Obesidad secundaria a síndrome endocrinológico en paciente pluripatológica / Obesity secondary to endocrinology syndrome in a polymorbid patient

Presentamos el caso de una paciente de 64 años, natural de Rumanía, con antecedentes médicos de síndrome de apnea-hipopnea, cirrosis hepática, EPOC y artrosis. Fumadora activa de un paquete de cigarrillos/día. La paciente es remitida desde la consulta de neumología para estudio ambulatorio por presentar como hallazgo incidental adenomas suprarrenales bilaterales y aumento progresivo de peso en los últimos 5 años. En el estudio de adenomas suprarrenales y obesidad se objetiva la presencia de un síndrome de Cushing. Es importante estudiar la aparición de la obesidad reciente en una paciente pluripatológica dado que puede haber otras causas secundarias además de las enfermedades subyacentes que presenta. Durante la presentación del caso clínico se realiza un abordaje esencial y práctico de la enfermedad adrenal. (AU)

We present the case of a 64-year-old woman from Romania with a medical history of obstructive sleep apnea-hypopnea syndrome, hepatic cirrhosis, COPD, and osteoarthritis. She smokes one pack of cigarettes per day. The patient is referred from the pulmonology department for an outpatient evaluation for an incidental finding of bilateral adrenal adenomas and progressive weight gain over the last five years. Cushing syndrome is detected during study of the adrenal adenomas and obesity. It is important to study recent-onset obesity in multimorbid patients as there could be other secondary causes in addition to the underlying diseases they present with. During the presentation of this clinical case, an essential, practical approach to the adrenal pathology is made. (AU)

Obesity secondary to endocrinology syndrome in a polymorbid patient.

We present the case of a 64-year-old woman from Romania with a medical history of obstructive sleep apnea-hypopnea syndrome, hepatic cirrhosis, COPD, and osteoarthritis. She smokes one pack of cigarettes per day. The patient is referred from the pulmonology department for an outpatient evaluation for an incidental finding of bilateral adrenal adenomas and progressive weight gain over the last five years. Cushing syndrome is detected during study of the adrenal adenomas and obesity. It is important to study recent-onset obesity in multimorbid patients as there could be other secondary causes in addition to the underlying diseases they present with. During the presentation of this clinical case, an essential, practical approach to the adrenal pathology is made.

Simultaneous versus delayed treatment of tobacco dependence in alcohol-dependent outpatients.

INTRODUCTION: There is a high prevalence of smoking among heavy drinkers, which is often forgotten even though it has important health consequences. AIM: To evaluate the effects that providing an intensive tobacco cessation treatment simultaneously with alcohol dependence treatment versus delayed treatment (first alcohol and 6 months later tobacco) has on alcohol and tobacco consumption. METHODS: Ninety-two alcohol-dependent smokers were randomized into either a simultaneous group, in which treatment was given concurrently for quitting both alcohol and tobacco, or a delayed group, in which help to quit smoking was given after 6 months. RESULTS: No differences were found in alcohol abstinence rates in time-to-first relapse or in cumulative abstinence at 6 months. Smoking cessation rates were low overall, but better at 3 months in the simultaneous group, although differences later disappeared. DISCUSSION: Participation in a smoking cessation program does not impair alcohol outcomes, at least during the first 6 months.

Intervención sobre el consumo de tabaco en un paciente con dependencia al alcohol ingresado para la desintoxicación* / Intervention on tobacco consumption in a patient with alcohol dependence admitted for detoxification

Objetivo. Exponer el caso clínico de un paciente con dependencia de la nicotina y del alcohol que ingresa de forma programada para desintoxicación enólica. Material y métodos. Se revisan los antecedentes orgánicos y psiquiátricos del paciente además de la historia toxicológica y sus repercusiones sociales. Resultados. Se realiza un tratamiento de desintoxicación programado con ansiolíticos y terapia grupal. Por otro lado, se aprovecha la ocasión para intervenir en el hábito tabáquico. El paciente decide reducir el consumo y se le procura apoyo psicológico y farmacológico. Conclusión. Un ingreso para desintoxicación de cualquier sustancia adictiva es una ocasión idónea para incidir en el consumo de tabaco (AU)

Objective. To present the case of an alcoholic patient with a scheduled admission for alcohol detoxification. Material and methods. Organic and psychiatric pathology are reviewed as well as toxicological history taking into account social problems related. Results. During admission the patient receives anxiolytics, group psychotherapy and advice on smoking too. He decides to reduce consume and is helped with psychological and pharmacological treatment. Conclusions. Detoxification admission is an opportunity to insist on smoking cessation (AU)

Características de personalidad en pacientes alcohólicos mediante el cuestionario Temperament and Character Inventory (TCI). Diferencias según la existencia de abuso de benzodiacepinas (BZD) y trastornos de la personalidad / Personality profile in alcoholic inpatients by TCI questionnaire. Differences between abusers and non abusers of benzodiazepines and between patients with personality disorders and patients without

Objetivos: Se pretende hallar características de personalidad diferenciales mediante el cuestionario TCI entre pacientes alcohólicos con o sin abuso de benzodiazepinas (BZD) o trastorno de la personalidad (TP) para convertirlos en criterios de mal o buen pronóstico y poder usarlos como dianas psicoterapéuticas. Metodología: Estudio transversal de 218 pacientes alcohólicos ingresados para desintoxicación, comparando las puntuaciones TCI entre abusadores o no de BZD y entre pacientes con TP o sin él. Resultados: los pacientes con abuso de BZD tienen mayor puntuación en Evitación del daño y menor en Autodirección que los no abusadores. Los pacientes con TP presentan mayor puntuación en Búsqueda de la Novedad y menor en Cooperación que los pacientes sin TP. Conclusiones: Los pacientes abusadores de BZD son menos maduros y autosuficientes, más influenciables, inseguros y muy evitadores de los riesgos. Los pacientes con TP se caracterizan por ser más impulsivos y menos cooperadores. Las características encontradas con el TCI son coherentes con las dificultades de estos pacientes durante el tratamiento y con las impresiones clínicas. Estas áreas problemáticas deberían convertirse en objetivos terapéuticos a modificar mediante el tratamiento. Por todo ello el TCI se revela un instrumento útil en la comprensión, evaluación e identificación de los pacientes alcohólicos y sus necesidades de tratamiento

Objective: To find differential personality traits, through the TCI questionnaire, between alcoholic patients who abuse benzodiazepines (BZD) and those who do not, and between patients affected by personality disorders (PD) and those not affected. These traits can then be used as criteria of good prognosis and as psychotherapeutic targets. Methods: Cross sectional study of 218 alcoholic inpatients, comparing TCI scores between BZD abusers and non-abusers, and between PD-affected patients and non-PD-affected patients. Results: BZD-abusing patients score higher in Harm Avoidance and lower in Self-Directedness than non-abusers. Patients with PDscore higher in Novelty-Seeking and lower in Cooperativeness than patients without PD. Conclusions: BZD-abusing patients are less mature and self-sufficient, more impressionable, insecure, and have a high tendency to avoid risk. Patients with PD are more impulsive and less cooperative. The characteristics found with TCI are coherent with the difficulties of these patients during treatment and with clinical impressions. These problematic areas should become therapeutic targets to be modified through treatment. For all of these reasons the TCI emerges as a useful instrument for understanding, assessing and identifying alcoholic patients and their treatment needs

[Group psychotherapy with young alcoholics: specialization or integration?]. / Grupos de terapia para alcohólicos jóvenes: especialización o integración?

INTRODUCTION: Group therapy (GT) is widely used in the treatment of alcoholism. Nevertheless, few data are available on the inclusion criteria for specific individual, as well as on specific group, techniques for the management of some types or groups of patients with homogeneous characteristics. METHOD: Compliance with group therapy has been analyzed in a sample of 459 alcoholics under 36 years of age, 303 of whom were placed in specific GT for young people (Y groups) and 156 were allocated in standard GT (NY) groups. RESULTS: Similar rates of discharge (16.8% vs 18.6%), withdrawals and drop-outs (63.4% vs 61.5%) of patients have been found in both groups. No differences were found in the survival function of time of compliance adjusted for gender and age (Y: 27.2%, and NY: 33.3% at one year, and Y: 18.4%, and NY: 21% at 2 years). CONCLUSIONS: There is no scientific evidence to support the use of Y groups in the treatment of young alcoholics. On the other hand, the possibility still exists that the use of groups with composition, techniques and specific objectives may provide improvement in compliance and in the therapeutic results as long as they adequately identify the characteristics of the patients who may benefit from a homogeneous treatment.

Grupos de terapia para alcohólicos jóvenes: ¿especialización o integración? / Group psychotherapy with young alcoholics: specialization or integration?

Introducción. A pesar de la amplia utilización de la terapia grupal (TG) para tratar el alcoholismo no existen criterios para su indicación individualizada a los distintos pacientes ni para el diseño de tipos o técnicas específicas de TG para algunas clases o grupos de enfermos con características homogéneas.Método. Se ha comparado la adherencia a la TG de 459 pacientes alcohólicos menores de 36 años, de los cuales 303 fueron asignados a grupos de TG específicos para jóvenes (grupos J) y 156 a grupos de TG convencionales (grupos NJ).Resultados. Los resultados del estudio han revelado similares porcentajes de altas (16,8 frente a 18,6 %), bajas y abandonos (63,4 frente a 61,5 %), así como similar supervivencia una vez ajustada la edad y el sexo, en ambos tipos de grupos de TG (J: 27,2 % y NJ: 33,3% al año; J: 18,4 % y NJ: 21 % a los 2 años).Conclusiones. Se concluye que no hay evidencias científicas que apoyen el uso de grupos de TG especializados para pacientes jóvenes. En cambio sigue abierta la posibilidad de que el empleo de grupos con composición, técnicas y objetivos específicos puede proporcionar una mejora en la adherencia y en los resultados terapéuticos siempre que se identifiquen convenientemente las características de los enfermos que pueden beneficiarse de un tratamiento homogéneo

Introduction. Group therapy (GT) is widely used in the treatment of alcoholism. Nevertheless, few data are available on the inclusion criteria for specific individual, as well as on specific group, techniques for the management of some types or groups of patients with homogeneous characteristics.Method. Compliance with group therapy has been analyzed in a sample of 459 alcoholics under 36 years of age, 303 of whom were placed in specific GT for young people (Y groups) and 156 were allocated in standard GT (NY) groups.Results. Similar rates of discharge (16.8 % vs 18.6 %), withdrawals and drop-outs (63.4 % vs 61.5 %) of patients have been found in both groups. No differences were found in the survival function of time of compliance adjusted for gender and age (Y: 27.2 %, and NY: 33.3 % at one year, and Y: 18.4 %, and NY: 21 % at 2 years).Conclusions. There is no scientific evidence to support the use of Y groups in the treatment of young alcoholics. On the other hand, the possibility still exists that the use of groups with composition, techniques and specific objectives may provide improvement in compliance and in the therapeutic results as long as they adequately identify the characteristics of the patients who may benefit from a homogeneous treatment

Repercusiones multiorgánicas de la inhalación de alcohol isopropílico y cloruro de metileno como substancias de abuso / Multiorganic involvement after inhalation of isopropyl alcohol and dichloromethane as a form of substance abuse

En España el consumo de substancias de abuso está muy extendido. Entre las drogas ilegales destaca, en el momento actual, la prevalencia de consumidores de cannabis, derivados anfetamínicos y cocaína. Los inhalables volátiles, como las colas, pegamentos, gasolina y disolventes, representan otra forma de consumo de drogas, pero que está poco arraigada en nuestro medio. Se presenta el caso de una mujer snifadora crónica de una laca para el pelo, que contenía alcohol isopropílico y cloruro de metileno, y que fue remitida al Servicio de Urgencias por una sobredosis. Durante el ingreso se constataron alteraciones en las estructuras subcorticales de los lóbulos frontales, en la biología hepática y renal y en las pruebas funcionales respiratorias. También se objetivó una disfunción de la citocromooxidasa mitocondrial. La paciente evolucionó favorablemente

Substance abuse is widespread in Spain. Currently, the consumption of cannabis, amphetamine derivatives and cocaine is notable. Volatile inhaled substances such as glue, petrol and solvents are forms of substance abuse whose use in Spain is comparatively infrequent. We present the case of a female chronic sniffer of hair lacquer, containing isopropyl alcohol and dichloromethane, who was admitted to the emergency department after an overdose. Tests revealed alterations in the subcortical structures of the frontal lobes, hepatic and renal abnormalities, and deficits in respiratory function tests, all of which were attributed to chronic solvent abuse. Mitochondrial cytochrome oxidase dysfunction was also observed

[Efficacy of group therapy of alcoholics. Results of a controlled clinical trial]. / Eficacia de la terapia de grupo para alcohólicos. Resultados de un ensayo clínico controlado.

BACKGROUND: Group therapy is widely used in psychiatry and psychology, specially in the treatment of alcoholism. Nevertheless, scientific evidence of its efficacy is scarce, and professionals tend very often to doubt about its usefulness. METHODS: Clinical trial to test the efficacy of group therapy to improve abstinence and compliance of alcoholics (CIE-10 criteria) randomly assigned to standard treatment plus group therapy (TG+, n = 45) versus standard treatment alone (TG-, n = 43) during 12 months. RESULTS: At 6 months follow up, the percentage of alcohol consumers (26 vs 20%) and dropouts (49 vs 36%), was slightly higher among the TG- group; while Cumulated Abstinence Duration (131 days [SD 57] versus 135 days [SD 64]) tended to be higher in the TG+ group. Differences increase at the one year follow up, reaching a significant level when measuring time to first relapse (233 vs 382 days; p = 0.04). Also, the probability to remain abstinent is clearly lower in the TG- (31 vs 76%). CONCLUSIONS: These results clearly show the efficacy of group therapy. Its effect appears from the 3rd month and increases from 6th to 12th months. Some patients, specially those who will have worse clinical evolution, refuse to attend group sessions. Also, some others who don't accept an abstinence oriented treatment, may interfere in group dynamics. In order to maximize group efficacy, extreme care should be taken in selection of patients, group composition, setting and leadership style.