ABSTRACT
INTRODUCTION: The aim of this study was to evaluate whether there are any differences in the clinical features of depression, personality and the G factor among women with and without premenstrual exacerbation (PE) of depression. MATERIAL AND METHODS: Ninety-nine outpatients diagnosed with major depression (DSM-IV) were interviewed twice. At baseline, the patients were not taking medication. The 74 patients who achieved remission (Hamilton rating scale for depression ≤7) after 16 weeks were evaluated again through the 16-personality factor (16-PF) questionnaire (5(th) edition) and the D48 (or Dominos) test. RESULTS: No differences in clinical characteristics or prognosis were found between the two groups of women, except for the greater presence of seasonal features among women with PE. Women with PE also scored higher for self-control on the 16-PF and scored lower on the D48 (Domino) test. The logistic analysis showed that higher self-control scores increased the risk for PE in 51.3% of the sample, while higher scores on the D48 test decreased the risk in 8.6%. CONCLUSIONS: There were no differences between the two groups in the clinical features or prognosis of depression, except for the higher rates of seasonal features in the PE group. In contrast, differences were found in personality traits and the D48 between the two groups.
ABSTRACT
Mujer de 17 años de edad, sin antecedentes de interés, que ingresó en la unidad de psiquiatría por un cuadro de 4 semanas de evolución, que cursaba con mutismo, agitación e insomnio. Había sido tratada con maprotilina, risperidona y lorazepam. Durante los primeros días del ingreso se modificó el tratamiento, pero continuó el empeoramiento psíquico y físico, ya que se negaba a alimentarse. Todos los estudios complementarios estuvieron dentro de la normalidad. A las 2 semanas del ingreso se observó fiebre de 38 °C en tres ocasiones. Se cambió el tratamiento a quetiapina, y según mejoraba su estado, aparecieron una paresia de la extremidad superior derecha y disartria. Ante la posibilidad de que se tratara de un efecto adverso a la quetiapina, se decidió su retirada. Antes de alcanzar la suspensión total, su estado empeoró de nuevo, con agitación, mutismo, tricotilomanía y fiebre. Se aumentó la dosis de quetiapina (600 mg/día) y volvió a mejorar. Al alta hospitalaria fue diagnosticada de catatonia letal (CL). La evolución desde entonces ha sido muy favorable, lo que ha permitido la suspensión progresiva del tratamiento. Durante los 4 meses previos a la última consulta se ha mantenido estable sin precisar tratamiento alguno (AU)
A 17-year-old woman, without antecedents of interest, was admitted to the psychiatric ward due to a clinical disorder consisting of mutism, agitation and insomnia for the previous 4 weeks. The patient had been unsuccessfully treated with maprotiline, risperidone and lorazepam. For the first 2 weeks after admission, the treatment was modified but the patient¿s psychic and physical status worsened, since she refused to eat. The results of all complementary investigations were normal. Two weeks after admission, the patient developed a fever (38 °C) on three separate occasions. The treatment was switched to quetiapine and the patient improved, but then dysarthria and right arm paralysis were observed. Given the possibility that these symptoms were adverse effects of quetiapine, the dose of this drug was reduced. However, before complete withdrawal, the patient developed agitation, mutism, trichotillomania and fever. The dose of quetiapine was increased to 600 mg/day with symptom remission. On discharge, the patient was diagnosed with lethal catatonia. Since then, the patient has remained asymptomatic, allowing quetiapine to be slowly reduced. During the 4 months before the last visit, the patient has remained stable and has required no treatment. Based on this case, we believe that atypical antipsychotics may be useful in the treatment of some patients with lethal catatonia. The difficulties that can be encountered in the differential diagnosis between lethal catatonia and neuroleptic malignant syndrome and the nosologic classification of these entities are discussed (AU)
