ABSTRACT
ABSTRACT Objectives: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. Methods: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. Results: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). Conclusions: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.
RESUMEN Objetivos: El diagnóstico psiquiátrico se basa en las manifestaciones clínicas, consecuencia del estado interno del paciente, de su situación vivencial, de la evolución de su enfermedad y de la respuesta a nuestras intervenciones. Actualmente, existen pocos datos objetivos que ayudan a establecer el diagnóstico por lo que éste se basa en criterios diagnósticos como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM). La DSM define diagnósticos por su estabilidad, sin embargo, existen varias causas de variabilidad caracterizadas por Spritzer et al. (1987): variación en el sujeto (cambio en el paciente), variación ocasional (diferentes episodios), variación en la información (nueva información) y variación en la observación (diferentes interpretaciones). Este trabajo pretende evaluar la estabilidad diagnóstica de los pacientes con Trastornos Psicóticos reinternados en nuestro internamiento psiquiátrico. Métodos: Análisis retrospectivo de los diagnósticos de los pacientes con Trastornos Psicóticos con reingresos en nuestro servicio. Se analizaron datos de los últimos 12 anos - 5422 admisiones con 507 pacientes con diagnóstico de interés en ese período. Resultados: El diagnóstico psiquiátrico se altera con el tiempo, sin embargo, algunos grupos revelan una mayor estabilidad a lo largo del tiempo - Perturbación Afectiva Bipolar y Esquizofrenia con el 69% y el 77%, respectivamente. Los diagnósticos como la depresión psicótica y la psicosis tóxica, revelan una estabilidad significativamente menor (8% y 21% respectivamente). Conclusiones: Conocer nuestra realidad nos hace conscientes de que una mirada transversal a los enfermos puede ser insuficiente y sólo el tiempo puede determinar un diagnóstico claro. Este trabajo puede ayudarnos a entender cómo evolucionan las enfermedades psicóticas.
ABSTRACT
ABSTRACT Haloperidol decanoate is a first generation antipsychotic drug used to treat patients with schizophrenic disorder who require prolonged parenteral antipsychotic therapy. Cases of oral haloperidol decanoate are rare, and only one has been reported in foreign literature. In this report, we present a case of an oral ingestion of haloperidol decanoate of a male with schizophrenic disorder who presented to the emergency department following an oral ingestion of 1 ampoule of haloperidol decanoate 100 mg. At presentation he was hemodynamically stable. He was maintained on vigilance for 12 hours after what was discharged to the outpatient unit for psychiatric follow-up. The bioavailability and pharmacokinetic of oral intake of haloperidol decanoate are unknown. Although there is a report of treatment with oral activated charcoal in this case there was no need of intervention.
RESUMO O decanoato de haloperidol é um antipsicótico de primeira geração utilizado no tratamento de pacientes com esquizofrenia que requeiram tratamento antipsicótico parentérico prolongado. Casos de intoxicação oral com decanoato de haloperidol são raros, e apenas um foi reportado na literatura estrangeira. Neste artigo apresentamos o caso de ingestão oral de decanoato de haloperidol realizada por um homem com esquizofrenia que se apresentou no serviço de urgência após a ingestão oral de uma ampola de 100 mg de decanoato de haloperidol. À apresentação, evidenciava estabilidade hemodinâmica. Foi mantido em vigilância durante 12 horas, após as quais teve alta e foi orientado a realizar consulta externa com psiquiatria para seguimento. A biodisponibilidade e a farmacocinética da ingestão oral de decanoato de haloperidol sãp desconhecidas. Apesar de estar descrito o tratamento oral com carvão ativado, neste caso não houve necessidade de intervenção.