Hyperprolactinemia associated with psychiatric disorders / Hiperprolactinemia asociada con trastornos psiquiátricos

Abstract Hyperprolactinemia may be associated with psychiatric disorders in the context of two scenarios: antipsychotic-induced hyperprolactinemia and psychiatric disorders arising from the medical treatment of hyperprolactinemia. Both situations are particularly common in psychiatric and endocrine clinical practice, albeit generally underestimated or unrecognized. The aim of this article is to provide tools for the diagnosis and treatment of hyperprolactinemia associated with psychiatric disorders to raise awareness, especially among psychiatrists and endocrinologists, so that these professionals can jointly focus on the appropriate management of this clinical entity.

Resumen La hiperprolactinemia puede asociarse con trastornos psiquiátricos en el contexto de dos escenarios: la hiperprolactinemia inducida por antipsicóticos y trastornos psiquiátricos surgidos por el tratamiento médico de la hiperprolactinemia. Ambas situaciones son particularmente comunes en la práctica clínica psiquiátrica y endocrinológica, aunque generalmente subestimadas o inadvertidas. El objetivo de este artículo es proporcionar herramientas de diagnóstico y tratamiento de la hiperprolactinemia asociada a trastornos psiquiátricos, para concientizar particularmente a psiquiatras y endocrinólogos a enfocar en conjunto el manejo apropiado de esta entidad.

Trastorno de control de impulsos (TCI) en enfermedad de Parkinson / Impulse control disorders (ICD) in Parkinson's disease

RESUMEN Los trastornos del control de impulsos (TCI) son complicaciones psiquiátricas de la enfermedad de Parkinson (EP), cada vez más reconocidos, pero que persisten subdiagnosticados y pueden llegar a ser muy disruptivos para la vida familiar del paciente, en especial si no son detectados a tiempo. Si bien uno de sus principales riesgos es el uso de agonistas dopaminérgicos, estos no son su única causa, se pueden ver sin relación con medicamentos o con cualquier tratamiento para la EP. Por lo tanto, se debe interrogar sistemáticamente por su presencia y educar al paciente y su familia para que sean reportados en cualquier momento. El objetivo de este capítulo es describir los diferentes tipos de TCI, sus factores de riesgo y tratamiento.

SUMMARY Impulse Control Disorders (ICD) are psychiatric complications of Parkinson's Disease (PD), increasingly recognized, but which persist underdiagnosed and can be vert disruptive to the patient's family life, especially if they are not detected in time. Although one of its main risks is the use of dopamine agonists, these are not the only cause, they can be seen without realtion to medications ot any treatment for PD, therefore it should be questioned systematically by their presence and educate the patient and his family to be reported at any time. The objective of this chapter is to describe the different types of ICD, their risk factors and treatment.

Agentes dopaminérgicos centrales análogos N-aralquil metoxilados del 2-aminoindano / Central dopaminergic agents analogues of N-aralkyl methoxylated of 2-aminoindane

RESUMEN La neurotransmisión dopaminérgica interviene en los mecanismos que involucran los procesos motores, cognoscitivos, conductuales y neurocrinos y su mal funcionamiento la involucra en los trastornos neurodegenerativos que afectan al sistema nervioso central (SNC), tales como en la enfermedad de Parkinson y la enfermedad de Huntington, entre otras. Con el propósito de encontrar una solución terapéutica a estas patologías, en publicaciones anteriores hemos reportado la síntesis, la evaluación farmacológica y el estudio teórico computacional de los compuestos análogos mono y dihidroxilados (sobre el anillo indano) del N-aralquil-2-aminoindano 4-8, análogos 4,7-dimetoxi-2-aminoindano-N-aralquil, bajo sus formas metoxiladas sobre el anillo bencénico del fragmento aralquil 9 y el derivado fenólico 10, así como también los análogos diclorados del N-aralquil-2-aminoindano 11 con actividades dopaminérgicas centrales. En el presente trabajo se sintetizaron los clorhidratos del 2-aminoindano- N-[2-(mono o dimetoxi)-fenil)-1-metil-etil] 12-15 y su evaluación farmacológica mostraron respuestas agonísticas como potenciales agentes antihuntington y antipárkinson.

SUMMARY Dopaminergic neurotransmission is implicated in mechanisms that involve motor, cognoscitive, conductual and neurocrine process, and its malfunction involucrates it in neurodegenerative disorders affecting central nervous system (CNS), like Parkinson's disease and Huntington's disease, among others. On the purpose of finding some therapeutic for these pathologies, in previous researches we have reported synthesis, pharmacological evaluation and theoretical computational study of compounds analogues mono or di hydroxilated (on indane ring) of N-aralkyl-2-aminoindane 4-8, analogues 4,7-dimethoxy-2-aminoindane-N-aralkyl, under its methoxylated forms on benzene ring of aralkyl fragment 9 and phenolic derivate 10, also dichlorade analogs of N-aralkyl-2-aminoindane 11 with central dopaminergic activities. In this work were synthesized hydrochlorides of 2-aminoindane-N-[(mono or di methoxy)-phenyl-1-methyl-ethyl] (12-15) and its pharmacologic evaluation showed agonistic responses as potential agents anti Huntington and/or anti Parkinson.

Association between REM sleep behaviour disorder and impulse control disorder in patients with Parkinson's disease. / Relación entre el trastorno de conducta del sueño REM y el trastorno de control de impulsos en pacientes con enfermedad de Parkinson.

INTRODUCTION: The relationship between impulse control disorder (ICD) and REM sleep behaviour disorder (RBD) has not yet been clarified, and the literature reports contradictory results. Our purpose is to analyse the association between these 2 disorders and their presence in patients under dopaminergic treatment. METHODS: A total of 73 patients diagnosed with Parkinson's disease and treated with a single dopamine agonist were included in the study after undergoing clinical assessment and completing the single-question screen for REM sleep behaviour disorder and the short version of the questionnaire for impulsive-compulsive behaviours in Parkinson's disease. RESULTS: Mean age was 68.88 ± 7.758 years. Twenty-six patients (35.6%) were classified as probable-RBD. This group showed a significant association with ICD (P=.001) and had a higher prevalence of non-tremor akinetic rigid syndrome and longer duration of treatment with levodopa and dopamine agonists than the group without probable-RBD. We found a significant correlation between the use of oral dopamine agonists and ICD. Likewise, patients treated with oral dopamine agonists demonstrated a greater tendency toward presenting probable-RBD than patients taking dopamine agonists by other routes; the difference was non-significant. CONCLUSIONS: The present study confirms the association between RBD and a higher risk of developing symptoms of ICD in Parkinson's disease.

Burning mouth syndrome: Clinical description, pathophysiological approach, and a new therapeutic option. / Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica.

INTRODUCTION: Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. METHODS: We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. RESULTS: Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. CONCLUSIONS: Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity.

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome / Tratamento da miocardiopatia periparto com agonista dopaminérgico e subsequente gestação com resultado satisfatório

Abstract Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Resumo Os mecanismos fisiopatológicos da miocardiopatia periparto ainda não são totalmente definidos, apesar de haver forte associação com vários fatores já conhecidos, incluindo a pré-eclâmpsia. O tratamento segue as mesmas recomendações para a insuficiência cardíaca com disfunção sistólica. Estudos clínicos e experimentais recentes sugerem que os produtos de degradação da prolactina podem induzir a miocardiopatia. A supressão farmacológica da produção de prolactina por agonista do receptor D2 da dopamina, bromocriptina ou cabergolina, vem demonstrando resultados satisfatórios na resposta terapêutica do tratamento. Apresentamos o relato de uma primigesta, adolescente, com miocardiopatia periparto que evoluiu para a normalização da função ventricular esquerda após a administração da cabergolina, utilizada como adjuvante na terapêutica da disfunção cardíaca. Subsequentemente, apesar do intervalo entre as gestações ser considerado curto, apresentou evolução satisfatória em uma nova gestação sem qualquer alteração cardíaca durante todo o período gestacional ou puerpério. Os agonistas dopaminérgicos, drogas de uso oral e de preço acessível para a maioria dos centros terciários, em particular em países subdesenvolvidos, não podem ser esquecidos frente a casos de miocardiopatia periparto.

[Clinical and psychopathological factors associated with impulse control disorders in Parkinson's disease]. / Factores clínicos y psicopatológicos asociados a los trastornos del control de impulsos en la enfermedad de Parkinson.

INTRODUCTION: Impulse control disorders (ICD) constitute a complication that may arise during the course of Parkinson's disease (PD). Several factors have been linked to the development of these disorders, and their associated severe functional impairment requires specific and multidisciplinary management. The objective of this study was to evaluate the frequency of ICDs and the clinical and psychopathological factors associated with the appearance of these disorders. METHODS: Cross-sectional, descriptive, and analytical study of a sample of 115 PD patients evaluated to determine the presence of an ICD. Clinical scales were administered to assess disease severity, personality traits, and presence of psychiatric symptoms at the time of evaluation. RESULTS: Of the 115 patients with PD, 27 (23.48%) displayed some form of ICD; hypersexuality, exhibited by 14 (12.2%), and binge eating, present in 12 (10.1%), were the most common types. Clinical factors associated with ICD were treatment with dopamine agonists (OR: 13.39), earlier age at disease onset (OR: 0.92), and higher score on the UPDRS-I subscale; psychopathological factors with a significant association were trait anxiety (OR: 1.05) and impulsivity (OR: 1.13). CONCLUSIONS: ICDs are frequent in PD, and treatment with dopamine agonists is the most important risk factor for these disorders. High impulsivity and anxiety levels at time of evaluation, and younger age at disease onset, were also linked to increased risk. However, presence of these personality traits prior to evaluation did not increase risk of ICD.

Piribedil and Pathological Gambling in six Parkinsonian patients / Piribedil e Jogo Patológico em seis pacientes parkinsonianos

Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them. Method Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG). Results All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Conclusion Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD. .

Os distúrbios do controle do impulso (DCI) na doença de Parkinson (DP) têm atraído crescente interesse. Eles são caracterizados pela incapacidade da pessoa em controlar o impulso para realizar um ato que pode ser prejudicial a ela própria ou aos outros. Embora os agonistas dopaminérgicos (AD), como um grupo, têm sido associados com distúrbios do controle do impulso, o piribedil tem sido relatado raramente como causa dos mesmos. Método Relatos de seis casos de pacientes parkinsonianos em uso de piribedil apresentando jogo patológico (JP). Resultados Todos os pacientes apresentaram DCI com o uso do piribedil. Dois deles receberam piribedil como primeiro tratamento e quatro deles que haviam desenvolvido DCI devido a outro AD, reapresentaram o quadro com piribedil. Conclusão Apesar de o piribedil estar disponível comercialmente apenas em alguns países, deveria ser considerado no diagnóstico diferencial de JP em pacientes com DP. .

Dopaminergic agonists in Parkinson's disease.

BACKGROUND: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. RESULTS: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. CONCLUSIONS: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored.

Avaliação do risco de valvulopatias cardíacas por cabergolina no tratamento de prolactinomas / Risk assessment of cardiac valve disorders by cabergoline to treat prolactinomas

Introdução: Os prolactinomas são os adenomas hipofisários mais comuns, representando 60% dos casos. Tratam-se de tumores geralmente benignos da hipófise, secretores de prolactina (PRL), que ocorrem sobretudo em mulheres com menos de 50 anos. O tratamento medicamentoso dos prolactinomas com agonistas dopaminéricos (AD) é muito eficaz e bem tolerado, levando à redução dos níveis séricos de PRL e até mesmo diminuição do tamanho do tumor, até mesmo com o seu desaparecimento em alguns casos. Atualmente, os AD utilizados para o tratamento de prolactinomas são representados pela bromocriptina (BC) e pela cabergolina (CAB), sendo este último o mais utilizado devido à maior tolerância e eficácia. O uso desta classe de medicação na doença do Parkinson ocasionou lesões valvulares cardíacas fibróticas. Objetivos: Avaliar o risco de lesão em válvulas cardíacas nos pacientes com prolactinomas e que fizeram o tratamento com CAB.Métodos: Estudo tipo caso-controle com análise comparativa de 20 casos do ambulatório e neuroendocrinologia da clínica de endocrinologia HSPM-SP e 20 controles do ambulatório de ecocardiograma do HSPM-SP, sendo avaliados os ecocardiogramas de ambos os grupos e analisados a morfologia e funcionalidade das válvulas cardíacas. Resultados: Em relação aos 20 ecocardiogramas dos casos, 6 estavam alterados, apresentando refluxos mitral e/ou tricúspide leves. Dos 20 ecocardiogramas dos controles, 12 apresentaram alterações, desde 1 com calcificação mitral e os demais com refluxo mitral e/ou tricúspides leves. Conclusão: Nosso trabalho não mostrou aumento da incidência de valvulopatia cardíaca em pacientes com prolactinomas tratados sob regimes habituais de CAB quando comparado com controles. Devemos usar a menor dose eficaz de cabergolina e solicitar ecocardiogramas se tratamentos longos e/ou com doses elevadas para farmacovigilância, como proposto pela agência européia de medicações

La enfermedad de Parkinson: neurología para psiquiatras / Parkinson's disease: neurological bases for psychiatrists

Parkinson's disease is a progressive and degenerative disease due to the loss of the substantia nigra dopaminergic neurons in the mesencephalon. Its manifestations are: tremor at rest, rigidity and slowing of movements, and alterations in posture and gait. The early onset of dementia or the presence of hallucinations, not related to the dopaminergic treatment, are associated with the presence of dementia with Lewy bodies (DLB) or Alzheimer's disease. The scales used to assess the stage and severity of Parkinson's disease are: the scale of Stages of Hoehn and Yahr, and the Unified Parkinson's Disease Rating Scale. Although there is not a drug that stops the progression of Parkinson's disease, the current treatment for this illness consist in: a) dopamine replacement through the use of its precursor, levodopa, b) administering substances, like ropinirole, pramipexole, and bromocriptine, that increase dopamine activity to stimulate their receptors, and c) inhibiting the enzymes that destroy dopamine as the catechol- O-methyltrans-ferase with entacapone, and monoamine oxidase type B (MAO B) with selegiline and rasagiline. Surgical treatment of Parkinson's disease consists of ablative procedures and deep brain stimulation. This review describes their indications, administration and side effects.

La enfermedad de Parkinson es una enfermedad degenerativa y progresiva debida a la pérdida de las neuronas dopaminérgicas de la sustancia nigra del mesencéfalo. Sus manifestaciones son: temblor en reposo, rigidez y enlentecimiento de los movimientos, alteraciones en la postura y en la marcha. La aparición temprana de problemas en la memoria o alucinaciones, no debidas al tratamiento, indica la presencia de demencia con cuerpos de Lewy. Las escalas utilizadas para evaluar el estado y la gravedad de la enfermedad de Parkinson son: la Escala de los Estadios de Hoehn y Yahr y la Escala Unificada de Calificación de la Enfermedad de Parkinson (UPDRS). Aunque todavía no existe un medicamento que detenga la evolución de la enfermedad de Parkinson, el tratamiento actual consiste en mejorar los síntomas mediante: a) la reposición de la dopamina por medio del uso de su precursor (levodopa, L-Dopa), b) la administración de sustancias que aumentan la actividad dopaminérgica al estimular a sus receptores (ropinirol, pramipexol, bromocriptina) y c) la inhibición de las enzimas que destruyen la dopamina como la catecol- O- metiltransferasa (COMT) con la entacapona, y a la monoamino oxidasa tipo B (MAO B) con la selegilina y la rasagilina. Existe además el tratamiento quirúrgico de la enfermedad de Parkinson que consiste en procedimientos ablativos y la estimulación cerebral profunda. En esta revisión se describen los elementos básicos de la enfermedad, su cuadro clínico y sus complicaciones. En una segunda parte se aborda el tratamiento médico con sus indicaciones, administración y efectos secundarios, y para terminar se describirá el tratamiento quirúrgico.

Long-term evolution and outcomes of microprolactinoma with medical treatment.

INTRODUCTION: Prolactinoma is the most frequent functioning pituitary adenoma. Most commonly occurs as microprolactinoma (less than 1cm in size), which may be cured with medical therapy, but few long-term studies are available about optimal duration of treatment with dopamine agonists to ensure cure after drug discontinuation and its withdrawal without recurrence are do not report consistent results. OBJECTIVE: To establish criteria for cure of microprolactinoma with medical treatment and to analyze the potential predictors involved. PATIENTS: A retrospective study was conducted on 47adult women with microprolactinoma followed up between 1975 and 2010; none of them had undergone prior surgery or radiotherapy, and all of them received treatment with a dopamine agonist for at least 4years. They were divided into two groups for analysis: cured patients with at least 4years with normal prolactin levels after drug discontinuation, and not cured patients. RESULTS: Cure was achieved in 57.4% of patients. Only age at diagnosis was a significant predictor: there were more young patients in the cured group and youngest patients needed less time to cure. Development of empty sella turcica or normal MRI were similar regarding time to cure. CONCLUSIONS: Microprolactinoma may be cured with dopamine agonists, and life-long treatment is not required, although more than 10years may be required to achieve cure, 11,6±5,3 years in our experience.

Análise retrospectiva do tratamento clínico em uma população de pacientes com prolactinoma / Retrospective analysis of clinical treatment in a population of patients with prolactinoma

Introdução: Os prolactinomas são os tumores hipofisários mais comuns e sua frequência varia de acordo com a idade e sexo. Os agonistas dopaminérgicos (ADs) são o tratamento de escolha para os pacientes com prolactinomas. Objetivos: Analisar os resultados do tratamento clínico dos pacientes com prolactinomas do nosso serviço de Endocrinologia do HSPM e realizar revisão bibliográfica sobre o tema. Caracterizar, na população estudada, apresentação clínico-laboratorial e radiológica no momento do diagnóstico e sua evolução durante e após a suspensão do tratamento. Materiais e métodos: Foram analisados 24 prontuários de pacientes com diagnóstico de prolactinoma que receberam tratamento medicamentoso, e 12 preencheram critérios de inclusão. Resultados: Dos 12 pacientes analisados, 7 obtiveram normoprolactinemia após 6 meses da interrupção do tratamento e 5 pacientes a mantiveram após 1 ano. Dos 7 pacientes, 100% eram do sexo feminino, a média de idade dos pacientes foi de 37,4 ± 9,4 anos e os sinais e sintomas encontrados foram galactorréia, oligoamenorréia, diminuição de libido e hirsutismo. Conclusão: O tratamento com AD é muito eficaz e bem tolerado nos pacientes com prolactinomas. A suspensão pode ser tentada, mas acompanhamento é necessário pela possibilidade de recidiva. Mais longo tempo de tratamento parece ter maior impacto no sucesso da remissão. Com esses dados esperamos conseguir desenvolver um protocolo de tratamento e retirada dos ADs em pacientes com prolactinomas no nosso serviço de endocrinologia

Aspectos sintomáticos neuropsiquiátricos asociados a la enfermedad de Parkinson con demencia / Sumptomatic and Neuropsychiatric Aspects Associated with Parkinson's Disease with Dementia

Como es sabido, la enfermedad de Parkinson suele presentar una evolución crónica, prolongada, e insidiosa. Para la cual aún no se disponen de terapéuticas efectivas que curen a dicha enfermedad, si no se posee un arsenal de fármacos (agonistas dopaminérgicos) capaces de mitigar los síntomas, mejorar y prolongar la calidad de vida y enlentecer el propio desarrollo de la enfermedad, que lleva hacia un deterioro profundo de la motricidad, funcionalidad y de las funciones neurocognitivas. También es sabida la asociación de la enfermedad de Parkinson con la demencia por la misma enfermedad. Pero a lo largo de ella, con o sin demencia, se suelen presentar en una proporción importante, una serie de síntomas asociados neuropsiquiátricos (NP), y neuroconductuales (NC) que hay que diferenciar si son producto de la propia enfermedad de Parkinson, o son desencadenados por el tratamiento. Algunos de estos síntomas asociados, los más importantes en cuanto a su frecuencia y gravedad sobre todo asociados a demencia son, depresión, excitación psicomotriz, ideación patológica, delirios, alucinaciones visuales, síndrome confusional (delirium), trastornos del sueño, ansiedad, apatía. Estos síntomas agravan la evolución de la propia enfermedad de Parkinson y la demencia asociada haciendo que su pronóstico se torne más desfavorable, y más deteriorante, afectando también a los cuidadores y alterando la calidad de vida del paciente y su entorno. En este trabajo me propongo dar una noción básica de dichos trastornos para su rápido reconocimiento y tratamiento, teniendo en cuenta la posible polifarmacia en estos pacientes, con las implicancias de las interacciones farmacológicas. La rápida resolución de estos síntomas asociados a la EP, con o sin demencia redundará en un menor deterioro funcional del paciente, mejorando su pronóstico y la calidad de vida del propio paciente y sus cuidadores.

Throughout the progression of Parkinson's disease, whether or not with dementia, a series of associated neuropsychiatric and neurobehavioral symptoms may appear, such as depression, anxiety, psychomotor agitation, delirium, visual hallucinations, confusional syndrome (delirium), sleep disorders, apathy, which aggravate the patients' prognosis and accelerate their overall deterioration and the quality of life of them and the people around them. The prompt identification and management of these associated neuropsychiatric and neurobehavioral symptoms, considered in conjunction with the possible pharmacological interactions among polymedicated patients, shall result in the patients' better quality of life and a more favorable prognosis.

Aspectos sintomáticos neuropsiquiátricos asociados a la enfermedad de Parkinson con demencia / Sumptomatic and Neuropsychiatric Aspects Associated with Parkinsons Disease with Dementia

Como es sabido, la enfermedad de Parkinson suele presentar una evolución crónica, prolongada, e insidiosa. Para la cual aún no se disponen de terapéuticas efectivas que curen a dicha enfermedad, si no se posee un arsenal de fármacos (agonistas dopaminérgicos) capaces de mitigar los síntomas, mejorar y prolongar la calidad de vida y enlentecer el propio desarrollo de la enfermedad, que lleva hacia un deterioro profundo de la motricidad, funcionalidad y de las funciones neurocognitivas. También es sabida la asociación de la enfermedad de Parkinson con la demencia por la misma enfermedad. Pero a lo largo de ella, con o sin demencia, se suelen presentar en una proporción importante, una serie de síntomas asociados neuropsiquiátricos (NP), y neuroconductuales (NC) que hay que diferenciar si son producto de la propia enfermedad de Parkinson, o son desencadenados por el tratamiento. Algunos de estos síntomas asociados, los más importantes en cuanto a su frecuencia y gravedad sobre todo asociados a demencia son, depresión, excitación psicomotriz, ideación patológica, delirios, alucinaciones visuales, síndrome confusional (delirium), trastornos del sueño, ansiedad, apatía. Estos síntomas agravan la evolución de la propia enfermedad de Parkinson y la demencia asociada haciendo que su pronóstico se torne más desfavorable, y más deteriorante, afectando también a los cuidadores y alterando la calidad de vida del paciente y su entorno. En este trabajo me propongo dar una noción básica de dichos trastornos para su rápido reconocimiento y tratamiento, teniendo en cuenta la posible polifarmacia en estos pacientes, con las implicancias de las interacciones farmacológicas. La rápida resolución de estos síntomas asociados a la EP, con o sin demencia redundará en un menor deterioro funcional del paciente, mejorando su pronóstico y la calidad de vida del propio paciente y sus cuidadores.(AU)

Throughout the progression of Parkinsons disease, whether or not with dementia, a series of associated neuropsychiatric and neurobehavioral symptoms may appear, such as depression, anxiety, psychomotor agitation, delirium, visual hallucinations, confusional syndrome (delirium), sleep disorders, apathy, which aggravate the patients prognosis and accelerate their overall deterioration and the quality of life of them and the people around them. The prompt identification and management of these associated neuropsychiatric and neurobehavioral symptoms, considered in conjunction with the possible pharmacological interactions among polymedicated patients, shall result in the patients better quality of life and a more favorable prognosis.(AU)

Aspectos sintomáticos neuropsiquiátricos asociados a la enfermedad de Parkinson con demencia / Sumptomatic and Neuropsychiatric Aspects Associated with Parkinsons Disease with Dementia

Como es sabido, la enfermedad de Parkinson suele presentar una evolución crónica, prolongada, e insidiosa. Para la cual aún no se disponen de terapéuticas efectivas que curen a dicha enfermedad, si no se posee un arsenal de fármacos (agonistas dopaminérgicos) capaces de mitigar los síntomas, mejorar y prolongar la calidad de vida y enlentecer el propio desarrollo de la enfermedad, que lleva hacia un deterioro profundo de la motricidad, funcionalidad y de las funciones neurocognitivas. También es sabida la asociación de la enfermedad de Parkinson con la demencia por la misma enfermedad. Pero a lo largo de ella, con o sin demencia, se suelen presentar en una proporción importante, una serie de síntomas asociados neuropsiquiátricos (NP), y neuroconductuales (NC) que hay que diferenciar si son producto de la propia enfermedad de Parkinson, o son desencadenados por el tratamiento. Algunos de estos síntomas asociados, los más importantes en cuanto a su frecuencia y gravedad sobre todo asociados a demencia son, depresión, excitación psicomotriz, ideación patológica, delirios, alucinaciones visuales, síndrome confusional (delirium), trastornos del sueño, ansiedad, apatía. Estos síntomas agravan la evolución de la propia enfermedad de Parkinson y la demencia asociada haciendo que su pronóstico se torne más desfavorable, y más deteriorante, afectando también a los cuidadores y alterando la calidad de vida del paciente y su entorno. En este trabajo me propongo dar una noción básica de dichos trastornos para su rápido reconocimiento y tratamiento, teniendo en cuenta la posible polifarmacia en estos pacientes, con las implicancias de las interacciones farmacológicas. La rápida resolución de estos síntomas asociados a la EP, con o sin demencia redundará en un menor deterioro funcional del paciente, mejorando su pronóstico y la calidad de vida del propio paciente y sus cuidadores.(AU)

Throughout the progression of Parkinsons disease, whether or not with dementia, a series of associated neuropsychiatric and neurobehavioral symptoms may appear, such as depression, anxiety, psychomotor agitation, delirium, visual hallucinations, confusional syndrome (delirium), sleep disorders, apathy, which aggravate the patients prognosis and accelerate their overall deterioration and the quality of life of them and the people around them. The prompt identification and management of these associated neuropsychiatric and neurobehavioral symptoms, considered in conjunction with the possible pharmacological interactions among polymedicated patients, shall result in the patients better quality of life and a more favorable prognosis.(AU)

Pramipexol en pacientes con apatía / Pramipexole in patients with apathy

Introducción: la apatía es un estado mental patológico, adquirido, que se caracteriza por una disminución del interés, pérdida de la motivación y/o déficit en la iniciación de la autoactivación, tanto cognitiva, como motora. Objetivo: evaluar la eficacia de pramipexol en pacientes ambulatorios con apatía. Método: diez pacientes ambulatorios con criterios clínicos de apatía (DSM-IV-like, Marin et al.) y un puntaje de 42+/-1 en la Escala de Evaluación de Apatía (AES) fueron ingresados al estudio. Los pacientes fueron evaluados al inicio, al mes y a los tres meses con la Escala de evaluación de Apatía (AES). Al ingreso del estudio se incluyó, también, laboratorio completo, una resonancia magnética de cerebro (RMN), el Inventario de depresión de Beck (BDI-I) y el MEC-30 (Miniexamen cognoscitivo) con el objetivo de evaluar patología psiquiátrica y/o neurológica coexistente. El ingreso de los pacientes al estudio se hizo entre octubre y diciembre de 2008. Conclusión: la apatía mejoró significativamente con el tratamiento, evidenciado al AES con un incremento promedio del 40,57 % respecto del inicio (valor incremento:9,75, DST: 6,78) siendo bien tolerado (dosis media: 0,125 mg/día), sn efectos secundarios significativos.

Background: Apathy is a mental disease, acquired, characterized by a diminished interest, loss of motivation with deficits in the initiation of self-activation, both cognitive and motor. Objective: Evaluate the efficacy of pramipexole in outpatients with apathy. Methods: were recluted ten autpatients with clinical criteria for apathy. The initial score was 42+/-1 in the AES (Apathy Evaluation Scale) when admitted to the study. Patients were assessed at baseline, at one month and finally at threee months using the Apathy Evaluation Scale (AES). At study entry was also included a complete laboratory, Magnetic resonance imaging (MRI), Beck Depression Inventory (BDI-I) and the MeC-30 (Mini Mental State Examination) in order to assess psychiatric disorders and exclude coexisting neurological or clinical pathology. The patients admission to the study was done between October and December, 2008. Conclusion: Apathy was improved significantly with treatment as evidenced at AES with an average of 40.57 % from baseline (value increase: 9.75, STD: 6.78) and well to lerted (mean dose: 0.125 mg/day).

Pramipexol en pacientes con apatía / Pramipexole in patients with apathy

Introducción: la apatía es un estado mental patológico, adquirido, que se caracteriza por una disminución del interés, pérdida de la motivación y/o déficit en la iniciación de la autoactivación, tanto cognitiva, como motora. Objetivo: evaluar la eficacia de pramipexol en pacientes ambulatorios con apatía. Método: diez pacientes ambulatorios con criterios clínicos de apatía (DSM-IV-like, Marin et al.) y un puntaje de 42+/-1 en la Escala de Evaluación de Apatía (AES) fueron ingresados al estudio. Los pacientes fueron evaluados al inicio, al mes y a los tres meses con la Escala de evaluación de Apatía (AES). Al ingreso del estudio se incluyó, también, laboratorio completo, una resonancia magnética de cerebro (RMN), el Inventario de depresión de Beck (BDI-I) y el MEC-30 (Miniexamen cognoscitivo) con el objetivo de evaluar patología psiquiátrica y/o neurológica coexistente. El ingreso de los pacientes al estudio se hizo entre octubre y diciembre de 2008. Conclusión: la apatía mejoró significativamente con el tratamiento, evidenciado al AES con un incremento promedio del 40,57 % respecto del inicio (valor incremento:9,75, DST: 6,78) siendo bien tolerado (dosis media: 0,125 mg/día), sn efectos secundarios significativos.(AU)

Background: Apathy is a mental disease, acquired, characterized by a diminished interest, loss of motivation with deficits in the initiation of self-activation, both cognitive and motor. Objective: Evaluate the efficacy of pramipexole in outpatients with apathy. Methods: were recluted ten autpatients with clinical criteria for apathy. The initial score was 42+/-1 in the AES (Apathy Evaluation Scale) when admitted to the study. Patients were assessed at baseline, at one month and finally at threee months using the Apathy Evaluation Scale (AES). At study entry was also included a complete laboratory, Magnetic resonance imaging (MRI), Beck Depression Inventory (BDI-I) and the MeC-30 (Mini Mental State Examination) in order to assess psychiatric disorders and exclude coexisting neurological or clinical pathology. The patients admission to the study was done between October and December, 2008. Conclusion: Apathy was improved significantly with treatment as evidenced at AES with an average of 40.57 % from baseline (value increase: 9.75, STD: 6.78) and well to lerted (mean dose: 0.125 mg/day).(AU)

Teste da ibopamina tópica em pacientes normais, suspeitos e portadores de glaucoma / Topic ibopamine test in normal, suspects and glaucoma patients

OBJETIVO: O objetivo deste estudo é avaliar os efeitos da ibopamina tópica a 2 por cento sobre a Pio (pressão intraocular) em olhos normais, suspeitos e olhos com glaucoma primário de ângulo aberto (GPAA) e sua eficácia como teste provocativo para glaucoma. MÉTODO: Foram selecionados 10 pacientes (20 olhos) com GPAA, 10 pacientes (20 olhos) suspeitos de GPAA e 10 pacientes (20 olhos) normais e submetidos ao teste da ibopamina a 2 por cento. O teste foi considerado positivo quando, em uma das medidas (30, 45 e 60 minutos) após a instilação de 2 gotas de colírio de ibopamina a 2 por cento, com intervalo de 5 minutos entre as gotas, houve aumento da Pio maior ou igual a 4 mmHg. RESULTADOS: O teste da Ibopamina foi positivo em 16 (80 por cento) olhos com GPAA (grupo 1), 9 (45 por cento) olhos suspeitos (grupo 2) e 6 (30 por cento) dos olhos considerados normais (grupo 3). A melhor relação sensibilidade/especificidade foi observada no minuto 60 para ambos os olhos (área sob a curva ROC: 0,90; sensibilidade: 90 por cento e especificidade: 90 por cento). Todos os pacientes referiram discreta ardência à instilação do colírio. CONCLUSÃO: Os resultados deste estudo sugerem que a ibopamina em forma de colírio pode representar uma alternativa na avaliação do equilíbrio hidrodinâmico intraocular em olhos com glaucoma.

PURPOSE: Evaluation of the effects of topic ibopamine in normal eyes, suspects and eyes with primary open-angle glaucoma (POAG) as well as your efficacy as a provocative test for glaucoma. METHODS: 10 POAG pacients (20 eyes), 10 pacients suspects of POAG (20 eyes) and 10 normal Pacients (20 eyes) were selected and submitted to the topic ibopamine test. The test was considered positive when in one of the measures (30, 45 and 60 minutes) after instillation of 2 drops of 2 percent ibopamine, 5 minutes apart, the intraocular pressure (IOP) elevation was = 4 mmHg. RESULTS: The ibopamine test was positive in 16 (88 percent) eyes with POAG, 9 (45 percent) eyes suspects of POAG and 6 (30 percent) normal eyes. The best sensitivity/specificity ratio was achieved at 60 minutes for both eyes (Se/Sp: 90 percent) . All patients described a slight burning after ibopamine's instillation. CONCLUSION: The results of this study suggests that topical 2 percent ibopamine is a secure alternative to evaluate outflow system impairment in eyes with glaucoma.