Interpretación psiquiátrica forense de la fórmula de inimputabilidad del nuevo Código Penal cubano de 2022 / Psychiatric forensic interpretation of non-imputability formula in the new 2022 Cuban Penal Code

Resumen: En 2022 el Código Penal cubano incorporó una nueva fórmula de inimputabilidad. Este artículo aborda el problema de cómo interpretarla y aplicarla durante las pericias psiquiátricas a imputados. Es su objetivo analizar desde la Psiquiatría dicha fórmula penal para su interpretación forense. Se muestran las críticas que, en publicaciones y ámbitos académicos, fueron hechas a la anterior fórmula; así como la norma complementaria del organismo rector para su interpretación pericial. Se expone y analiza la actual fórmula, elaborada con asesoría de psiquiatras al proceso legislativo, para superar aquellas críticas, pero que, precisamente por diferente, demanda actualizar su interpretación y los métodos periciales para calificar casos acertadamente, detectar simulación y ser controlable como prueba por los jueces. Un criterio de interpretación fue elaborado por el autor y se le sometió a grupos de expertos para consensuar una propuesta final normativa, consistente en considerar pericialmente pretenso inimputable a quién actuó ilícitamente por un trastorno psicótico diagnosticado que se manifestó directamente en el delito, lo que debe quedar demostrado en el informe. En su generalidad, estos criterios pueden aplicarse a valoración de inimputabilidad según otros códigos penales.

Introduction: In 2022 a new Cuban Penal Code incorporated a new requirement of non-imputability. This article approaches to the problem of how to interpret and apply this new non-imputability formula to the psychiatric examination of defendants and has the objective of analyzing it in forensic interpretation. It shows the academic and publisher's criticism made of the previous Cuban non-imputability formula and the complementary precept of the health ministry for forensic interpretation. The new non-imputability formula, elaborated with psychiatrists' assistance during a legislative process to surpass those previous criticisms, is exposed and analyzed. This new different penal requirement put under obligation to change in forensic interpretations and methods to identify criminal non-imputability, pretenders and to be a clue controlled by judges. A new forensic interpretation criterion was elaborated and submitted to groups of psychiatrist experts, to obtain a normative proposition that considered in possible non-imputability of the person who committed the crime during a diagnosed psychotic disorder that was the certain direct determinant of the fact. The psychiatric report may show all mentioned below and, in general view, according to other penal codes, these criteria can be applied in the forensic expertise relative to non-imputability.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Análisis de alteraciones del discurso en estados mentales de alto riesgo de psicosis (EMAR): una revisión sistemática / Speech disturbances analysis in ultra-high risk of psychosis (UHR): a systematic review

INTRODUCCIÓN: La necesidad de intervenir precozmente en la psicosis ha llevado a la búsqueda de biomarcadores útiles en su predicción, donde el análisis del lenguaje hablado destaca por su fácil obtención y bajo coste económico. En esta revisión sistemática se analizan las principales alteraciones del lenguaje en pacientes con riesgo ultra alto de psicosis (UHR), evaluando su prevalencia y su relación con la transición a la psicosis. MÉTODOS: Se realizó una búsqueda en las bases de datos PubMed y Embase de estudios en inglés o español, así como en las listas de referencias de los artículos encontrados. RESULTADOS: De 140 artículos identificados, se incluyeron 15. Las variables del lenguaje analizadas fueron Cohesión Lingüística, Coherencia Semántica, Complejidad Sintáctica, Producción Metafórica, Prosodia Emocional y Trastorno del Pensamiento Formal (TFP). La prevalencia encontrada osciló entre el 21% y el 85% para las alteraciones incluidas en el TFP, sin que se hayan encontrado medidas de prevalencia para el resto de las variables. La precisión global para la transición de RH a psicosis osciló entre el 70% y el 100% en todos los estudios. CONCLUSIONES: Existe un amplio abanico de alteraciones del habla en los pacientes con RHU, donde la PTF es la más estudiada. La prevalencia de estas alteraciones parece ser alta, especialmente en lo que respecta a la PTF. El análisis de esas alteraciones del habla en pacientes con RHU aparece como una excelente herramienta para predecir la transición a la psicosis, particularmente a través de la transcripción de entrevistas y el uso de la Inteligencia Artificial.

INTRODUCTION: The need for early intervention in psychosis has led to the search for useful biomarkers in its prediction, where the analysis of spoken language stands out for its easy obtaining and low economic cost. In this systematic review, we analyze the main speech disturbances in patients at ultra-high risk for psychosis (UHR), evaluating their prevalence and their relationship with transition to psychosis. METHODS: A search was carried out in PubMed and Embase databases for studies in English or Spanish, as well as the reference lists of the articles found. RESULTS: Of 140 articles identified, 15 were included. The variables of the language analyzed were Linguistic Cohesion, Semantic Coherence, Syntactic Complexity, Metaphorical Production, Emotional Prosody and Formal Thought Disorder (TFP). The prevalence found ranged between 21% and 85% for disturbances included within the TFP, with no prevalence measures for the rest of the variables. The global accuracy for UHR transition to psychosis ranged from 70% to 100% across studies. CONCLUSION: There is a wide range of speech disorders in UHR patients, where the TFP is the most studied one. The prevalence of these alterations seems to be high, especially with regard to TFP. The analysis of those speech alterations in UHR patients appears as an excellent tool to predict transition to psychosis, particularly through interview transcription and the use of Artificial Intelligence.

Influence of migration on the thought process of individuals at ultra-high risk for psychosis

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student's t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.

Encefalitis límbica: clínica, patogenia y problemas diagnósticos / Limbic encephalitis: clinic, pathogenesis and diagnostic problems

La encefalitis límbica es una enfermedad infrecuente y potencialmente grave, que puede o no ser paraneoplásica y se caracteriza por déficit de la memoria reciente, alteraciones psiquiátricas y convulsiones. De origen autoinmunitario, está asociada a anticuerpos séricos e intratecales contra antígenos neuronales intracelulares y de superficie, con especial afectación de zonas límbicas. En este artículo se revisan aspectos históricos y epidemiológicos, patogenia, síndromes más frecuentes y mejor delimitados, histopatología y estudios complementarios. Se repasan también las dificultades del diagnóstico diferencial y la necesidad de descartar siempre un tumor subyacente. La detección de autoanticuerpos neuronales es importante para el diagnóstico, la planificación terapéutica y el pronóstico. La inmunoterapia y, si corresponde, el tratamiento de la neoplasia son cruciales para lograr una recuperación neurológica sustancial. La encefalitis límbica es una entidad probablemente subdiagnosticada, con un pronóstico más favorable si se trata de forma temprana. El actual conocimiento de su patogenia puede además aportar claridad para la mejor comprensión de otros síndromes neurológicos y psiquiátricos que puedan compartir mecanismos autoinmunitarios, como algunos trastornos psicóticos y epilepsias farmacorresistentes. (AU)

Limbic encephalitis is a rare and potentially serious disease, which may or may not be paraneoplastic and is characterized by recent memory deficits, psychiatric disturbances and seizures. Of autoimmune origin, it is associated with serum and intrathecal antibodies against intracellular and surface neuronal antigens, with special involvement of limbic areas. This article reviews historical and epidemiological aspects, pathogenesis, more frequent and better defined syndromes, histopathology and complementary studies. The difficulties of differential diagnosis and the need to always rule out an underlying tumor are also reviewed. Detection of neuronal autoantibodies is important for diagnosis, therapeutic planning and prognosis. Immunotherapy and, if appropriate, neoplasm treatment, are crucial to achieve substantial neurological recovery. Limbic encephalitis is probably an underdiagnosed entity, with a more favorable prognosis if treated early. The current knowledge of its pathogenesis may also provide clarity for a better understanding of other neurological and psychiatric syndromes that may share autoimmune mechanisms, such as some psychotic disorders and drug-resistant epilepsies. (AU)

Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation

Objective: Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique). Methods: Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded. Results: Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value. Conclusion: Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand.

Validation of the Portuguese version of the Community Assessment of Psychic Experiences and characterization of psychotic experiences in a Brazilian sample

Objective: We investigated: i) the reliability and validity of a Brazilian version of the Community Assessment of Psychic Experiences (CAPE), developed to detect and characterize psychotic experiences in the general population; and ii) the association between psychotic experiences, childhood adversity, and cannabis use in a population-based sample. Methods: We performed factorial analyses and generalized linear models with CAPE scores as the dependent variable in a sample composed of 217 first-episode psychosis patients, 104 unaffected biological siblings, and 319 non-psychotic population-based participants. Results: After removing seven items from its positive dimension and two items from its negative dimension, a 33-item Brazilian version of the CAPE showed acceptable adjustment indices (confirmatory fit index = 0.895; goodness of fit index = 0.822; parsimony goodness of fit index = 0.761; root mean square error of approximation [RMSEA] = 0.055, p [RMSEA ≤ 0.05] = 0.04) and internal consistency in all its dimensions (> 0.70). Childhood adversity was associated with higher scores in all three dimensions, as well as with total score. Lifetime cannabis use was associated with higher scores only in the positive dimension. Conclusion: The proposed Brazilian version of the CAPE corroborates the tridimensional approach for assessing psychosis-proneness, and the frequency and severity of psychotic manifestations are distributed as a spectrum in the general population.

Trombosis senovenosa cerebral en un recién nacido con mutación MTHFR C677T tratado con enoxaparina / Cerebral sinovenous thrombosis in a newborn with mutation of MTHFR C677T treated with enoxaparin

Resumen: Introducción: La trombosis senovenosa cerebral neonatal (TSVC), es una patología rara y generalmente grave, de la cual se conoce poco sobre los mecanismos fisiopatológicos responsables y, aunque controvertido, se ha sugerido que la trombofilia genética, puede desempeñar un rol en la patogénesis. Debido a los temores de un sangrado intracraneal el tratamiento anticoagulante con heparina de bajo peso mole cular es controvertido. Objetivo: presentar un recién nacido con una trombosis senovenosa cerebral neonatal, discutir los factores de riesgo trombofílico, y el manejo con heparina de bajo peso molecu lar de la trombosis venosa cerebral. Caso Clínico: Recién nacido de término que debutó a los 8 días de vida con convulsiones clónicas, rechazo al pecho más hipoactividad motora. La neuroimagen con RM mostró una TSVC involucrando múltiples senos venosos, un infarto hemorrágico talámico dere cho y congestión venosa de la sustancia blanca frontal. El estudio de trombofilia puso de relieve una mutación homocigota del gen MTHFR C677T. El tratamiento con heparina de bajo peso molecular se asoció a repermeabilización del seno sagital superior a los 23 días de iniciada la terapia. Conclusio nes: La presentación clínica de la TSVC en el neonato es inespecífica, probablemente en relación con la extensión y gravedad de la lesión y el desarrollo de complicaciones asociadas, como infartos he morrágicos venosos intraparenquimatosos o hemorragia intraventricular. Estas complicaciones son detectables mediante Ecografia o Resonancia Magnética, y deben hacer sospechar una TSVC. En esta experiencia el tratamiento anticoagulante mostró ser seguro y prevenir la extensión de la trombosis.

Abstract: Introduction: Neonatal cerebral sinovenous thrombosis (CSNT) is a rare and generally serious con dition about which there is little knowledge of the responsible pathophysiological mechanisms and, although controversial, it has been suggested that genetic thrombophilia may play a role in its patho genesis. Out of concern for intracranial bleeding, the anticoagulant treatment with low-molecular- weight heparin is controversial. Objective: To present a case of a newborn with neonatal CSNT, to analyze the thrombophilic risk factors, and the management of cerebral venous thrombosis with low-molecular-weight heparin. Clinical Case: Full-term newborn who presented at eight days of life breastfeeding rejection, clonic seizures, and locomotor hypoactivity. The MRI neuroimaging showed a CSNT involving multiple venous sinuses, a right thalamic hemorrhagic infarction, and venous congestion in frontal white matter. Thrombophilia study highlighted a homozygous MTHFR C677T mutation. Treatment with low-molecular-weight heparin was associated with repermeabilization of the superior sagittal sinus after 23 days of starting therapy. Conclusions: The clinical presentation of CSNT in the neonate is nonspecific, probably related to the extent and severity of the injury and the development of associated complications, such as venous hemorrhagic infarctions and intraparenchymal or intraventricular hemorrhage. These complications are detected through ultrasound or MRI, and they should make us suspect a CSNT. In this experience, the anticoagulant treatment proved to be safe and prevents thrombus propagation.

Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode

Objective: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. Methods: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). Results: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. Conclusion: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.

Schneider's first-rank symptoms as predictors of remission in antipsychotic-naive first-episode psychosis

Objective: German psychiatrist Kurt Schneider proposed the concept of first-rank symptoms (FRS) of schizophrenia in 1959. However, their relevance for diagnosis and prediction of treatment response are still unclear. Most studies have investigated FRS in chronic or medicated patients. The present study sought to evaluate whether FRS predict remission, response, or improvement in functionality in antipsychotic-naive first-episode psychosis. Methods: Follow-up study of 100 patients at first episode of psychosis (FEP), with no previous treatment, assessed at baseline and after 2 months of treatment. The participants were evaluated with the standardized Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) and for presence of FRS. Results: Logistic regression analysis showed that, in this sample, up to three individual FRS predicted remission: voices arguing, voices commenting on one's actions, and thought broadcasting. Conclusion: Specific FRS may predict remission after treatment in FEP patients. This finding could give new importance to Kurt Schneider's classic work by contributing to future updates of diagnostic protocols and improving estimation of prognosis.

Vicissitudes do debate etiológico sobre o autismo: leituras a partir da psicanálise lacaniana / Vicissitudes of the etiological debate on autism: readings from the Lacanian psychoanalysis / Vicissitudes del debate etiológico sobre el autismo: lecturas a partir del psicoanálisis lacaniano

Este artigo teve como objetivo estabelecer uma discussão sobre diferentes modos de compreender a etiologia do autismo dentro do campo da psicanálise lacaniana, um deles que circunscreve o autismo enquanto psicose e o outro que o compreende como uma nova estrutura nosográfica. Para tanto, foi preciso retornar às elaborações de Jacques Lacan sobre a constituição do sujeito para que fosse possível refletir sobre os percursos teóricos dos autores identificando convergências, como a perseguição que o sujeito autista vive em relação aos signos da presença do Outro, e de que ordem são as divergências sobre a etiologia do autismo, se puramente políticas ou se possuem relevância clínica e epistêmica. A partir de proposições lacanianas como o estádio do espelho e os processos de alienação e separação, foi possível desenvolver a questão da entrada - forçada - do sujeito na linguagem e identificar a dimensão real do gozo que pode contribuir com a discussão clínica sobre a complexidade da aquisição da linguagem no sujeito autista.

This article aimed to establish a discussion about different ways of understan-ding the etiology of autism within the field of Lacanian psychoanalysis, one of which circumscribes autism to the realm of psychosis and the other that understands it as a new nosographic structure. In order to do so, it was neces-sary to return to Jacques Lacan's elaborations on the constitution of the subject so that it would be possible to reflect on the theoretical paths of the authors, identifying convergences, such as the persecution that the autistic subject expe-riences in relation to the signs of the presence of the Other, and of what order are the divergences about the etiology of autism, whether purely political or if they have clinical and epistemological relevance. From Lacanian propositions such as the mirror stage and the processes of alienation and separation, it was possible to develop the issue of the forced entry of the subject into language and to identify the real dimension of jouissance that may contribute to the clinical discussion on the complexity of the language acquisition in the autistic subject.

Este artículo tuvo como objetivo establecer una discusión sobre diferentes modos de comprender la etiología del autismo dentro del campo del psicoaná-lisis lacaniano, uno de ellos circunscribe el autismo como psicosis, y el otra lo comprende como una nueva estructura nosográfica. Por lo tanto, fue necesario retomar a las elaboraciones de Jacques Lacan sobre la constitución del sujeto para que fuera posible reflexionar sobre los recorridos teóricos de los autores, identificando convergencias, como la persecución que el sujeto autista vive en relación a los signos de la presencia del Otro, y de que orden son las diver-gencias sobre la etiología del autismo, si son simplemente políticas o si tienen relevancia clínica y epistémica. A partir de proposiciones lacanianas como el estadio del espejo y los procesos de alienación y separación, fue posible desar-rollar la cuestión de la entrada ­ forzada ­ del sujeto en el lenguaje y identificar la dimensión de lo real del goce, que puede contribuir con la discusión clínica acerca de la complejidad de la adquisición del lenguaje en el sujeto autista.

Síndromes psicóticos / Psychotic syndromes: clinical case summary

Paciente de 47 años, casada, con 3 hijos. Antecedentes de patología psiquiátrica en madre y hermano. Sin antecedentes psiquiátricos previos. Ingresa hace 4 años al Servicio. Con síntomas polimorfos, varios diagnósticos desde el ingreso, pero con respuesta al tratamiento y con periodos de estabilidad psicopatológica demás de un año. Conocida en varios dispositivos del servicio. Diagnósticos: Trastorno Delirante, Obs. Trastorno Afectivo Bipolar, Trastorno Esquizoafectivo

Patient 47 years old, married, with 3 children. History of psychiatric pathology in mother and brother. No previous psychiatric history. Enter the Service 4 years ago. With polymorphic symptoms, several diagnoses from admission, but with response to treatment and with periods of psychopathological stability over a year. Known in several service devices. Diagnoses: Delusional Disorder, Obs. Bipolar Affective Disorder, Schizoaffective Disorder

Comorbid addictive behaviors in disordered gamblers with psychosis

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors - specifically food bingeing - in this population may be warranted.

A psychotic experience during adolescence: reasoning about differential diagnosis. case report

ABSTRACT CONTEXT: The aim of the present clinical review was to illustrate the diagnostic difficulty associated with psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying during this period. It was also intended to illustrate the observation that not all hallucinations occur in the context of a declared psychotic disorder. Case Report: The patient was a 16-year-old adolescent girl who came to the Emergency Department of Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the International Classification of Diseases, 10th edition. CONCLUSIONS: Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpatient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient's conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.

Parte III: las locuras histéricas / Part III: the hysterical follies

Caso Clínico Paciente María R.A., 28 años, Escolaridad básica en programa diferencial, dueña de casa, Casada, 9 años de matrimonio. Su pareja tiene 62 años. Actualmente vive con esposo e hijo de 2 años, en Maipú. Durante 2016, María consultó en distintos servicios de urgencia, recibiendo distintos diagnósticos: Conversión, Síndrome conversivo. Se ingresa en Urgencia con diagnóstico: Síndrome Psicótico lúcido. Paciente en cama, sin movimientos espontáneos, con rigidez, mirada fija, deshidratada, no acepta alimentarse, negativista, no establece contacto visual, no responde preguntas simples, sin embargo, en forma espontánea puede permanecer hablando, dando cuenta de contenidos delirantes. El día de su ingreso a sector se inició terapia Electro convulsiva, y completó 5 sesiones. Tras la primera sesión paciente evoluciona favorablemente, se levanta de la cama, solicita agua, es capaz de comer. Síntomas psicóticos ceden tras la tercera sesión, señalando además no recordar nada de lo ocurrido. En entrevista de evolución paciente vigil, orientada TE, actitud parcialmente cooperadora. En cuanto a las psicosis histéricas en sí, es una psicosis aguda, de rápida curación cuando se las trata adecuadamente y Bleuler habla de los llamados estados crepusculares histéricos. La duda diagnóstica es entre un trastorno disociativo tipo psicosis histérica o bien un trastorno psicótico agudo, refiriéndose a trastornos de presunto origen disociativo con sintomatología que podríamos denominar pseudopsicótica. La CIE-10 clasifica las psicosis agudas no afectivas, como Trastornos psicóticos agudos y transitorios (TPAT), (Acute and Transient Psychotic Disorders (ATPD) en inglés), comparten las características comunes de inicio agudo dentro de dos semanas, y la presencia de síntomas psicóticos típicos. La descripción de TPAT fue influenciada por los conceptos de psicosis cicloide, bouffée délirante y psicosis reactiva. No es sorprendente, por lo tanto, que los ATPD de la CIE-10 (al menos diagnósticamente) sean un heterogéneo grupo de trastornos. Tanto los sistemas CIE como DSM se basan en síntomas, y descuentan los aspectos "no empíricos" del diagnóstico, que pueden constituir el «fenómeno" esencia de un trastorno psicótico. Actualmente, no existe una categoría de diagnóstico para definir individuos que están experimentando tal psicopatología y tienen un riesgo significativamente mayor de desarrollar esquizofrenia u otro desorden psicótico. Trastorno histriónico de la personalidad (HPD), como argumento aquí, no es una patología mental real; más bien, "histriónico" se refiere a un rasgo o grupo de rasgos de personalidad que podría conducir a algún otro trastorno mental.

Clinical case. Patient María R.A., 28 years old, Basic schooling in differential program, housewife, Married, 9 years of marriage. His partner is 62 years old. Currently lives with husband and 2 year old son in Maipú. During 2016, Maria consulted in different emergency services, receiving different diagnoses: Conversion and conversion syndrome. Urgency is entered with diagnosis: Syndrome Psychotic lucid. Patient in bed, without spontaneous movements, with rigidity, stare, dehydrated, does not accept to feed, negativist, does not establish visual contact, does not answer simple questions, however, spontaneously can remain talking, giving account of delusional contents. On the day of his admission to the sector, Electro Convulsive therapy was started, and he completed 5 sessions. After the first patient session he progresses favorably, gets up from bed, requests water, is able to eat. Psychotic symptoms give way after the third session, noting also not remember anything of what happened. In an evolution interview, vigil patient , oriented TE, partially cooperative attitude. As for hysterical psychoses per se, it is an acute, rapidly healing psychosis when properly treated and Bleuler speaks of so-called hysterical crepuscular states. The diagnostic doubt is between a dissociative disorder type hysterical psychosis or an acute psychotic disorder. referring to disorders of presumed dissociative origin with symptomatology that we could call pseudopsychotic. The ICD-10 classifies acute non-affective psychoses, as Acute and Transient Psychotic Disorders (ATPD), share the common characteristics of acute onset within two weeks, and the presence of typical psychotic symptoms. The description of ATPD was influenced by the concepts of cycloid psychosis, bouffée délirante and reactive psychosis. It is not surprising, therefore, that the ATPD of the ICD-10 (at least diagnostically) is a heterogeneous group of disorders. Both CIE and DSM systems are based on symptoms and discount the "non-empirical" aspects of diagnosis, which may constitute the "phenomenon" essence of a psychotic disorder. Currently, there is no diagnostic category to define individuals who are experiencing such psychopathology and have a significantly increased risk of developing schizophrenia or other psychotic disorder. Histrionic Personality Disorder (HPD), as an argument here, is not a real mental pathology; rather, "histrionic" refers to a trait or group of personality traits that could lead to some other mental disorder.

Revisión de trastornos psiquiátricos en enfermedad de Parkinson (EP): a propósito de un caso / Review of psychiatric disorders in Parkinson's disease (PD): about a case

La Enfermedad de Parkinson se inicia generalmente en las personas entre los 50 y 60 años, La mayoría de los pacientes de Parkinson se encuentran en situación de doble vulnerabilidad: vejez y discapacidad. El objetivo del tratamiento es reducir la velocidad de progresión de la enfermedad, controlar los síntomas y los efectos secundarios derivados de los fármacos que se usan para tratarla. La presentación de las alteraciones psiquiátricas se caracteriza por episodios de alucinaciones, trastornos confusionales, trastornos del control de los impulsos, hipersexualidad o Parasomnias, siendo de presentación habitualmente vespertina. Estos pueden evolucionar llegando a cuadros de psicosis, estados confusionales crónicos, ideas delirantes en forma permanente, con alto contenido paranoide, existiendo un gran riesgo de intentos suicidas.

Parkinson's disease usually begins in people between the ages of 50 and 60. Most Parkinson's patients are in a situation of double vulnerability: old age and disability. The goal of treatment is to reduce the rate of progression of the disease, control of the symptoms and side effects derived from the drugs used to treat it. The presentation of the psychiatric alterations is characterized by episodes of hallucinations, confusional disorders, disorders of the control of the impulses, hypersexuality or Parasomnias, being usually of evening presentation. These can evolve into psychosis, chronic confusional states, persistent delusional ideas, with high paranoid content, and there is a high risk of suicide attempts.

Trastorno de espectro autista y psicosis / Autism spectrum disorder and psychosis

Paciente Felipe S. S., 24 años. Soltero. Escuela especial hasta los 15 años. Antecedentes psiquiátricos familiares (+). A 2 años, el diagnóstico de Autismo. Escuela especial hasta los 15 años. 18 años: conducta disruptiva, irritable, agresivo, intento de suicido. Examen mental en contexto hospitalario: Contacto autista, asintónico. Hipomímico, con escasos movimientos complementarios. Con signos catatónicos de presentación intermitente (imantación, pseudoflexibilidad cérea). Además, presenta frecuentemente ecolalia. Presencia de alucinaciones auditivas (impresionan del mundo externo, a veces personificadas y otras anónimas), visuales y cinestésicas. Presenta constantes desajustes conductuales, con inquietud psicomotora transitoria y reiteradas agresiones hacia personal. Tratamiento farmacológico: Clozapina 500 mg. al día. Olanzapina 30 mg al día. Ácido Valproico 750 mg al día.

Felipe S. S., 24 years old. Single. Special school up to 15 years. Family psychiatric history (+). At 2 years, the diagnosis of Autism. Special school up to 15 years. 18 years: disruptive, irritable, aggressive behavior, attempted suicide. Mental examination in hospital context: Autistic, asyntonic contact. Hipomimic, with few complementary movements. With catatonic signs of intermittent presentation (magnetization, waxy pseudoflexibility). In addition, he frequently presents echolalia. Presence of auditory hallucinations (impressions of the external world, sometimes personified and others anonymous), visual and kinesthetic. He presents constant behavioral imbalances, with transient psychomotor restlessness and repeated aggressions towards personnel. Pharmacological treatment: Clozapine 500 mg. up to date. Olanzapine 30 mg daily. Valproic Acid 750 mg daily.