ABSTRACT
Introducción. El International Affective Picture System (IAPS)1 cuenta con una serie de estímulos pictóricos emocionales, normativos e internacionalmente accesibles, y está considerado el sistema más fiable y válido para el estudio experimental de las emociones. El IAPS se ha utilizado en la investigación sobre trastornos mentales como esquizofrenia, depresión mayor, ansiedad o rasgos psicopáticos de la personalidad. Asimismo es frecuente su uso como variable independiente en estudios de neuroimagen. Algunas de las aproximaciones al trastorno límite de la personalidad consideran que el elemento psicopatológico fundamental en estos sujetos es la disregulación afectiva, de la que se derivarían síntomas principales, tales como la intolerancia a la frustración, la reactividad o la disforia. El objetivo de este trabajo de revisiónes reunir y analizar la información sobre el estudio de la regulación emocional y del uso del IAPS en los distintos trastornos mentales. Métodos. Se realiza una revisión en las distintas bases de datos de los estudios publicados en población general y en poblaciones clínicas, así como de las características internas del test. Resultados. De acuerdo a los resultados descritos en los estudios revisados, el IAPS parece capaz de delimitar patrones específicos de respuesta emocional a estímulos en distintos trastornos mentales, incluyendo los trastornos del estado de ánimo y la esquizofrenia. Conclusiones. El uso del IAPS en el estudio del trastorno límite de la personalidad podría ser de interés para la comprensión y el tratamiento de los trastornos límite de la personalidad en los que la disregulación emocional es un factor principal (AU)
Introduction. The International Affective Picture System (IAPS) uses a series of emotional, normative and internationally accessible pictorial stimuli and is considered to be the most reliable and valid system in the experimental study of emotions. The IAPS has been used in research on mental disorders such as schizophrenia, major depression, anxiety or psychopathic personality traits. Furthermore, it is frequently used as independent variable in neuroimaging studies. Some of the approaches to borderline personality disorder consider that the fundamental psychopathological element in these subjects is affective dysregulation, from which the principal symptoms such as intolerance to frustration, reactivity or dysphoria are derived. This review paper has aimed to gather and analyze the information on the study of emotional regulation and the use of the IAPS in the different mental disorders. Methods. A review is made of the different data bases of the studies published in the general population and in the clinical populations as well as of the internal characteristics of the test. Results. In agreement with the results described in the studies reviewed, the IAPS seems capable of defining specific responses to stimuli in different mental disorders, including mood disorders and schizophrenia. Conclusions. In conclusion, the use of the IAPS in the study of borderline personality disorder could be of interest for the understanding and treatment of borderline personality disorder in which emotional dysregulation is a principal factor (AU)
Subject(s)
Humans , Male , Female , Mental Disorders/diagnosis , Mental Disorders/psychology , Schizophrenic Psychology , Self Concept , Psychopathology/methods , Personality Disorders/epidemiology , Personality Disorders/psychology , Bipolar Disorder/psychology , Depression/psychology , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Depression/epidemiology , Diagnostic and Statistical Manual of Mental DisordersABSTRACT
INTRODUCTION: Borderline personality disorder (BPD) is usually treated with a combination of antipsychotic and anticonvulsant drugs although only limited efficacy is obtained in many patients. A major problem in the treatment of BPD is the lack of compliance derived form the pathological impulsivity of BPD patients. METHODS: Twelve severe BPD patients refractory to previous treatment with drug combinations for three months were treated with intramuscular long-acting risperidone for a six-month period. Clinical changes were rated with the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale, anxiety and aggression scales. Functional improvement was evaluated with the Global Assessment of Functioning (GAF). RESULTS: Six-month treatment with IM risperidone was associated with significant improvement of CGI (t: 5.7 - 4.0; p<0.01) and of GAF (t: -4.5; gl: 10; p<0.01). Clinical improvement was robust after the first month of treatment. No relevant extrapiramidal side effects were reported with the exception of mild psychomotor slowing which requires dose adjustments in four patients. CONCLUSIONS: Treatment with i.m. long acting risperidone during six months was associated with significant clinical and functional improvement and excellent tolerability in a group of BPD patients refractory to previous treatment. The results indicate that the effect of IM risperidone in BPD should be further investigated in large placebo-controlled trials.
Subject(s)
Antipsychotic Agents/therapeutic use , Borderline Personality Disorder/drug therapy , Risperidone/therapeutic use , Adolescent , Adult , Delayed-Action Preparations/therapeutic use , Drug Resistance , Female , Humans , Male , Severity of Illness IndexABSTRACT
Introducción. Este trabajo describe las bases racionales que justifican el uso de la técnica de la depleción aguda de triptófano en los trastornos de la conducta alimentaria (TCA), así como la metodología y el diseño empleado en nuestros estudios. La técnica de la depleción de triptófano ha sido descrita y utilizada en estudios previos de manera segura y permite evaluar la función serotoninérgica cerebral. Por ello puede ser de interés en la investigación de las hipótesis sobre la deficiencia serotoninérgica en los trastornos de la conducta alimentaria. Asimismo, y dada la relación de las disfunciones de la actividad de serotonina con los síntomas impulsivos, la técnica puede ser útil en la diferenciación biológica de los distintos subtipos, restrictivo y bulímico, de TCA. Método. Se estudia la respuesta sintomática de 57 pacientes mujeres diagnosticadas de TCA y de 20 mujeres control a una prueba de depleción de triptófano. Para ello se administra una solución con todos los aminoácidos esenciales a excepción del triptófano precedida por una dieta pobre en triptófano de 2 días de duración. Se miden las cifras de triptófano plasmático a las 2 y a las 5 h tras la administración de la bebida. Se miden las respuestas alimentarias y emocionales mediante escalas específicas a lo largo de las 5 h siguientes a la depleción. Se realiza también un estudio de las características básicas de la personalidad y de los rasgos de impulsividad. Se estudia la relación de la respuesta a la prueba con los distintos subtipos clínicos y con las características temperamentales e impulsivas de las pacientes. Resultados. La prueba fue efectiva en la reducción del triptófano plasmático, cuyas cifras descendieron significativamente (76%) en la muestra global. La prueba fue bien tolerada y no se produjeron efectos adversos graves. Dos pacientes abandonaron la prueba por intolerancia gástrica a la bebida. Conclusiones. La prueba de depleción de triptófano es eficaz en la reducción del triptófano plasmático en los TCA y puede ser válida para el estudio de la función serotoninérgica y de su relación de los síntomas alimentarios e impulsivos de los TCA
Introduction. This work describes the rational bases justifying the use of acute tryptophan depletion technique in eating disorders (ED) and the methods and design used in our studies. Tryptophan depletion technique has been described and used in previous studies safely and makes it possible to evaluate the brain serotonin activity. Therefore it is used in the investigation of hypotheses on serotonergic deficiency in eating disorders. Furthermore, and given the relationship of the dysfunctions of serotonin activity with impulsive symptoms, the technique may be useful in biological differentiation of different subtypes, that is restrictive and bulimic, of ED. Methods. 57 female patients with DSM-IV eating disorders and 20 female controls were investigated with the tryptophan depletion test. A tryptophan-free amino acid solution was administered orally after a two-day low tryptophan diet to patients and controls. Free plasma tryptophan was measured at two and five hours following administration of the drink. Eating and emotional responses were measured with specific scales for five hours following the depletion. A study of the basic characteristics of the personality and impulsivity traits was also done. Relationship of the response to the test with the different clinical subtypes and with the temperamental and impulsive characteristics of the patients was studied. Results. The test was effective in considerably reducing plasma tryptophan in five hours from baseline levels (76%) in the global sample. The test was well tolerated and no severe adverse effects were reported. Two patients withdrew from the test due to gastric intolerance. Conclusions. The tryptophan depletion test could be of value to study involvement of serotonin deficits in the symptomatology and pathophysiology of eating disorders
Subject(s)
Female , Humans , Feeding and Eating Disorders/physiopathology , Tryptophan , Serotonin , Tryptophan/physiology , Impulsive Behavior/diagnosis , Psychiatric Status Rating Scales , Personality AssessmentABSTRACT
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