Influencia de la anhedonia en la evolución clínica del trastorno depresivo / Influence of anhedonia on the clinical course of depressive disorder

La anhedonia es la ausencia o capacidad reducida para experimentar placer. Es un síntoma importante en la depresión y un síntoma negativo de la esquizofrenia. Se presenta un estudio descriptivo prospectivo (diciembre 2018 a julio de 2020) con un seguimiento de seis meses, desarrollado en las Consultas Externas de Psiquiatría del Hospital Central de la Defensa Gómez Ulla. Para cuantificar la anhedonia se ha empleado la escala SHAPS y para el seguimiento de la clínica depresiva el cuestionario CET-DE. Se aplican también otras escalas como la escala CGI (impresión subjetiva gravedad/mejoría por parte del psiquiatra) y la EVA modificada (impresión subjetiva del paciente de su estado de gravedad). De 60 pacientes reclutados, 48 completaron el protocolo del estudio (2 visitas), siendo 60 % mujeres con una media de edad de 48 años. En la visita basal el porcentaje de anhedónicos fue del 67 %, de los cuales el 48 % fue considerado grave por parte del profesional sanitario. La presencia de anhedonia se relacionó con mayor puntuación en la escala CET-DE. Tras la intervención psicoterapéutica, en la visita final el porcentaje de anhedónicos fue del 29 % y se clasificaron como graves por parte del profesional sanitario un 25 % de los pacientes. La persistencia de anhedonia en la visita final fue un factor de mala evolución clínica, pudiendo concluir que es un componente de la sintomatología residual de la depresión y un indicador de mal pronóstico. (AU)

Anhedonia is the absence or reduced ability to experience pleasure. It is a major symptom of depression and a negative symptom of schizophrenia. We present a prospective descriptive study (December 2018 to July 2020) with a 6-month follow-up, developed in the Psychiatric Outpatient Clinic of the “Hospital Central de la Defensa, Gómez Ulla”. The SHAPS scale was used to quantify anhedonia and the CET-DE questionnaire was used to monitor clinical depression. Other scales such as the CGI scale (subjective impression of severity/improvement was use by the psychiatrist) and the modified VAS (patient’s subjective impression of his or her state of severity) were also applied. Out of 60 patients recruited, 48 completed the study protocol (2 visits), 60 % were women with a mean age of 48 years. At the firts visit the percentage of anhedonia was 67 %, with 48 % considered severe by the physician. The presence of anhedonia was related to a higher score on the CET-DE scale. After the psychotherapeutic intervention, the percentage of anhedonia at the last visit was 29% in general and 25% of patients were classified as severe by the health professional. The persistence of anhedonia at the final visit was a factor of poor clinical evolution and we can conclude that it is a component of the residual symptomatology of depression and an indicator of poor prognosis. (AU)

Influencia de la anhedonia en la evolución clínica del trastorno depresivo / Influence of anhedonia on the clinical course of depressive disorder

La anhedonia es la ausencia o capacidad reducida para experimentar placer. Es un síntoma importante en la depresión y un síntoma negativo de la esquizofrenia. Se presenta un estudio descriptivo prospectivo (diciembre 2018 a julio de 2020) con un seguimiento de seis meses, desarrollado en las Consultas Externas de Psiquiatría del Hospital Central de la Defensa Gómez Ulla. Para cuantificar la anhedonia se ha empleado la escala SHAPS y para el seguimiento de la clínica depresiva el cuestionario CET-DE. Se aplican también otras escalas como la escala CGI (impresión subjetiva gravedad/mejoría por parte del psiquiatra) y la EVA modificada (impresión subjetiva del paciente de su estado de gravedad). De 60 pacientes reclutados, 48 completaron el protocolo del estudio (2 visitas), siendo 60 % mujeres con una media de edad de 48 años. En la visita basal el porcentaje de anhedónicos fue del 67 %, de los cuales el 48 % fue considerado grave por parte del profesional sanitario. La presencia de anhedonia se relacionó con mayor puntuación en la escala CET-DE. Tras la intervención psicoterapéutica, en la visita final el porcentaje de anhedónicos fue del 29 % y se clasificaron como graves por parte del profesional sanitario un 25 % de los pacientes. La persistencia de anhedonia en la visita final fue un factor de mala evolución clínica, pudiendo concluir que es un componente de la sintomatología residual de la depresión y un indicador de mal pronóstico. (AU)

Anhedonia is the absence or reduced ability to experience pleasure. It is a major symptom of depression and a negative symptom of schizophrenia. We present a prospective descriptive study (December 2018 to July 2020) with a 6-month follow-up, developed in the Psychiatric Outpatient Clinic of the “Hospital Central de la Defensa, Gómez Ulla”. The SHAPS scale was used to quantify anhedonia and the CET-DE questionnaire was used to monitor clinical depression. Other scales such as the CGI scale (subjective impression of severity/improvement was use by the psychiatrist) and the modified VAS (patient’s subjective impression of his or her state of severity) were also applied. Out of 60 patients recruited, 48 completed the study protocol (2 visits), 60 % were women with a mean age of 48 years. At the firts visit the percentage of anhedonia was 67 %, with 48 % considered severe by the physician. The presence of anhedonia was related to a higher score on the CET-DE scale. After the psychotherapeutic intervention, the percentage of anhedonia at the last visit was 29% in general and 25% of patients were classified as severe by the health professional. The persistence of anhedonia at the final visit was a factor of poor clinical evolution and we can conclude that it is a component of the residual symptomatology of depression and an indicator of poor prognosis. (AU)

[Prognosis value of the immunohystochemical expresion of the p21WAF1 in the larynx cancer]. / Valor pronóstico de la expresión inmunohistoquímica de la proteina p21WAF1 en cáncer de laringe.

In this paper we carried out an immunohistochemical study of protein p21WAF1 (EA10) expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at "Virgen de la Salud" Hospital (Toledo, Spain). In the cases with lymph node metastasis we also studied p21WAF1 expression at this level. Furthermore we have analysed the value of protein p21WAF1 expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we evaluate the relationship between p21WAF1 expression and other clinic and pathologic parameters.

Valor pronóstico de la expresión inmunohistoquímica de la proteina p21WAF1 en cáncer de laringe / Prognosis value of the immunohystochemical expression of the P21WAF1 in the larynx cancer

En este trabajo hemos estudiado la expresión inmunohistoquímica de la proteína p21WAF1 (EA10) en una serie de 195 pacientes con cáncer de laringe que fueron diagnosticados, tratados y seguidos durante al menos 5 años en el servicio de ORL del Hospital “Virgen de la Salud” (Toledo). En los casos que presentaron metástasis ganglionares analizamos también la expresión de p21WAF1 a dicho nivel. Además se ha analizado el valor pronóstico de la expresión de p21WAF1 en este tipo de tumores (desarrollo de recidivas, mortalidad por cáncer de laringe y supervivencia) y estudiamos la posible relación de dicha expresión con otros parámetros clínicopatológicos

In this paper we carried out an immunohistochemical study of protein p21WAF1 (EA 10) expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at «Virgen de la Salud» Hospital (Toledo, Spain). In the cases with lymph node metastasis; we also studied p21WAF1 expression at this level. Furthermore we have analysed the value of protein p21WAF1 expression as a prognostic factor (tumor recurrence, deads due to cancer and survival (and we evaluate the relationship between p21WAF1 expression and other clinic and pathologic parameters. Keywords: p21WAFl Protein. Larynx cancerIn this paper we carried out an immunohistochemical study of bcl-2 protein expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at «Virgen de la Salud» Hospital (Toledo. Spain). In the cases with lymphonode metastasis we also analysed bcl-2 protein expression at this level. Furthermore we have studied the value of bcl-2 protein expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we analysed the relationship between bcl-2 protein expression and other clinic and pathologic parametersIn this paper we carried out an immunohistochemical study of protein Rb (G3-245) expression in a series of 195 patients with laryngeal carcinoma that were diagnosticated, treated and followed at the Department of Otolaryngology at «Virgen de la Salud» Hospital (Toledo, Spain) for a time of 5 years. In the cases with lymph node metastasis we also studied Rb expression at this level. Furthermore we have analysed the value of Rb expression as a prognostic factor (tumor recurrence, deads due to cancer and survival) and we evaluate the relationship between Rb expression and other clinic and pathologic parameters

[Bilateral neck dissection and venous reconstruction with internal saphenous vein in cancer of the larynx]. / Vaciamiento cervical radical bilateral y reconstrucción venosa con vena safena interna, en cáncer de laringe.

Radical neck dissection (RND) is a surgical procedure for treating patients with cervical metastatic adenopathies generally dues to head and neck tumours. Since Crile, in 1906, began this technique, because of the important postoperative complications noticed, related to disturbances of the venous return when the dissection was bilateral, was suggested a 15 days-term between the two operations. We have verified that it is much better to reconstruct the blood drainage through a venous graft simultaneously. This is a useful technique already described in the literature. We contribute with one case.

[Verrucous carcinoma: retrospective study of 8 cases]. / Carcinoma verrucoso: estudio retrospectivo de 8 casos.

Clinical findings, histopathology, therapeutic management and evolution of 8 cases of laryngeal verrucous carcinomata, treated at Virgen de la Salud Hospital from 1981 till 1997, are discussed. With the excuse of perform a retrospective perusal of our series, the AA. review the medical literature regarding possible new questions about this uncommon growth: as radiotherapy versus surgery and aetiological link of the tumor with the human papilloma virus.

[Our results in the surgery of otosclerosis]. / Nuestros resultados en la cirugía de la otosclerosis.

A statistical study is made of the results of 78 stapedectomies carried out during the last six years in the Virgen de la Salud Hospital of Toledo, Spain. An auditive gain of 90%, averaging 27 dBs, was found. Other parameters assessed were age, sex, prosthesis type, and failures.

[Social change. The climacteric and depression]. / Cambio social. Climaterio y depresión.

We study different socio-environmental factors in relationship with depression in the climacterium. Our sample are women who have been diagnostic of depression and are impatient in the Department of Psychiatry of University Hospital San Carlos. The isolation and the social and familiar changes are the most important events that happen to the women depressive climacteric. The Spanish women in climacteric age have lived in a cultural-educational environment focus toward a maternal role. Because of this her personality has development dependent and submission.