Esquizofrenia y su asociación con enfermedades médicas crónicas / The association of schizophrenia with chronic non transmissible diseases

The life expectancy of patients with schizophrenia (SCH) is 11 to 20 years less than the general population. There is an association between SCH and various diseases and chronic conditions, highlighting the cardio-metabolic diseases. This association has been attributed to the use of antipsychotics, however, evidence has also shown intrinsic susceptibility of schizophrenic patients the development of chronic conditions. This review aims to update knowledge about chronic conditions such as cardiometabolic risk and sleep, bone and kidney disorders related to SCH. These patients have a high prevalence of risk behaviors, including smoking and poor diet. They have a worse metabolic profile than the general population and a greater likelihood of developing metabolic syndrome, diabetes and cardiovascular disease. SCH has also been associated with other chronic diseases such as osteoporosis and chronic kidney disease. The high prevalence of these comorbidities in schizophrenic population is not explained solely by the antipsychotic treatment, therefore intrinsic mechanisms associated to SCH are postulated to be associated with these conditions. This new information requires a change in the multidisciplinary medical approach for the study and management of schizophrenic patients.

Córtex prefrontal y trastornos del comportamiento: modelos explicativos y métodos de evaluación / Prefrontal cortex and behavioral disorders: theoretical framework and neuropsychological evaluation

Los trastornos del córtex prefrontal (CPF) permiten explicar la sintomatología de importantes cuadros neurológicos y psiquiátricos, tales como las secuelas de traumatismos encéfalo-craneanos y las esquizofrenias. Sin embargo, y a pesar de la gran importancia de sus funciones, su estudio se ha visto dificultado por razones teóricas, experimentales y clínicas. Recientemente han surgido dos nuevos modelos que intentan explicar los mecanismos a la base del funcionamiento del CPF. Presentamos una revisión de las principales manifestaciones clínicas ante su disfunción, los modelos explicativos postulados tradicionalmente, además de las dos propuestas recientes de Koechlin y Mesulam, para finalizar con una revisión de los instrumentos más utilizados en el ámbito clínico para la evaluación de las funciones propias de esta región, denominadas funciones ejecutivas y de autorregulación del comportamiento.

Dysfunction of prefrontal cortex explains the symptoms of many neurological and psychiatric disorders, such as the consequences of cerebral trauma and schizophrenia. Although the importance of frontal lobe functions in complex cognition has long been recognized, systematic research efforts to specify the nature, organization and roles of these functions have been difficult for theoretical, experimental and clinical reasons. Recently, two new theoretical frameworks have been proposed to explain the role of prefrontal cortex. In this paper, we present a revision of the main clinical manifestations secondary to prefrontal dysfunction, the frameworks proposed by Mesulam and Koechlin to explain the role of prefrontal cortex in behavior and the principal instruments available to evaluate executive and strategic self-regulation functions.