Melancholic major depression and epilepsy.

An analysis is carried out of a set of psychic phenomena appearing always in the same way: an experience suddenly invades the consciousness, unfolding automatically and with great intensity. This psychic automatism, of which the patient is a passive observer, is accompanied by an overwhelming feeling of strangeness. Our hypothesis is that these phenomena are the expression of partial seizures with a psychic content, and the name Paroxysmal Psychic Automatisms is proposed for all of them. A comparative study is then made of the phenomenology of partial seizures with a psychic content, on the one hand, and of that of melancholic major depression, on the other. It reveals a wealth of clinical information indicating an overlap between the two conditions. Finally, a set of well-established scientific data is analysed concerning epilepsy and depression, especially epidemiological and psychopharmacological information, which takes on a new meaning in the light of the hypothesis developed in this paper.

Epileptic consciousness: concept and meaning of aura.

This research is based on previous publications that have analyzed certain neuropsychological phenomena that always have the same characteristic clinical features: a vivid experience of sudden onset and automatic development, accompanied by an intense sensation of strangeness. When these automatisms are accompanied by only mental symptoms, the designation paroxysmal psychic automatisms (PPAs) is proposed, and they should be interpreted as partial seizures (PSs) with a psychic content whenever they clearly exhibit the four features of suddenness, passivity, intensity, and strangeness. This interpretation is based on the existence of a wealth of scientific literature indicating an overlap between PPAs and PSs; moreover, bibliographic reviews indicate that the clinical signs just defined as characterizing PPAs are precisely those defining the epileptic consciousness.

Panic and epilepsy.

Research is presented to support a hypothesis that panic attacks, when they have the same clinical signs as the epileptic consciousness, should be diagnosed as partial seizures with a psychic content. After setting out the four clinical signs defining it (suddenness, automatic nature, great intensity and strangeness), an extensive review of the literature is made in search of scientific information to support the hypothesis, which reveals a wealth of concurring scientific evidence, at both the clinical and preclinical levels, to support the hypothesis presented here. In conclusion, new research is proposed with a view to drawing up interviews and clinical scales in order to quantify the four clinical signs objectively.

[Reflex sympathetic dystrophy: psychological and psychopathologic features]. / Distrofia simpático refleja: aspectos psicológicos y psicopatológicos.

It has traditionally been accepted that a predisposing psychological field exists with the appearance of the reflex sympathetic dystrophy. Nevertheless, there is no unanimous agreement in this interpretation, since surveys exist unanimous are in favour the reactive character of the psychological effect on reflex sympathetic dystrophy. In this study, we revise literature already published on the subject, present arguments on the psychological evaluation tests carried out to date and propose the possibility of using other test unanimous are easier to manage and to interpret.

Three forms of somatization presenting in primary care settings in Spain.

The objective of this paper is to study the prevalence and clinical characteristics of functional, hypochondriacal, and presenting somatization (FSTS, HSTS, and PSTS, respectively) defined by standardized criteria, as well as the validity of their distinction in primary care in Spain. A two-stage epidemiological study of a representative sample (N = 1559) of primary care patients was carried out. In the first phase, the validated Spanish versions of General Health Questionnaire, Mini-Mental State Examination, and CAGE were used. In the second phase, the Standardized Polyvalent Psychiatric Interview, an interview for the multiaxial assessment of medical patients, was employed. The prevalence of any form of somatization in Spain was 21.3% (FSTS: 16.2%, PSTS: 9.4%, HSTS: 6.7%). Overlap of any of the three clinical forms was very frequent (42.7%). FSTS patients tended to be more chronic and showed higher scores in fatigue but lower scores in both depression and anxiety. Chronicity was frequent among somatizers, particularly in those who fulfilled more than one kind of somatization. Differences in diagnostic distribution among the three groups were also observed. In conclusion, this is the first study giving support to the validity of the distinction among three types of somatization in Spain, but overlap was more frequent than reported in North American studies.

Attribution in somatizers: stability and relationship to outcome at 1-year follow-up. Grupo Morbilidad Psiquica y Psicosomática de Zaragoza (GMPPZ).

The aim of this study was to determine whether attributional style is a stable pattern in somatizers, to analyse the sociodemographic and psychopathological characteristics that can modify it, and to study the relationship between attributional pattern and outcome. A total of 147 somatizers and 46 psychologizers from a representative sample (n = 1559) of primary care patients in Zaragoza, Spain were followed up for 1 year. Attribution of somatic symptoms was a stable construct in somatizers. Patients who modified attribution were younger (by 15 years on average), tended to be without a partner, and had a shorter illness duration (by 20 months on average) than those who maintained it. Attribution showed no correlation with outcome at the 1-year follow-up.

[The approach to pulmonary ventilation change]. / Aproximación a la alteración ventilatoria pulmonar.

OBJECTIVE: To study the epidemiological behaviour of pulmonary diseases with ventilation disorder to assess their development within primary care. DESIGN: Prospective study. SETTING: Primary care. Tudela West Health Centre (Navarra). PARTICIPANTS: 166 patients with one of the classic patterns of disorder found by Spirometry were chosen and monitored for a year. RESULTS: 72.3% were male with an average age of 63.2. 7.8% were new cases. 62.0% were smokers/ex-smokers. 80.1% had another associated pathology. An overall decrease in ventilatory function values was noted: this was more pronounced in cases of recurrence. 2.08 medicines were used, with smaller FEV1 [correction of FVE1]-fraction of ventricular ejection-leading to more medicines, of which the beta-adrenergics were the most common. 25.3% showed poor therapeutic compliance, deteriorating with age. 55% used inhalers badly. The number of medicines increased with decompensation. There were on average 3.5 consultations per year at the health centre. CONCLUSIONS: Tudela's findings are similar to those in other areas. There is poor therapeutic compliance among people of geriatric age. The burden of control falls on primary care.

Screening of somatization disorder: validation of the Spanish version of the Othmer and DeSouza test.

The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.

Somatisation in primary care in Spain: I. Estimates of prevalence and clinical characteristics. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza.

BACKGROUND: This is the first attempt to study the prevalence and clinical characteristics of somatisation (ST) in a representative primary care sample in Spain. METHOD: The sample consisted of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, Spain, examined by two-phase screening. First phase (lay interviewers): Spanish versions of GHQ-28, CAGE questionnaire, substance abuse, Mini-Mental State Examination. Second phase (research clinicians and psychiatrists): Standardised Polyvalent Psychiatric Interview, which permits the reliable coding of Bridges & Goldberg's ST criteria. RESULTS: The prevalence of somatisers was 9.4% (34.5% of the cases) and most patients (68.7%) were diagnosed in the depression or anxiety DSM-IV categories. The severity was moderate in 401% and 66.6% were chronic (six or more months). No significant demographic differences were found with non-cases. Backache was the most frequent somatic presentation (71.4+%). CONCLUSIONS: ST in primary care is a much broader phenomenon than categories such as somatoform disorders reflect. It may be less influenced by sociodemographic factors, but more chronic than previously reported.

Somatisation in primary care in Spain: II. Differences between somatisers and psychologisers. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza.

BACKGROUND: This study is the first attempt to document the differences between somatisers (STs) and psychologisers (PGs) in Spanish primary care patients. METHOD: A sample of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, were examined in a two-phase screening using Spanish versions of GH-28, CAGE questionnaire, substance abuse, MMSE and SPPI. STs and PGs were diagnosed according to operationalised Bridges & Goldberg's criteria. RESULTS: ST was found to be three times more prevalent than PG, but the ratio ST: PG was highest (10.5) in the DSM-IV category dysthymia. Generalised anxiety disorder was the most frequent diagnosis in STs and major depressive episode the most frequent in PGs. No significant differences between the two groups have been found in demographic characteristics. Total GHQ scores were significantly higher in PGs, but global SPPI scores were not. Most psychopathological scores were higher in PGs, but both somatic symptoms and suspiciousness were higher in STs. The psychopathological findings are consistent with hypotheses related to blame avoidance and defensiveness in STs. CONCLUSIONS: ST is three times more prevalent than PG, but the ratio ST: PG depends heavily on diagnostic categories. While most psychopathological scores are higher in PGs, both patient groups are similarly disturbed. Previously assumed socio-demographic differences between STs and PGs have not been found in this study.

[Somatization disorders in primary care: differential clinical aspects. Study Group of Psychic and Psychosomatic Morbidity of Zaragoza, Primary Care Section]. / Trastorno por somatización en atención primaria: aspectos clínicos diferenciales. Grupo de Estudio de la Morbilidad Psíquica y Psicosomática de Zaragoza, Sección de Atención Primaria (GEMPPZ, AP).

BACKGROUND: To identify specific sociodemographic and psychopathological features of somatization disorder (SD) patients in relation to other patients with psychiatric and organic morbidity in primary care (PC) setting. METHODS: A group of SD patients from PC was compared with other two control groups: the first one made of patients with psychiatric morbidity (with or without organic disease) and the second group of patients with only organic disease without psychiatric morbidity. Polivalent standardized psychiatric interview (PSPI), a specific psychiatric interview for PC settings, was used as diagnostic instrument. RESULTS: 1) there is a female predominance in SD statistically significant compared with organic patients and with a trend to significance in relation to psychiatric patients. Age, marital status and educational level show no significant differences among the groups; 2) in relation to psychopathology, SD patients show, in relation with organic patients, statistically higher levels in all items measured by PSPI. On the contrary, SD overwhelmed psychiatric patients in just four items: somatic symptoms, fatigue, reported anxiety and hystrionism as well as sexual problems and lack of social support, and 3) high psychiatric morbidity (85%) in SD, most of them affective and anxiety diagnosis, make it difficult to differentiate from the other patients suffering from psychiatric morbidity in PC. CONCLUSION: Patients with SD show a very different profile compared with those with organic disease in relation to psychiatric symptoms and social problems. On the other hand, when compared with patients with psychiatric disorders, differences are rather scarce. In addition, affective and anxiety comorbidity associated make it difficult the diagnosis. For this reason, the use of screening instruments for SD seems mandatory.

[Anxiety scales and Goldberg's depression: an efficient interview guide for the detection of psychologic distress]. / Escalas de ansiedad y depresión de Goldberg: una guía de entrevista eficaz para la detección del malestar psíquico.

OBJECTIVES: Validation of Goldberg's Anxiety and Depression scales in our settings. DESIGN: Transverse study. Two phases screening at population previously stratified and randomly allocated. SITE. National Health Institute's Primary Care Centres at the city of Zaragoza. PATIENTS AND OTHER PARTICIPANTS: 444 patients, aged 19 and older, who attend their general practitioner for a new episode of illness. The sample has been previously stratified by sex and age. MEASUREMENTS AND MAIN RESULTS: At the first stage the sample has been studied with a Health Survey consisting of a variety of sound validity (General Health Questionnaire-28 items version, spanish version of Folstein's mini Mental Status Examination, CAGE and another drug and over the counter products screening questionnaire) and the new scales, that we attempt to validate. At the second stage "the possible cases" chosen at the first phase and 10% of possible non cases are assessed with a comprehensive Psychiatric Interview: EPEP (Standardized Polyvalent Psychiatric Interview). CONCLUSIONS: The new scales E.A.D.G. have supported their validity for the screening of the most prevalent psychiatric disturbances in primary care settings. Their validity for the screening of the most prevalent psychiatric disturbances in primary care settings. They have outstanding and promising advantages when compared to traditional methods: brevity, simplicity, discriminatory ability between anxiety and depression and usefulness as an interview guideline.

A new interview for the multiaxial assessment of psychiatric morbidity in medical settings.

A new semistructured instrument, the Standardized Polyvalent Psychiatric Interview or SPPI has been developed primarily for assessing medical patients. It has been built on the Clinical Interview Schedule and is intended to evaluate individuals in a multiaxial schema: psychopathology, including duration and severity of disorder; somatic disturbance; social problems and social supports: and pre-morbid personality, with special emphasis on 'neuroticism'. The SPPI generates enough information to allow the use of different research diagnostic criteria, including DSM-III-R, ICD-10 and Goldberg's criteria of 'attribution' of somatic symptoms and 'relationships between psychiatric and physical disorder'. It also includes a section related to recommended treatment. The new interview fulfils standards of feasibility, face and content validity. An incomplete block design, inter-rater reliability study was carried out with a consecutive sample of 48 out-patients referred to the Psychosomatic-Liaison Service of the University Hospital of Zaragoza. A broad range of agreement coefficients were calculated, the results being quite acceptable (most kappas are in the range from 0.7 to 0.9) and tending to support the procedural validity of the interview.

[Standardized evaluation of obsessive phenomena in patients in general medicine. Prevalence and correlations]. / Evaluation standardisée des phénomènes obsessionnels chez les patients de médecine générale. Prévalence et corrélations.

Clinical experience in general hospital psychiatry and literature reviews supported the conjecture that psychopathological disturbances are frequent among medical patients. Wide discrepancies of prevalence data reported by different authors, however, suggested the importance of undertaking screening studies with standardized methods of assessment. Our initial studies in oncological patients confirmed the hypothesis, but also documented obsessive phenomena, assessed with Present State Examination (PSE) criteria, in more than one third of patients diagnosed of depression Consecutive studies in different medical samples have replicated those preliminary findings in the last one, close to one quarter of first day consecutive patients seen in an internal medicine out-patient clinic, and more than three quarters of the ones diagnosed of either anxiety or depression with Research Diagnostic Criteria, had obsessive symptoms as defined by the Clinical Interview Schedule (CIS). Obsessive symptoms, however, have also been observed in individuals considered to be "non-cases" and tend to follow a "continuum" distribution, rather than a categorical one They tend to be more frequent in cases diagnosed as neurotic or reactive, rather than in the endogenous ones and to correlate with neuroticism measured by the EPQ-A. Particularly among out-patients, where the psychopathology seemed to be related to the absence of demonstrable somatic illness and probably to the presence of social distress, the hypothesis could be advanced that obsessive symptoms, among other psychopathological phenomena, are quantitative reactions to environmental situations in predisposed individuals. Nevertheless, in samples such as the endocrine in-patients, correlations have also been demonstrated between obsessive or other psychopathological symptoms and biological deviations such as hormonal levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Emotional disturbances in endocrine patients. Validity of the scaled version of the General Health Questionnaire (GHQ-28).

The 28-item General Health Questionnaire (GHQ) has been validated against the criterion of the Clinical Interview Schedule (CIS) in Spanish patients in hospital with several types of endocrinological illnesses. The screening instrument correctly identified 91 of 100 respondents as exhibiting psychiatric disorder. The questionnaire's efficacy was similar at the time of medical discharge, when the rate of disorder was significantly lower. Significant correlations were found between GHQ total scores and endocrine blood measures in Addison's disease, and in Type I diabetes. The four subscales of the GHQ sum to provide additional information concerning somatic symptoms and anxiety.

Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a Spanish population.

This study confirms the validity of a Spanish version of the General Health Questionnaire in its scaled 28-item version. The screening instrument was tested on a sample of 100 patients attending an internal medicine out-patient clinic, who were examined independently by psychiatrists standardized in the use of the Clinical Interview Schedule (CIS). The questionnaire correctly identified 85% of 'cases' with a cutting score of 6/7 (sensitivity 76.9%, specificity 90.2%), and 83% of cases with a cutting score of 5/6 (sensitivity 84.6%, specificity 82%), suggesting a discriminative power almost as good as the Spanish GHQ-60. It has the important advantage of being considerably shorter and, although the 4 subscales are by no means independent, its concurrent validity with CIS ratings suggests that they provide additional information concerning anxiety and depression.