[Contribution of dissociative symptoms to antisocial behavior in a sample of high-school students]. / Contributions des symptômes dissociatifs aux comportements antisociaux dans un échantillon d'adolescents scolarisés.

INTRODUCTION: The link between dissociative disorders and delinquent behavior has been reported in forensic and clinical adolescents. Despite the frequency of dissociative symptoms in nonclinical adolescents, the relation between dissociative disorders and antisocial behavior has not been studied in community samples of adolescents. AIM OF THE STUDY: The aim of this study is to investigate the relative contribution of dissociative symptoms and other psychopathological variables (depressive symptoms, borderline and psychopathic personality traits often reported to be associated with behavioral problems) to antisocial behavior in a sample of high-school students. METHOD: A sample of 130 participants (84 girls, 46 boys; mean age=16.9+/-1.2) completed self-report questionnaires, the adolescent-dissociative experience scale (A-DES), the center for epidemiological studies-depression scale (CES-D), the Levenson self-report psychopathy scale (LSRP), the scale of the personality disorder questionnaire (PDQ-4+) assessing the borderline personality traits, and the scale of the PDQ-4+ assessing antisocial behavior and antecedent of conduct disorder (aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules) for the diagnosis of antisocial personality disorder. In the present study, the internal consistency of these scales was satisfactory or excellent as assessed using Cronbach's alpha. Regarding the A-DES, the CES-D, the borderline traits scale, the antisocial behavior scale, alphas were 0.94, 0.76, 0.78, and 0.91, respectively. The consistency of the LSRP scale assessing callousness (a callous, selfish, and manipulative use of others), which is considered as the core dimension of psychopathy was satisfactory (alpha=0.83), whereas the consistency of the scale assessing impulsivity was poor (alpha=0.49). This scale was not used in the present study. RESULTS: The comparison between boys and girls revealed the differences usually reported in studies on community samples of adolescents. Girls displayed higher scores on dissociative and depressive symptoms, and borderline traits. Boys had higher score on callousness. Among girls, dissociative symptoms were positively and moderately related to depressive symptoms (r=0.62, p<0.05), borderline traits [(r=0.62, p<.05), callousness (r=0.41, p<0.05). Among boys, these associations were weaker (depressive symptoms, (r=0.45, p<0.05); borderline traits, (r=0.47, p<0.05); callousness, (r=.24, NS)]. A multiple regression analysis predicting antisocial behavior with the psychopathological variables showed that sex was a significant predictor (p<0.01). The analysis was repeated for males and females separately. Among boys, the model explained a negligible fraction of the variance in antisocial behaviors (R(2)=0.12). No predictors were significant, perhaps because of the lack of power of this analysis (dissociative symptoms, beta=0.07, p=0.71; CES-D, beta=0.20, p=0.22; borderline traits, beta=0.19, p=0.30; callousness, beta=0.17, p=0.27). Among girls, the model explained a modest part of the variance (R(2)=0.30). Dissociative symptoms were the strongest predictor of antisocial behavior (beta=0.54, p<0.001). Depressive symptoms were significantly and negatively related to antisocial predictor (CES-D, beta=-0.36, p=0.006). Borderline traits (beta=0.08, p=0.54) and callousness (beta=0.18, p=0.009) were not significant predictors. DISCUSSION: As in other studies, antisocial behavior appeared more linked to psychopathological variables in girls than in boys. The most salient result was the influence of dissociative symptoms on antisocial behavior in girls contrary to boys. Three hypotheses may explain this link: dissociative symptoms may facilitate antisocial acting-outs; dissociation may be a defense against anger and affect dysregulation; antisocial behavior and dissociative symptoms may be linked to a third variable such as trauma antecedents. Whereas depressive symptoms were positively linked to antisocial behavior among boys, depressive symptoms were negatively and significantly linked to antisocial behavior among girls. Depressive symptoms may inhibit antisocial behavior in girls. The association between dissociative and depressive symptoms and antisocial behavior in girls warrants further studies.

[Nutritional status assessment in leprous hospitalized patients in Argentina]. / Evaluación del estado nutricional de pacientes en un hospital con lepra en Argentina.

INTRODUCTION: Leprosy is a regional problem of public health in the Argentine Republic. It has seen a continuous decrease of the prevalence in the last 10 years, with value is about 0.17/10000 citizen and the detection rate is constant about 0.10/10000 citizen. Even the death rate is low, its importance is given for the physicals, socials, permanents and the progressive disabilities that its produce if there no early diagnostic and a regular and complete treatment. The Dr. Baldomero Sommer National Hospital, that give a complete assistance to the leprosy patients either to the pavilion patients or the ill patients that help oneselves and live in houses with their families and where it is given food assistance to promote and increase their quality of life. OBJECTIVES: Evaluate The nutritional state of the ill patients that help oneselves and live in houses with their families. Analyze the caloric and proteic brought by the institution. MATERIAL AND METHODS: It is a transversal and descriptive study. We made a nutritional evaluation of the patients that live in each of the 4 suburb of the hospital, whom has been previously appointed by the coordinator of the zone, with the porpoise of identify the nutritional state of each one of the patients, quantify the nutritional risk, and indicate, adequate and monitories the nutritional support. The diagnostic was realized by the dietician through: anthropometric parameters (weight, height and body mass index), biochemical parameters, according to the clinical history: albumin, cholesterol, urea, hematocrito and associated illness. RESULTS: We evaluated 219 patients of 246, with a middle age of 56.4 years, 62.2% males and 57.8% females. We detected that obesity was the nutritional disorder with mayor prevalence in these population (74.3%) and with mayor incidence in the moderate obesity in males and mayor incidence in severe obesity in females. The prevalence of malnourishment was 3.6% and well-nourished was 23.7%, 27 of the patients (10.9%) did not go to the nutritional evaluation. The 2.8% of the patients did not have an actual laboratory for more than 2 years. In the clinical histories, we found that the dosage of albumin in an average of 4.2 g/dl, and the 2.8% of the patients did not have any value of albumin. The values of hematocrito and urea determinate an adequate brought of proteins in the evaluated population. Inside the nutritional diagnostic we considerate the search of diabetes (present ion the 9.7% of the patients), dislipemia (present ion the 32.8% of the patients, taken a level of 200 mg / dl of cholesterol), chronic renal deficiency (present in the 9.3% of the patients), and arterial hypertension (present in the 33.6% of the patients). CONCLUSIONS: Exist a high prevalence of moderate-severe obesity in the studied population that have no coincidence with the universal literature. These data shows the necessity to adequate the caloric and proteic brought to the patients. The majority of the patients presented Dislipemia and or diabetes and or arterial hypertension. Promote the development of educational programs to better the nutritional state of the risk population, better the quality of life and reduce cardiovascular risks, using an international model that include strategies for the following of a health diet and an increase of physical activity.

Evaluación del estado nutricional de pacientes en un hospital con lepra en Argentina / Nutritional status assessment in leprous hospitalized patients in Argentina

Introducción: En la República Argentina la Lepra es un problema de salud pública regional. Se observa un continuo descenso de la tasa de prevalencia en los últimos 10 años. El hospital Nac. Dr. Baldomero Sommer brinda asistencia integral al enfermo de Lepra en las modalidades de atención de los pacientes en pabellones y salas de internación en casas que habitan enfermos autoválidos y sus familiares, donde se les provee asistencia alimentaria . Objetivos: Evaluar el estado nutricional de pacientes que residen en el hospital. Analizar el aporte calóricoproteico brindado por la Institución. Material y métodos: Estudio Transversal y Descriptivo. Se realizó una Evaluación Nutricional a los pacientes que residen en los 4 barrios que se encuentran en el hospital. Se obtuvo información disponible en las historias clínicas sobre Parámetros Bioquímicos y de las patologías asociadas prevalentes. Resultados: Se evaluaron 219 pacientes, de un total de 246, edad promedio 56,4 años, 62,2% Hombres y 37,8% Mujeres. La Obesidad resultó el trastorno nutricional de mayor prevalencia (74,3%). Desnutrición 3,6%, Eunutridos 23,7%. No concurrieron a la evaluación 10,9% de los pacientes y 2,8% no tenían laboratorio actualizado (+ de 2 años). El promedio Albúmina fue 4,2 g/dl, 28,45% no tenían registrado valor de Albúmina. Los valores de Hto, Urea determinaron un adecuado aporte proteico. Dentro del diagnóstico nutricional se tuvo en consideración la búsqueda de patologías prevalentes como Diabetes que estuvo presente en el 9,7% de los pacientes, Dislipidemia = 32,8%, IRC = 9,3%, HTA = 33,6%. Conclusiones: Existe una alta prevalencia de Obesidad Moderada-Severa en la población estudiada que no es coincidente con la literatura actual y pone de manifiesto la necesidad de adecuar a la brevedad el aporte calórico-proteico. Impulsar medidas preventivas a través de Programas de Educación con el propósito de mejorar el estado nutricional de la población en riesgo, mejorar la calidad de vida, reducir los factores de riesgo cardiovasculares, utilizando un modelo de intervención que incluya estrategias para el seguimiento de una dieta saludable y el aumento de la actividad física

Introduction: Leprosy is a regional problem of public health in the Argentine Republic. It has seen a continuous decrease of the prevalence in the last 10 years, with value is about 0.17/10000 citizen and the detection rate is constant about 0.10/10000 citizen. Even the death rate is low, its importance is given for the physicals, socials, permanents and the progressive disabilities that its produce if there no early diagnostic and a regular and complete treatment. The Dr. Baldomero Sommer National Hospital, that give a complete assistance to the leprosy patients either to the pavilion patients or the ill patients that help oneselves and live in houses with their families and where it is given food assistance to promote and increase their quality of life. Objectives: Evaluate The nutritional state of the ill patients that help oneselves and live in houses with their families. Analyze the caloric and proteic brought by the institution. Material and methods: It is a transversal and descriptive study. We made a nutritional evaluation of the patients that live in each of the 4 suburb of the hospital, whom has been previously appointed by the coordinator of the zone, with the porpoise of identify the nutritional state of each one of the patients, quantify the nutritional risk, and indicate, adequate and monitories the nutritional support. The diagnostic was realized by the dietician through: anthropometric parameters (weight, height and body mass index), biochemical parameters, according to the clinical history: albumin, cholesterol, urea, hematocrito and associated illness. Results: We evaluated 219 patients of 246, with a middle age of 56.4 years, 62.2% males and 57.8% females. We detected that obesity was the nutritional disorder with mayor prevalence in these population (74.3%) and with mayor incidence in the moderate obesity in males and mayor incidence in severe obesity in females. The prevalence of malnourishment was 3.6% and well-nourished was 23.7%, 27 of the patients (10.9%) did not go to the nutritional evaluation. The 2.8% of the patients did not have an actual laboratory for more than 2 years. In the clinical histories, we found that the dosage of albumin in an average of 4.2 g/dl, and the 2.8% of the patients did not have any value of albumin. The values of hematocrito and urea determinate an adequate brought of proteins in the evaluated population. Inside the nutritional diagnostic we considerate the search of diabetes (present ion the 9.7% of the patients), dislipemia (present ion the 32.8% of the patients, taken a level of 200 mg / dl of cholesterol), chronic renal deficiency (present in the 9.3% of the patients), and arterial hypertension (present in the 33.6% of the patients). Conclusions: Exist a high prevalence of moderate-severe obesity in the studied population that have no coincidence with the universal literature. These data shows the necessity to adequate the caloric and proteic brought to the patients. The majority of the patients presented Dislipemia and or diabetes and or arterial hypertension. Promote the development of educational programs to better the nutritional state of the risk population, better the quality of life and reduce cardiovascular risks, using an international model that include strategies for the following of a health diet and an increase of physical activity

[Study of dissociative disorders and depersonalization in a sample of young adult French population]. / Etude des troubles dissociatifs et de la dépersonnalisation au sein d'un échantillon de la population française adulte jeune.

UNLABELLED: Questioned by several researches about dissociative disorders, the authors study differences established on the nosographic register, through a quantitative study and a psychodynamic argumentation in a sample of french population. From the utilisation of the Dissociative Experiences Scale (DES) created by Bernstein E and Putnam FW (1986), which is an excellent screening tool for dissociative disorders and constructed on DSM II diagnostic criterions, the authors will show the interest of a psychodynamic analysis of dissociative disorders, in the face of the diagnostic difficulty in relation to several approaches of this concept. This difficulty is studied giving the background to dissociative disorders and depersonalization. Ionescu (1999) shows that between 1890 and 1910 dissociation represents one of major themes of psychology, psychopathology and psychiatry. Then, this interest about dissociation decreases and will be almost non-existent in the middle of the twentieth century. The interest for dissociative disorder will grow in the eighties with north-american studies about multiple personality disorders. Until 1980, dissociative disorders exist in DSM II as a list of symptoms included into hysterical neurosis, among the conversive disorders. In 1980, the publication of DSM III replaces the notion of hysteria with the notion of dissociative disorder. In this way, we can see on the one hand somatoform disorders quarterly corresponding to the ancient version of conversive hysteria, and on the other hand dissociative disorders characterized by a perturbation of consciousness, memory, identity or perception of environment. In 1994, The DSM IV delete the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They include now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). Depersonalization disorders consist of "persistent or recurrent episodes of depersonalization characterized by a feeling of detachment or estrangement from one's self. The individual may feel like an automation or like he or she is living in a dream or movie" (DSM IV). Depersonalization disorder cannot be diagnosed if it is part of schizophrenia, panic disorder, acute stress disorder or dissociative identity disorder. Various depressive disorders, hypocondriasis or obsessive-compulsive disorders can accompany depersonalization disorder. The first purpose of this study will search the frequency of dissociative disorders and depersonalization in a sample of normal population. Further, the inclusion of depersonalization amongst dissociative disorders seems not so evident: depersonalization belongs to self-consciousness disorder in french psychiatry. This fact seems more logical insofar as dissociative disorders have all together a memory and consciousness perturbation, and this perturbation is missing from depersonalization's feeling. The second purpose will be to clarify and specify the particularity of depersonalization among dissociative diorders, from the psychopathological point of view. METHODOLOGY: The sample (n = 248) is made up of french young adults aged 17 to 30 (mean age = 20, SD = 15 and 24% is male population). Subjects were streamming from universities. The screening tool which was used is the Dissociative Experiences Scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. Normal scores are in the range of 5 to 15 in american adults. RESULTS: The utilization of principal component analysis (PCA) with varimax rotation is justified by the will to compare this study with American's studies. The mean score obtained is 17.44%, and 13.3% of the scores exceed a psychiatric threshold at 30%. The descriptive analysis shows that the component 1 (PCA without varimax rotation) represents 33.02% of total explained variance. This result demonstrates that the structure of the DES is based on one concept, the same as the american population, it is the concept of dissociation. The Principal Component Analysis with varimax rotation of the DES ratings yielded a tree-factor solution: imaginative absorption (F1), depersonalization-derealization (F2) and dissociative amnesia (F3). Mean score for each factor is respectively: F1 = 21.56%, F2 = 13.95%, F3 = 11.04%. DES reliability was studied through computation of Cronbach's coefficient (0.92). The PCA with varimax rotation brings to the fore a full dissociative disorder without any trouble of memory and consciousness. This fact questions again once more the link between hysteria and dissociative disorders. There is here a clinical distinction between depersonalization-derealization and other dissociative disorders. Indeed, the absence of significant alteration of memory and conscience is specific of depersonalization and derealization in this study. CONCLUSION: Finally, this study concurs with DSM IV dissociative criterions. At last, one factor of PCA is composed by the association of depersonalization and derealization, in contradiction with DSM IV definition. This result shows that, into the french population, we cannot divide the two concepts.

[POEMS syndrome]. / Síndrome de POEMS.

Poems syndrome is a rare multisystemic disorder. It manifestations are Polyneuropathy, Organomegaly, Endocrinopathy, and/or Edema, Monoclonal protein and changes in the Skin. (P.O.E.M.S.) Though some bibliography make no difference with osteoesclerotic myeloma it is considered a real syndrome. The polyneuropathy is customarily severe. Although high levels of immunoglobulins has been found in the poems, it has not been isolated a specific antibody that explain the polyneuropathy even though it is strongly suspected. The organomegaly, endocrinopathy, changes in the skin and other systems and involved organs could be in relationship to products secreted by plasmatic cells. We review the physiopathology and bibliography of the Poems, especially its neurological expression its nosologic location different from osteosclerotic myeloma and a possible relationship to the Herpes Virus 8. It was crossed in Medline the terms P.O.E.M.S. and syndrome and were obtained 271 abstracts that were all examined and finally selected the bibliography considerate meaningful for the objectives. It is presented briefly a case. P.O.E.M.S. is a syndrome that is associated to multiple plasma cell dyscracia, included the osteoesclerotic myeloma. Prognosis and the treatment vary with the underlying disease. As physiopathology of this syndrome is insinuated the action of the interleukins 1-beta (IL-1 beta) and 6 (IL-6), the vascular growth endothelial factor (VGEF), the tumoral necrosis factor alpha (TNF-alpha) and antibodies anti-nerve. The P.O.E.M.S. is a syndrome with own identity. The Herpes Virus 8 may plays a key rol to uncover the Poems physiopathology.

Síndrome de POEMS. / [POEMS syndrome]

Poems syndrome is a rare multisystemic disorder. It manifestations are Polyneuropathy, Organomegaly, Endocrinopathy, and/or Edema, Monoclonal protein and changes in the Skin. (P.O.E.M.S.) Though some bibliography make no difference with osteoesclerotic myeloma it is considered a real syndrome. The polyneuropathy is customarily severe. Although high levels of immunoglobulins has been found in the poems, it has not been isolated a specific antibody that explain the polyneuropathy even though it is strongly suspected. The organomegaly, endocrinopathy, changes in the skin and other systems and involved organs could be in relationship to products secreted by plasmatic cells. We review the physiopathology and bibliography of the Poems, especially its neurological expression its nosologic location different from osteosclerotic myeloma and a possible relationship to the Herpes Virus 8. It was crossed in Medline the terms P.O.E.M.S. and syndrome and were obtained 271 abstracts that were all examined and finally selected the bibliography considerate meaningful for the objectives. It is presented briefly a case. P.O.E.M.S. is a syndrome that is associated to multiple plasma cell dyscracia, included the osteoesclerotic myeloma. Prognosis and the treatment vary with the underlying disease. As physiopathology of this syndrome is insinuated the action of the interleukins 1-beta (IL-1 beta) and 6 (IL-6), the vascular growth endothelial factor (VGEF), the tumoral necrosis factor alpha (TNF-alpha) and antibodies anti-nerve. The P.O.E.M.S. is a syndrome with own identity. The Herpes Virus 8 may plays a key rol to uncover the Poems physiopathology.