotic disorders (298.8) in the DSM IV-TR.
We review the case histories of patients diagnosed with psychogenic psychosis for the purpose of analysing the stability of the diagnosis and its current validity.
Material and methods:
The sample consisted of 15 patients admitted to the Psychiatric Department of the Conxo Hospital in Santiago de Compostela (Spain) with a diagnosis of psychogenic psychosis between 1998 and 2006. A descriptive analysis was made based on a series of socio-demographic and clinical variables. Afterward, in October 2006, patients were followed up in their respective mental health units to verify their current diagnosis and clinical status.
The sample included 14 women and 1 man with mean age of 33,7 years. The most frequent prior personality trait was histrionic (42%). Persecutory delusions (58%) and auditory hallucinations (46%) were the predominant psychotic symptoms. In the months after follow-up, the majority of patients maintained the diagnosis of psychogenic psychosis (73%), while 9% of patients were diagnosed with dysthymia, and 2 patients developed schizophrenia with deterioration.
The majority of patients in our sample diagnosed with psychogenic psychosis maintain a stable diagnosis over time and do not present deterioration.
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