ABSTRACT
BACKGROUND AND IMPORTANCE: Deep brain stimulation of the posteromedial hypothalamus (PMH DBS) appears to be an effective treatment for drug-resistant aggressiveness. Weaver syndrome (WS) is a rare genetic disorder in which patients develop some degree of intellectual disability and rarely severe behavioral alterations that may benefit from this procedure. CLINICAL PRESENTATION: We present the case of a 26-yr-old man diagnosed with WS presenting with uncontrollable self and heteroaggressiveness and disruptive behavior refractory to pharmacological treatment and under severe physical and mechanical restraining measures. The patient was successfully treated with bilateral PMH DBS resulting in affective improvement, greater tolerance for signs of affection, regularization in his sleep pattern and appetite disturbances at 12-mo follow-up. A detailed description and video of the procedure are presented, and a review of the clinical characteristics of WS and the utility and benefits of PMH DBS for refractory aggressiveness are reviewed. CONCLUSION: To our knowledge, this is the first case of refractory aggressiveness described in WS as well as the first patient with WS successfully treated with PMH DBS.
Subject(s)
Craniofacial Abnormalities , Deep Brain Stimulation , Abnormalities, Multiple , Aggression , Congenital Hypothyroidism , Hand Deformities, Congenital , Humans , Hypothalamus , MaleABSTRACT
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Subject(s)
Humans , Depression/epidemiology , Primary Health Care/statistics & numerical data , Data Collection/methods , Health Research Evaluation , Epidemiologic StudiesABSTRACT
Los trastornos depresivos constituyen un grupo enormemente heterogéneo de cuadros clínicos, cuya severidad se distribuye en un continuum que abarca, desde cuadros de dudosa o inconsistente significación clínica y próximos a las reacciones emocionales no patológicas, hasta cuadros severos con gran afectación funcional y riesgo vital. El episodio depresivo y la depresión mayor son categorías heterogéneas e imprecisas y el término depresión, aunque ampliamente utilizado en medios profesionales y extra profesionales, es todavía más ambiguo. Se subrayan algunas características clínicas que diferencian los trastornos depresivos con significación clínica del resto. Frente a la heterogeneidad clínica de los trastornos depresivos existe una llamativa uniformidad en el abordaje terapéutico, basado en la administración indiscriminada de fármacos antidepresivos para cualquier cuadro del amplio espectro de trastornos depresivos. Sería necesario desarrollar protocolos de actuación, con abordajes específicos, biológicos, psicoterapéuticos y psicosociales en función de los datos de eficacia de cada tipo de abordaje y de cada paciente específico, restringiendo los tratamientos farmacológicos a los cuadros en que han mostrado eficacia (AU)
Depressive disorders constitute a very heterogeneous group of clinical syndromes which includes from depressive syndromes of doubtful clinical significance to very severe and disabled disorders of high risk for life. The depressive episode and major depression categories, according to diagnostic criteria, are also very heterogeneous and vague entities. The depression term, widely used in scientific literature, is excessively ambiguous. In spite of this clinical heterogeneity, there is a striking uniformity in therapeutic management of depressive syndromes, based excessively in antidepressant drugs. Development of practice guidelines including not only biological but psychotherapeutic and psychosocial techniques is needed. Pharmacologic treatments should be restricted to more severe depressive episodes (AU)
Subject(s)
Humans , Male , Female , Depression/epidemiology , Depression/pathology , Affective Symptoms/epidemiology , Psychotherapy/methods , Antidepressive Agents/therapeutic useABSTRACT
El parasuicidio supone un importante problema de salud pública, tanto por su elevada incidencia como por las importantes consecuencias a nivel médico y social. La forma habitual de abordar este problema es a través del estudio de las características del paciente parasuicida y del intento de suicidio. Nuestro estudio se compone de una muestra de 184 pacientes atendidos por parasuicidio. Se han valorado características sociodemográficas, clínicas y psicosociales del paciente, así como las características del parasuicidio, sus repercusiones médicas y el grado de intencionalidad suicida. El perfil del paciente fue el de una mujer soltera, de, 36'7 años de media, que convive con otras personas y está en paro. Más de la mitad de la muestra estaba ya en tratamiento psiquiátrico, siendo el diagnóstico más frecuente el de trastorno de personalidad. El método más usado fue el de ingestión de psicofármacos, benzodiacepinas y antidepresivos fundamentalmente. El 20 por ciento requirió ingreso hospitalario y el 50 por ciento fue derivado al Centro de Salud Mental para seguimiento. Respecto a la intencionalidad, se hallaron 2 subgrupos con diferentes frecuencia, diagnóstico, pronóstico y tratamiento (AU)
The parasuicide is an important public health problem because of its high frequency and its medical and social consequences. The patient's clinical features and the suicide attempt's characteristics are the most important clinical topics on studyng this problem. We studied 184 patients who committed parasuicide. Sociodemographic, clinical and psychosocial patient's features, parasuicide's characteristics, medical consequences and suicide intentionality were analyzed. The typical patient's profile was age 36´7, single, unemployed and not living alone woman. 54% of the sample was already receiving psychiatric attention. The most usual diagnose was personality disorder. The most usual method was ingestion of psychotropics drugs. 20% of the sample required hospital admission, and 50% was referred to his Mental Health Center. According to suicide intentionality two groups resulted. These two groups presented differences on frequency, prognosis, diagnosis and treatment. The foregoing are just some of the findings presented in this article (AU)
