The association between schizophrenia and violent or homicidal behaviour: the prevention and treatment of violent behaviour in these patients / Asociación entre la esquizofrenia y la conducta homicida o violenta prevención y tratamiento del comportamiento violento en estos pacientes

BACKGROUND AND OBJECTIVE: This review article aims to discuss and evaluate the risk factors for the development of violence and homicidal behaviour and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. METHOD: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed. RESULTS: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some socio-demographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes. Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine. CONCLUSION: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.

ANTECEDENTES Y OBJETIVO: Este artículo de revisión esta dirigido a discutir y evaluar los factores de riesgo en el desarrollo de la violencia y el comportamiento homicida, frente a la efectividad y los resultados de los antipsicóticos atípicos preferidos en pacientes diagnosticados con esquizofrenia. MÉTODOS: Para este propósito, se procedió a hacer una revisión exhaustiva de la literatura psiquiátrica. Asimismo se realizó un análisis y selección de los artículos en los bancos de datos internacionales, abarcando el periodo entre 1970 y 2010. RESULTADOS: Aunque el riesgo de comportamiento homicida es más alto en los pacientes con esquizofrenia si se le compara con la población mundial, poco se sabe de las condiciones pertinentes que desatan actos de violencia entre los pacientes con esquizofrenia. Los resultados disponibles sugieren que ciertos factores - que incluyen algunas características sociodemográficas, edad juvenil, alcoholismo, abuso de substancias, no cumplimiento con el tratamiento, correspondencia con los rasgos de desorden de personalidad antisocial y el subtipo paranoico, historia de ideación e intentos suicidas, así como antecedentes de hospitalizaciones frecuentes - aumentan la potencialidad de los episodios violentos. Los datos disponibles muestran la clozapina como la opción terapéutica más racional para prevenir el comportamiento violento en los pacientes con esquizofrenia. Hay evidencias provenientes de ensayos controlados aleatorios que fundamentan el efecto anti-agresivo específico de la clozapina. CONCLUSIÓN: La práctica clínica debe detectar y monitorear de cerca a los pacientes con riesgo de cometerr homicidio. Hay muchos ensayos que muestran la eficacia de la clozapina en controlar el comportamiento violento y agresivo.

Depressão, estado emocional e doença arterial coronária / Depression, emotional state and coronary artery disease

A depressão e doença arterial coronariana (DAC) são duas doenças muito prevalentes. Além disso, o comprometimento da qualidade de vida e expectativa de vida são características de ambas as situações. Existem várias condições que, além de agravar a depressão e facilitar o desenvolvimento da DAC, ainda pioram o prognóstico em pacientes com DAC estabelecida. São elas: adesão inferior a orientações médicas (medicamentos e modificações no estilo de vida), maior ativação e agregação plaquetária, disfunção endotelial e disfunção autonômica (diminuição da variabilidade da frequência cardíaca). A literatura recente tem mostrado que a depressão por si só está se tornando um fator de risco independente para eventos cardíacos, tanto na prevenção primária e como na secundária. Como o diagnóstico de depressão em pacientes com doença cardíaca é difícil, devido às semelhanças dos sintomas, o profissional de saúde deve realizar uma avaliação cuidadosa para diferenciar os sinais clínicos de depressão daqueles relacionados com doenças cardíacas em geral. Tratamentos bem sucedidos da depressão têm mostrado melhora na qualidade de vida dos pacientes e nos resultados cardiovasculares. No entanto, estudos clínicos multicêntricos são necessários para apoiar essa inferência. Aligação prática entre profissionais qualificados é necessária para melhor gestão dos pacientes deprimidos com excessode risco no desenvolvimento de DAC. Assim, as implicações fisiopatológicas e clínicas entre depressão e DAC são discutidas neste artigo.

Depression and coronary artery disease (CAD) are both extremely prevalent diseases. In addition, compromised quality of life and life expectancy are characteristics of both situations.There are several conditions that aggravate depression and facilitate the development of CAD, as well as provoke aworse prognosis in patients with already established CAD:inferior adherence to medical orientations (medications and life style modifications), greater platelet activation and aggregation, endothelial dysfunction, and impaired autonomic dysfunction (lowered heart rate variability). Recent literature has shown that depression alone is becoming an independent risk factor for cardiac events both in primary and secondary prevention. As the diagnosis of depression in patients with heart disease is difficult, due to similarities of symptoms, the health professional should perform a careful evaluation to differentiate the clinical signs of depression from those related with general heart diseases. Successful therapy of depression has been shown to improve patients’quality of life and cardiovascular outcome. However, multicentric clinical trials are needed to support this inference. A practical liaison between qualified professionals is necessary for the better management of depressed patients with excess risk in developing CAD. Accordingly, pathophysiological and clinical implications between depression and CAD are discussed in this article.

Study of the relationship of psychosocial disorders to bruxism in adolescents.

BACKGROUND AND AIM: Bruxism has been defined as a diurnal or nocturnal parafunctional habit. Etiology of bruxism has remained controversial and some investigators believe that psychological factors may play a major role in promoting and perpetuating this habit. The aim of this case-control study was to assess the existence of an association between bruxism and psychosocial disorders in adolescents., Participants were chosen among 114, 12-14 year old students (girls). They were divided into two groups, bruxers and nonbruxers, on the basis of both validated clinical criteria and interview with each patient. A few participants were excluded on the basis of presence of systemic disorders, TMJ disorders, other oral habits, primary teeth, defective restorations and premature contacts. Following matching of two groups in regard to parent's age and education, mother's marital status, child support status, mother's employment status, and socio-economical status, 25 cases and 25 controls were enlisted. A self report validated questionnaire (YSR, 11-18 yr) was then filled out by both groups for the evaluation of 12 psychosocial symptoms. RESULTS: Remarkable differences in certain psychosocial aspects were found between the two groups. Prevalence of psychosocial disorders including Thought Disorders (P < 0.005), Conduct Disorders (P < 0.05), Antisocial Disorders (P < 0.06) as identified by YSR was significantly higher in bruxers. Significant differences between the two groups also emerged in total YSR scores (P < 0.005). The results of Odds Ratio revealed that a bruxer adolescent has 16 times greater probability for psychosocial disorders than a non-bruxer one. Fischer exact test and T-test were used and Odds Ratio and Confidence Interval was estimated. CONCLUSION: Support to the existence of an association between bruxism and psychosocial disorders has been provided.

Síndrome del hemisferio derecho en niños: una entidad clínica a definir / Right hemisphere syndrome in children: a clinical entity to be defined

El síndrome hemisférico derecho es una entidad diagnóstica inicialmente planteada en adultos, secundario a lesiones adquiridas a este nivel. La literatura describe un cuadro clínico similar en niños, como resultado de un trastorno del desarrollo que puede ser de origen genético o adquirido por noxas perinatales. Las características clínicas en que se basa esta entidad se relacionan básicamente con trastornos en la interacción social, síntomas conductuales, alteraciones pragmáticas del lenguaje, signos físicos de disfunción hemicuerpo izquierdo y hallazgos específicos en pruebas neuropsicológicas (WISC discordante, alteraciones visoespaciales, discalculia). También se ha descrito el hallazgo de parientes con síntomas similares. Las formas clínicas de este cuadro en niños no están claramente estandarizadas, con pruebas que sean universalmente aceptadas. Se presenta una serie de 3 casos con trastornos de conducta cuya evaluación clínica cumpliría con los criterios diagnósticos planteados. Se comentan los hallazgos de la literatura, y se describen las perspectivas terapéuticas que en la actualidad existen

Edipismo; autoenucleaçäo bilateral / Edipism; bilateral self-enucleation

Os autores descrevem uma patologia rara, o edipismo, autoenucleaçäo bilateral. O termo edipismo é utilizado para descrever a enucleaçäo realizada pelo próprio paciente. Este tipo de automutilaçäo é encontrada em pacientes psiquiátricos, principalmente esquisofrênicos

Prevención del suicidio en niños y adolescentes / Prevention of suicide in children and adolescents

La frecuencia de conductas suicidas en niños y jóvenes está aumentando, ubicándolas entre las principales causas de muerte en adolescentes. Los factores de riesgo son tanto biológicos como psicológicos, familiares, sociales y psiquiátricos. Las medidas de prevención pueden ser muy efectivas y son aplicables en la comunidad, la familia y las organizaciones de atención de salud, con el objeto de disminuir la incidencia del suicidio en la población de riesgo

Organicidad en adolescentes antisociales patología psiquiátrica / Organicity in antisocial adolescent psychiatric disease

Se presentan los resultados preliminares de una investigación realizada en el marco del Programa Juventud, sobre patología psiquiátrica en 300 adolescentes antisociales. Se hace especial referencia a la organicidad y al retraso mental. El estudio considera 250 variables que serán analizadas mediante análisis multifactorial. Se presenta también esbozo del modelo teórico que se utilizará en el análisis. No se plantean todavía las conclusiones