Leucoencefalopatía hipóxica tardía tras autointoxicación; del abordaje psiquiátrico al neurológico / Delayed hypoxic leukoencephalopathy after autointoxication, from the psychiatric approach to neurological

La Leucoencefalopatía Hipóxica Tardía es un proceso poco frecuente y de patogenia aun desconocida en el que se describe la aparición de sintomatología confusional y deterioro cognitivo agudo tras un periodo de 2 a 10 días de aparente recuperación completa de la hipoxia. En algunos casos ha sido notificada a su vez sintomatología psiquiátrica aguda entre la que destaca apatía, ansiedad e incluso el desarrollo de psicosis. Clásicamente asociada a intoxicaciones por monóxido de carbono también se han descrito episodios secundarios a autointoxicaciones con tóxicos y psicofármacos que cursan con hipotensiones prolongadas. La bibliografía y el número de casos publicados son realmente escasos. En las presentes notas clínicas se recoge la evidente excepcionalidad, en el plazo de cuatro años, de dos pacientes con un trastorno mental previo que ingresan en la Unidad de Hospitalización Psiquiátrica de Agudos tras una autointoxicación. Desde una perspectiva psiquiátrica se desarrolla el concepto de esta desconocida entidad clínica al tiempo que se describe el inevitable paso desde el abordaje psiquiátrico al neurológico (AU)

is a rare and still unknown pathogenesis process that provokes the appearance of acute confusional symptomatology and cognitive deterioration after a period of 2 to 10 days of apparent complete recovery from hypoxia. In some cases, acute psychiatric symptoms, including apathy, anxiety and even the development of psychosis, have been observed. Mainly associated with carbon monoxide poisoning, these symptoms have also been found as secondary to self-poisoning with toxic and psychotropic drugs that cause prolonged hypotensive episodes. The number of published cases and the literature on the subject is really scanty. The rare case, within four years, of two patients with a prior mental disorder who entered Psychiatric Inpatients Unit after autointoxication, is collected in these clinical notes. They develop, from a psychiatric perspective, the concepts of this unknown clinic entity and the inevitable passage from the psychiatric approach to neurological (AU)

Tras 6 meses de tratamiento antipsicótico: ¿mejoría de la salud mental a costa de la salud física? / After six months of anti-psychotic treatment: Is the improvement in mental health at the expense of physical health?

Introducción. La morbimortalidad por causas cardiovasculares en pacientes con esquizofrenia es superior a la de la población general, hecho que se ha puesto más de manifiesto desde la generalización del uso de antipsicóticos de segunda generación. Objetivos. Examinar la incidencia del síndrome metabólico tras seis meses de tratamiento antipsicótico en pacientes con un primer episodio psicótico no tratado con anterioridad y determinar cambios prospectivos en los parámetros que definen los criterios del síndrome metabólico. Método. Estudio observacional con diseño de cohortes prospectivo incluyendo pacientes que ingresaron en la unidad de agudos del Hospital Donostia. Resultados. Veintiún pacientes fueron incluidos en el estudio, completando el mismo 19. Un 26,3% de los pacientes desarrollaron síndrome metabólico a los 6 meses. Se observaron diferencias estadísticamente significativas en los siguientes parámetros: 1) medida del perímetro abdominal con un incremento de 14,6 cm a los 6 meses (p = 0,001); 2) niveles de triglicéridos con un incremento medio sobre la medida inicial de 48,99 mg/dl (p = 0,039); 3) niveles de glucosa en ayunas con un aumento medio de 10,72 mg/dl (p = 0,001). Conclusiones. Se observaron importantes cambios en los parámetros metabólicos en un periodo corto con el consiguiente riesgo de eventos cardiovasculares asociado en un grupo de pacientes jóvenes. Son necesarias intervenciones dirigidas a asegurar una correcta monitorización de estos pacientes que permitan llevar a cabo medidas para minimizar riesgos(AU)

Introduction. Morbidity and mortality due to cardiovascular causes in patients with schizophrenia are higher than in the general population, a fact that has been observed more since second generation anti-psychotics came into general use. Objectives. To determine the incidence of metabolic syndrome in patients with a previously untreated first psychotic episode, as well as the prospective changes in the parameters that define the criteria of metabolic syndrome. Method. An observational study with a prospective cohort design including patients who were admitted to the Acute Unit of Donostia Hospital. Results. A total of 21 patients were included in the study, of which 19 completed it. Just over one-quarter (26.3%) of the patients developed a metabolic syndrome at six months. Statistically significant differences were observed in the following parameters: (1) abdominal perimeter measurement with an increase of 14.6cm at six months (P=.001); (2) triglyceride levels with a mean increase over the initial measurement of 48.99mg/dl (P=.039); and (3) fasting blood glucose levels with a mean increase of 10.72mg/dl (P=.001). Conclusions. Significant changes were observed in metabolic parameters in a short period with the subsequent risk of associated cardiovascular events in a group of young patients. Actions are required to be directed at ensuring appropriate monitoring of these patients in order to measures to minimise the risks(AU)

After six months of anti-psychotic treatment: Is the improvement in mental health at the expense of physical health?

INTRODUCTION: The morbidity and mortality due to cardiovascular causes in patients with schizophrenia is higher than in the general population, a fact that has been observed more since second generation anti-psychotics came into general use. OBJECTIVES: To determine the incidence of metabolic syndrome in patients with a previously untreated first psychotic episode, as well as the prospective changes in the parameters that define the criteria of metabolic syndrome. METHOD: An observational study with a prospective cohort design including patients who were admitted to the Acute Unit of Donostia Hospital. RESULTS: A total of 21 patients were included in the study, of which 19 completed it. Just over one-quarter (26.3%) of the patients developed a metabolic syndrome at six months. Statistically significant differences were observed in the following parameters: 1) abdominal perimeter measurement with an increase of 14.6 cm at six months (P=.001); 2) triglyceride levels with a mean increase over the initial measurement of 48.99 mg/dl (P=.039); and 3) fasting blood glucose levels with a mean increase of 10.72 mg/dl (P=.001). CONCLUSIONS: Significant changes were observed in metabolic parameters in a short period with the subsequent risk of associated cardiovascular events in a group of young patients. Actions are required directed at ensuring appropriate monitoring of these patients in order to measures to minimise the risks.