Manejo farmacológico del episodio depresivo bipolar en adolescentes: actualización bibliográfica / Pharmacological management of bipolar depressive episode in adolescents: bibliographic update

El manejo farmacológico del episodio depresivo en contexto del trastorno bipolar constituye un desafío para el clínico tanto en psiquiatría adultos como infantoadolescente. El presente trabajo tiene por objetivo actualizar y sintetizar la evidencia disponible respecto al manejo farmacológico para la depresión bipolar en población pediátrica. Metodología: Se realizó una búsqueda de las publicaciones de los últimos 5 años en bases de datos. Resultados: La evidencia muestra como primera línea el uso de antipsicóticos de segunda generación por sobre los estabilizadores del ánimo en este grupo etario; demostrando lurasidona y lanzapina/fluoxetina eficacia similares. Lurasidona es una opción con mejor perfil de seguridad por asociarse a menos efectos adversos y mejor adherencia. El uso de antidepresivos debe considerarse dentro de los pasos iniciales del manejo, asociado a un antipsicótico de segunda generación. Conclusiones: Se destaca la importancia de la sospecha, evaluación y diagnóstico adecuado para guiar la decisión de manejo integral. A pesar de los riesgos y consideraciones existentes, es importante considerar el uso en primera línea de antipsicóticos de segunda generación y de antidepresivos en el manejo de un cuadro depresivo en contexto de la enfermedad bipolar. La escasez de estudios en el tratamiento farmacológico de la depresión bipolar en general y especialmente en población pediátrica limita la generalización y extrapolación de los resultados a la realidad local.

The pharmacological management of the depressive episode in the context of bipolar disorder constitutes a challenge for the clinician both in adult and child-adolescent population. The objective of this paper is to update and synthesize the available evidence regarding the pharmacological management of bipolar depression in the pediatric population. Methodology: A search of the publications of the last 5 years in databases was carried out. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy lurasidone and lanzapine/fluoxetine. Lurasidone is an option with a better safety profile as it is associated with fewer adverse effects and better adherence. The use of antidepressants should be considered within the initial steps of management, associated with a second generation antipsychotic. Conclusions: The importance of suspicion, evaluation and adequate diagnosis to guide the decision of comprehensive management is highlighted. Despite the existing risks and considerations, it is important to consider the first-line use of second-generation antipsychotics and antidepressants in the management of a depressive episode in the context of bipolar illness. The scarcity of studies on the pharmacological treatment of bipolar depression in general and especially in the pediatric population limits the generalization and extrapolation of the results to the local reality.

Delusional Jealousy: How Can Treatment be Improved? A Case Report / Delirio celotípico: ¿cómo se puede mejorar el tratamiento? Un reporte de caso

RESUMEN Introducción: Aunque el delirio celotípico represente solo cerca del 10% de los trastornos delirantes, se asocia un riesgo de violencia grave y suicidio. Con este caso clínico se pretende explorar las dificultades en el tratamento farmacológico del trastorno de delirio celotípico y resumir los hallazgos más recientes en el tratamiento de esta enfermedad. Métodos: Reporte de caso. Presentación del caso: Un varón de 76 anos tuvo un ingreso involuntario en el departamento de psiquiatría debido a amenazas de agresión física a su esposa en el contexto de ideas irreductibles de su infidelidad. Inicialmente se observó una mejoría de los síntomas con risperidona y su formulación inyectable de acción prolongada, pero la aparición de efectos secundarios hipotensivos requirió la prescripción off-label de palmitato de paliperidona 50 mg/ml. Conclusiones: Pocos estudios, principalmente reportes de casos, abordan el tratamiento específico del delirio celotípico. Dadas las consecuencias negativas para los pacientes y sus cónyuges, se necesita una mejor evidencia científica para el tratamiento de esta enfermedad.

ABSTRACT Introduction: Although delusional jealousy accounts for merely 10% of delusional disorders, it is associated to risk of serious violence and suicide. With this clinical case, we intend to explore the difficulties in the pharmacological approach of delusional jealousy disorder and to summarise the most recent findings in the treatment of this condition. Methods: Case report. Case presentation: A 76-year-old man involuntarily admitted to a psychiatric ward due to threats of physical aggression to his wife in the context of irreducible ideas of her infidelity. Initially, we observed an improvement of symptomatology with risperidone and its long-acting injectable formulation, but the emergence of hypotensive side effects required the off-label use of paliperidone palmitate 50 mg/ml. Conclusions: Few studies, mainly case reports, look at the specific treatment of delusional jealousy. Given the negative consequences for patients and for their spouses, better scientific evidence to treat this condition is needed.

Estudio de utilización de fármacos antipsicóticos en el hospital psiquiátrico Manuel Piti Fajardo de Manzanillo

Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo del tipo prescripción- indicación y estudio cuantitativo de consumo, con el objetivo de identificar los patrones de prescripción de antipsicóticos en pacientes con diagnóstico de esquizofrenia y trastornos relacionados hospitalizados en el Hospital Psiquiátrico Manuel Piti Fajardo de Manzanillo en el periodo comprendido de enero de 2013 a enero de 2015. Los datos se obtuvieron de las historias clínicas. La mayoría de los pacientes se encontraban en el rango de edad comprendido entre los 18 y 40 años de edad, del sexo femenino y soltero. Un mayor porcentaje tenía un tiempo de enfermedad mayor a cinco años, un tiempo de hospitalización mayor a un mes, y no tenía hospitalizaciones previas. El diagnóstico más frecuente fue el de esquizofrenia. Un pequeño grupo de pacientes presentó alguna comorbilidad psiquiátrica, como el trastorno depresivo. El antipsicótico más empleado, sea como monoterapia o en combinación con otro antipsicótico, fue clorpromazina. En general estos medicamentos fueron empleados dentro del rango terapéutico, con buena respuesta al tratamiento; las reacciones adversas medicamentosas que se presentaron fueron principalmente trastornos extrapiramidales y sedación; la asociación de antipsicóticos con depresores del sistema nervioso central fue la interacción medicamentosa potencial más frecuente.

An observational, descriptive, longitudinal and retrospective study of the prescription-indication type and quantitative study of consumption was carried out, with the aim of identifying the patterns of prescription of antipsychotics in patients with a diagnosis of schizophrenia and related disorders hospitalized at the Manuel Piti Fajardo Psychiatric Hospital of Manzanillo in the period from January 2013 to January 2015. The data were obtained from medical records. Most of the patients were in the 18 to 40 year age range, female, and single. A higher percentage had a time of illness greater than five years, a hospital stay greater than one month, and had no previous hospitalizations. The most frequent diagnosis was schizophrenia. A small group of patients presented some psychiatric comorbidity, such as depressive disorder. The most widely used antipsychotic, either as monotherapy or in combination with another antipsychotic, was chlorpromazine. In general, these drugs were used within the therapeutic range, with a good response to treatment; the adverse drug reactions that occurred were mainly extrapyramidal disorders and sedation; the association of antipsychotics with central nervous system depressants was the most frequent potential drug interaction.

Foi realizado um estudo observacional, descritivo, longitudinal e retrospectivo da prescrição-indicação e estudo quantitativo do consumo, como objetivo de identificar os padrões de prescrição de antipsicóticos em pacientes diagnosticados com esquizofrenia e transtornos relacionados internados no Hospital Psiquiátrico Manuel Piti Fajardo, em Manzanillo, no período de janeiro de 2013 a janeiro de 2015. Os dados foram obtidos a partir de prontuários. A maioria dos pacientes estavan afaixa etária entre 18 e 40 anos, do sexo feminino e solteiro. O percentual maior apresentou tempo de doença superior a cinco anos, tempo de internação superior a um mês, não com internações anteriores. O diagnóstico mais frequente foi a esquizofrenia. Um pequeno grupo de pacientes tinha alguma comorbidade psiquiátrica, como transtorno depressivo. O antipsicótico mais usado, seja como monoterapia ou em combinação com outro antipsicótico, foi a clororomazina. Em geral, esses fármacos foram utilizados dentro da faixa terapêutica, com boa resposta ao tratamento; as reações adversas de drogas que ocorreram foram principalmente distúrbios extrapiridais e sedação; a associação de antipsicóticos com depressores do sistema nervoso central foi a interação potencial mais frequente de drogas.

Síndrome neuroléptico maligno inducido por risperidona y facilitado por sepsis de origen urinario: clínica y fisiopatología / Malignant neuroleptic syndrome induced by risperidone and facilitated by sepsis of urinary origin: clinical aspects and physiopathology

La risperidona es un antagonista selectivo monoaminérgico, con una elevada afinidad por receptores dopaminérgicos, que puede producir síndrome neuroléptico maligno (SNM), considerado una emergencia médica con alto riesgo de muerte. Tiene una incidencia de hasta el 3% y su mortalidad está entre el 10 y 20%. Se reporta el caso de una paciente de 56 años, que reunía los criterios clínicos del SNM, inducido por el uso de risperidona y facilitado por una sepsis de origen urinario. El tratamiento se condujo con un agente agonista dopaminérgico y cambio del antipsicótico, procedimientos que resultaron en una adecuada evolución clínica. El SNM es una entidad de baja prevalencia, para la cual existen criterios diagnósticos con especificidad y sensibilidad mayor del 90%, por lo que debe diferenciarse claramente de otras patologías. Se discute el mecanismo mediante el cual la infección urinaria facilitaría la ocurrencia de esta enfermedad. El diagnóstico precoz mejora la respuesta al manejo adecuado que se establezca en cada caso.

Risperidone is a selective monoaminergic antagonist with a high affinity for dopamine receptors that can cause neuroleptic malignant syndrome (NMS), considered a life-threatening medical emergency. It has an incidence of up to 3% and its mortality is between 10 and 20%. The case of a 56-year-old female who met the clinical criteria of NMS, induced by the use of risperidone and facilitated by a sepsis of urinary origin, is reported. It was managed with a dopamine agonist and the change of antipsychotic, which resulted in a favorable clinical course. The NMS is a low-prevalence entity whose diagnosis has specificity and sensitivity greater than 90%, reason for which must be clearly differentiated from other pathologies. The mechanism by which urinary infection could facilitate the occurrence of this disease is discussed. Early diagnosis improves the response to an adequate management to be established in each case.

Efectos secundarios metabólicos de los antipsicóticos de segunda generación / Metabolic side effects of second-generation antipsychotics

Resumen: Los antipsicóticos se prescriben ampliamente para el tratamiento de un gran número de problemas neuropsiquiátricos. Los antipsicóticos se dividen en dos clases de acuerdo con su estructura química, los típicos o de primera generación y los atípicos o de segunda generación. Estos últimos tienen mayores beneficios que los primeros porque producen menos efectos secundarios extrapiramidales; sin embargo, diversos estudios efectuados en humanos y en animales han relacionado su administración con efectos secundarios metabólicos, como obesidad, aumento de peso, diabetes, dislipidemias, síndrome metabólico y resistencia a la insulina. Debido a estos efectos se han establecido guías clínicas para el control y la vigilancia de los pacientes con algún tratamiento con este tipo de fármacos. El objetivo de este artículo es revisar algunos efectos secundarios metabólicos producidos por los antipsicóticos de segunda generación, así como su posible mecanismo de acción y el seguimiento o control metabólico que los pacientes en tratamiento con estos fármacos deben llevar. La búsqueda de los artículos se realizaron en las bases de datos PubMed, EBSCOHOST, DynaMed e IntraMed.

Abstract: Antipsychotics are widely prescribed to treat a large number of neuropsychiatric problems. Antipsychotics are divided in two classes according to their chemical structure, typical or first generation and the atypical or second generation. The second-generation antipsychotics have greater benefits because they produce less extrapyramidal side effects; however, several studies in both humans and animals have related their administration to metabolic side effects, such as obesity, weight gain, diabetes, dyslipidemia, metabolic syndrome and insulin resistance. Because of the effects, clinical guidelines for the control and monitoring of patients with a treatment with these drugs have been established. The aim of this paper is to review some metabolic side effects produced by the second-generation antipsychotics and its possible mechanism of action, as well as the metabolic control or monitoring that patients treated with these drugs should have. The research of the articles was made in the databases: PubMed, EBSCOHOST, DynaMed and IntraMed.

What happens after an oral ingestion of haloperidol decanoate? - A case report / O que ocorre após a ingestão oral de decanoato de haloperidol? - Um caso clínico

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.

Evaluación de síndrome metabólico en varones hospitalizados en Unidad de Corta Estadía Psiquiátrica Marzo 2017 / Evaluation of metabolic syndrome in Hospitalized Men in the Short Stay Psychiatric Unit. March 2017

El síndrome metabólico (SM) corresponde a un conjunto de factores de riesgo derivados de la obesidad visceral e insulinoresistencia. 35.3% de la población adulta chilena presentó SM en el período 2009 - 2010, con diferencia significativa entre hombres y mujeres (41.6% vs 30.9%, respectivamente). En Estados Unidos se ha calculado que la media de años potencialmente perdidos en pacientes con enfermedades mentales va de 25 a 30, comparada con la población general. La principal causa de muerte es la enfermedad coronaria. La mayoría de los pacientes en tratamiento neuroléptico en hospitales psiquiátricos no reciben control de factores de riesgo metabólicos. La evidencia señala que los pacientes esquizofrénicos no son adecuadamente pesquisados ni tratados por Dislipidemia (hasta un 88% de estos pacientes siguen sin tratamiento) ni por hipertensión (hasta un 62%). El objetivo de este trabajo es evaluar factores de riesgo cardiovascular en varones hospitalizados en unidad de corta estadía psiquiátrica del Instituto Psiquiátrico Dr. José Horwitz Barak. Se evaluó a 35 pacientes varones, de los cuales un 37% presentó SM, un 45.3% presentó sobrepeso.

The metabolic syndrome (MS) corresponds to a set of risk factors derived from visceral obesity and insulin resistance. 35.3% of the Chilean adult population had MS in the 2009-2010 period, with a significant difference between men and women (41.6% vs 30.9%, respectively). In the United States, it has been estimated that the average number of years potentially lost in patients with mental illness ranges from 25 to 30, compared with the general population. The main cause of death is coronary heart disease. Most patients on neuroleptic treatment in psychiatric hospitals do not receive control of metabolic risk factors. The evidence indicates that schizophrenic patients are not adequately researched or treated for dyslipidemia (up to 88% of these patients remain untreated) or hypertension (up to 62%). OBJECTIVE: To evaluate cardiovascular risk factors in hospitalized men in a short stay psychiatric unit of the Psychiatric Institute Dr. José Horwitz Barak. Thirty-five male patients were evaluated, of which 37% had MS, and 45.3% were overweight.

Post-stroke psychosis: how long should we treat? / Psicose após acidente vascular cerebral: até quando devemos tratar?

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Resumo Objetivo: Descrever o caso raro de um paciente que desenvolveu sintomas psicóticos após um acidente vascular cerebral (AVC) no nível do hemisfério direito que remitiram com tratamento antipsicótico, mas parece precisar de uma terapêutica de manutenção com antipsicótico em baixa dosagem. Descrição de caso: Um homem de 65 anos apresentou-se no serviço de urgência psiquiátrica por um quadro persistente de delírio de ciúmes, ilusões visuais e agitação com início cerca de 1 mês após AVC isquêmico no nível da artéria cerebral posterior direita. Esses sintomas só desapareceram com doses terapêuticas de antipsicótico (risperidona 3 mg/dia). Após 2 anos de seguimento, o paciente não mais apresentava atividade delirante, e o tratamento antipsicótico foi progressivamente descontinuado durante o ano seguinte. No entanto, 1 semana após a suspensão total, o paciente começou a ficar agitado e desconfiado, tendo-se reiniciado a risperidona 0,25 mg/dia, com rápida remissão clínica. O paciente está medicado com esta baixa dose de antipsicótico há um ano, permanecendo psicopatologicamente compensado e sem sintomas psicóticos. Comentários: A psicose é uma complicação relativamente rara após AVC. Segundo nosso conhecimento, não há casos descritos até ao momento de psicose após AVC que, aparentemente, requerem uma dose baixa contínua de antipsicótico. Nosso caso sugere que uma terapêutica de manutenção com antipsicótico em baixa dosagem pode ser necessária para determinados pacientes com psicose após AVC, especialmente para aqueles com fatores de risco e início não agudo dos sintomas.

Antipsicóticos y suicidio / Antipsychotics and suicide

La relación entre antipsicóticos y suicidio es controversial debido a las diferencias expuestas en la literatura acerca de su acción específica. Uno de los puntos de discusión ha sido el aumento de la sintomatología depresiva y el impacto de algunos efectos secundarios sobre la suicidalidad, principalmente acinesia, acatisia y disquinesia tardía. Otro elemento controvertido es el efecto paradójico producto de la aminoración de los síntomas positivos al incrementar paralelamente la instrospección. Se revisará críticamente la principal evidencia disponible en torno al uso de antipsicóticos en relación al suicidio en el contexto de trastornos psicóticos y afectivos. No existe evidencia directa que avale una disminución en las tasas de suicidio con el uso de antipsicóticos de primera generación en trastornos psicóticos, probablemente por fallas metodológicas y por la multifactorialidad del fenómeno. En relación a los de segunda generación, podrían participar como protectores frente al riesgo suicida. En los trastornos esquizofrénicos se ha considerado a la clozapina como un fármaco antisuicida, debido a una acción antidepresiva directa y un efecto indirecto mediado por un mejoramiento en las funciones cognitivas. El mayor uso de antipsicóticos en los trastornos afectivos se observa en el espectro bipolar, sin reportarse mayor efectividad en el manejo del suicidio al compararse con estabilizadores del ánimo. Es crucial identificar el mecanismo de acción específico de los antipsicóticos para evaluar su real efecto sobre la suicidalidad.

The opinions about the relationship between antipsychotics and suicide are controversial due to differences on reported evidence about their specific action. One ofthe most discussed topics is the increase of depressive symptomatology and the impact of some secondary effects on suicidality, mainly akinesia, akathisia and tardive diskynesia. Another polemical topic is the paradoxical effect due to the decrease ofpositive symptoms when increasing insight. We performed a critical review of the available literature concerning to the use of antipsychotics in relation to suicide in the context of psychotic and affective disorders. When appraising psychotic disorders, there was no direct evidence to support a reduction in suicide rates when using first-generation antipsychotics, probably due to methodological issues and multifactoriality ofthe phenomenon. Nevertheless, second-generation antipsychotics could be protective against suicide risk, specifically clozapine, which is considered as an antisuicidal drug on schizophrenic disorders due to a direct antidepressant action and an indirect effect mediated by an improvement in cognitive functions. On the other hand, when appraising affective disorders, bipolar spectrum has demonstrated the greatest use of antipsychotics drugs, showing effectiveness in the management ofsuicide not greater than mood stabilizers. It becomes essential to identify the specific mechanism of action of antipsychotic drugs to assess their real effect on suicidality.

Incremento del glutamato en el estriado de asociación en esquizofrenia. Resultados preliminares de un estudio longitudinal con espectroscopia con resonancia magnética / Glutamate increase in the associative striatum in schizophrenia: a longitudinal magnetic resonance spectroscopy preliminary study

Objetivo: Comparar los niveles de glutamato en el núcleo caudado dorsal, región rica en dopamina, y el cerebelo, región pobre en dopamina, en pacientes con esquizofrenia, durante un episodio psicótico agudo, después de recibir tratamiento antidopaminérgico (risperidona) y en controles sanos. Métodos: Se incluyeron 14 pacientes con esquizofrenia aguda sin tratamiento y 14 controles sanos. A los pacientes se les realizaron dos estudios de espectroscopia por resonancia magnética de protones (ERM1H). El primero antes de tratamiento y el segundo a las seis semanas de tratamiento efectivo. Los controles fueron evaluados en una ocasión. Los niveles de glutamato fueron normalizados con la concentración de creatina. Resultados: Los niveles de glutamato/creatina fueron mayores en el caudado dorsal de los pacientes previo a tratamiento (t=-2.16, p=0.03) y después del tratamiento en comparación con los controles (t=2.12, p=0.04). Los niveles de glutamato en el cerebelo no cambiaron con el tratamiento y fueron iguales a los controles. Conclusiones: Nuestros resultados indican que el incremento delglutamato en el caudado dorsal se encuentra en relación con la enfermedad y no cambia después de seis semanas de tratamiento antipsicótico efectivo. Más aún, la ausencia de diferencias en el cerebelo sugiere que el incremento del glutamato presente en la esquizofrenia se podría relacionar a regiones con abundante inervación dopaminérgica.

OBJECTIVE: To compare glutamate levels (Glu) found in the dorsal-caudate nucleus (a dopamine rich region) and in the cerebellum (a low dopamine region) among: 1) schizophrenia patients undergoing an acute psychotic episode, 2) after receiving antidopaminergic treatment (Risperidone), and 3) healthy controls. METHODS: Fourteen drug-free patients with schizophrenia and fourteen healthy controls were included. Patients underwent two proton magnetic resonance spectroscopy (1H-MRS) studies, one prior to treatment and the second after 6-weeks of daily Risperidone treatment. Controls underwent one 1H-MRS study. Glutamate levels were normalized according to the relative concentration of Creatine (Cr). RESULTS: The dorsal-caudate nucleus among schizophrenia patients showed higher levels of Glu/Cr during the drug-free condition (t = -2.16, p = 0.03) and after antipsychotic treatment (t = 2.12, p = 0.04) compared with controls. No difference was observed in the cerebellum between the drug-free, post-treatment and controls conditions. CONCLUSIONS: Our results suggest that the Glu increase observed in the dorsal-caudate in schizophrenia is illness-mediated and does not change after 6-weeks of antipsychotic treatment. Moreover, the lack of change detected in the cerebellum suggests that the Glu increase in schizophrenia is not ubiquitous within the brain and that may be associated with dopamine target regions.

Avaliação de aspectos cognitivos em homens portadores de esquizofrenia em tratamento com haloperidol ou clozapina / Cognitive aspects evaluation of schizophrenic men under haloperidol or clozapine treatment

OBJETIVO: Avaliar, sob o ponto de vista psicológico, aspectos cognitivos de pacientes portadores de esquizofrenia associados ao tipo de medicamento antipsicótico em uso. MÉTODOS: Participaram dois grupos: no grupo 1 os pacientes em tratamento com haloperidol (n = 14) e no 2 aqueles em tratamento com clozapina (n = 16). Ambos os grupos eram formados por indivíduos com esquizofrenia em tratamento psiquiátrico ambulatorial no Hospital de Clínicas de Porto Alegre (HCPA), cuja faixa etária variou entre 18 e 59 anos. Foram usados como instrumentos o Operational Checklist for Psychotic Illness (OPCRIT) para definição do diagnóstico de esquizofrenia e a técnica de Rorschach. Também se realizou a análise de variância (ANOVA) seguida do teste de Bonferroni, com nível de significância de p < 0,05 sobre os dados do teste de Rorschach. RESULTADOS: O grupo 1 apresentou F+ < 80 por cento; FK < KF + K; FC < CF + C. O grupo 2 apresentou F+ > 80 por cento; FK = KF + K; FC > CF + C. Ambos os grupos apresentaram escore de forma (sigmaF) na faixa clínica considerada normal. CONCLUSÃO: Os resultados do Rorschach permitem inferir que os pacientes medicados com clozapina apresentam indicativos de capacidade de produção e adaptação à tarefa, controle pelo uso da inteligência sobre impulsos e instintos, capacidade para suportar frustração e funcionamento do raciocínio lógico em melhores condições do que os pacientes medicados com haloperidol.

OBJECTIVE: Evaluate from a psychological point of view cognitive aspects of schizophrenic patients, associated with the antipsychotic medicine type taken. METHODS: The study analyzed three groups: group 1 patients medicated with haloperidol (n = 14); group 2 - patients medicated with clozapine (n =16). Groups 1 and 2 were schizophrenic men under psychiatric treatment at Hospital de Clínicas de Porto Alegre (HCPA). The age of all subjects ranged from 18 to 59 years. The following tools were used in the study: the Operational Checklist for Psychotic Illness (OPCRIT) to diagnose schizophrenia, and the Rorschach technique. The Rorschach data was subject to a variance analysis (ANOVA) followed by a Bonferroni test with a confidence interval of p < 0.05. RESULTS: Group 1 presented F+ < 80 percent; FK < KF + K; FC < CF + C. Group 2 presented F+ > 80 percent; FK = KF + K; FC > CF + C. Both groups presented sigmaF within the clinical range considered normal. CONCLUSION: The results show that patients medicated with clozapine present a relative capacity to participate on activities and tasks. Besides, they can control impulses and instincts by intellectual means in a superior fashion than patients medicated with haloperidol. Finally, it was also concluded that clozapine users present a greater ability to tolerate frustration, and a better general intellectual performance than haloperidol users.