Comparison of the effectiveness of venlafaxine in peri- and postmenopausal patients with major depressive disorder.

INTRODUCTION: This study examines the difference in the efficacy and tolerability of an antidepressant inhibiting the reuptake of norepinephrine and serotonin--IRNS--on climacteric patients diagnosed of major depressive disorder, comparing the therapeutic response between perimenopausal and postmenopausal patients. METHODS: Observational, prospective, open-label, multicenter study 24 weeks study. The sample consisted of women between 45 and 55 years diagnosed of major depressive disorder. The study drug was venlafaxine extended release at doses according to the investigator's clinical criteria. The efficacy was assessed using repeated measures of the scales: Hamilton Depression Rating Scale and Blatt-Kupperman Menopausal Index. RESULTS: 36 depressed women were included in the study and 35 completed it. The patient's age range was 47 to 55 years old. Throughout the study, a significant clinical improvement in depressive and hormonal symptoms was seen. The comparison of the pattern of improvement, according to the menstrual status of the patients, showed no significant different between pre and postmenopausal patients. Perimenopausal women reported a higher rate of adverse events. CONCLUSION: The Venlafaxine was effective in treating depressive and hormonal symptoms regardless of the menstrual status of climacteric patients with a slightly worse tolerance in perimenopause.

Síntomas residuales en la depresión / Residual symptoms in depression

A pesar de la efectividad de la respuesta a los antidepresivos, la persistencia de síntomas subsindrómicos tras el tratamiento de los episodios depresivos es un fenómeno frecuente. Más del 30% de los pacientes que responden a un tratamiento antidepresivo presentan síntomas residuales, sobre todo los que sufren episodios depresivos más graves al inicio. Los síntomas residuales más frecuentes son los síntomas subsindrómicos de las esferas afectiva, somática y cognitiva, y las alteraciones del sueño. La presencia de síntomas residuales empeora el pronóstico del trastorno depresivo, con recaídas más frecuentes y más rápidas y déficits en la funcionalidad que se asocian con alteraciones neuroanatómicas. A la vista de los datos a la hora de enfocar el tratamiento de un trastorno depresivo es necesario tener en cuenta la posibilidad de persistencia de síntomas residuales y buscar, con todos los medios al alcance, la recuperación del paciente (AU)

Despite successful response to therapy, subsyndromal depressive symptoms appear to be the rule in unipolar depression. Residual symptoms are present in more than 30% of patients who respond to antidepressants, specifically in subjects with more severe initial illness. The most prevalent residual symptoms are affective, somatic, cognitive and sleep disturbance. It has been shown that such persistent symptoms are associated with a higher risk of relapse, chronicity and functional impairment; associated with neuroanatomical changes. It is important to consider the possibility of persistence subthreshold symptoms and look for new therapeutic strategies for improving the level of remission in the treatment of major depressive disorder (AU)

Trastorno psicótico agudo y trastorno del movimiento secundario a tratamiento con clorhidrato de tramadol y bromuro de hioscina / Tittle

Se presenta el caso de una paciente de 17 años sin antecedentes psiquiátricos, que presentó un cuadro de trastorno del movimiento de carácter coreico y síntomas psicóticos asociado a tratamiento con tramadol y N-butilbromuro de hioscina que cedió con la retirada del fármaco y tratamiento antipsicótico, volviendo la paciente a la situación de normalidad

We present the case of a 17 year old woman who suffered choreic-like movements and psychotic symptoms as a side effect of tramadol plus hioscine N-butilbromuro treatment. Treatment withdrawal and antipsychotic treatment improved the movement disorder and the psychopathology coming back the patient to the baseline situation

La ziprasidona como tratamiento coadyuvante en el tratamiento del trastorno obsesivo-compulsivo resistente / Ziprasidone as coadjuvant treatment in resistant obsessive-compulsive disorder treatment

Existen datos que sugieren que los antipsicóticos atípicos pueden ser útiles en el tratamiento del trastorno obsesivocompulsivo (TOC). El presente trabajo presenta el caso de una paciente diagnosticada de TOC grave y resistente a distintos tratamientos antidepresivos y antipsicóticos (incluyendo clozapina). La paciente presentó mejoría clínicamente significativa (medida por una disminución en la puntuación en las escalas Y-BOCS e ICG) en las 4 semanas posteriores a la sustitución de clozapina por ziprasidona, mejoría que se mantuvo posteriormente. Las peculiaridades famacodinámicas de la ziprasidona podrían hacer a este fármaco más eficaz que otros antipsicóticos como tratamiento coadyuvante en el TOC

Data suggest that atypical antipsychotics may be useful in the treatment of obsessive-compulsive disorder (OCD). We report the case of a patient diagnosed of serious OCD resistant to various antidepressant and antipsychotic treatments (including clozapine). The patient had clinically significant improvement (measured by decrease in the score of the Yale-Brown Obsessive Compulsive (Y-BOCS) and the Clinical Global Impression (CGI) scales) in the four weeks alter switching from clozapine to ziprasidone, improvement that was subsequently maintained. The pharmacodynamic characteristics of ziprasidone could make this drug more effective than other antipsychotics as coadjuvant treatment in OCD

[Ziprasidone as coadjuvant treatment in resistant obsessive-compulsive disorder treatment]. / La ziprasidona como tratamiento co adyuvante en el tratamiento del trastorno obsesivo-compulsivo resistente.

Data suggest that atypical antipsychotics may be useful in the treatment of obsessive-compulsive disorder (OCD). We report the case of a patient diagnosed of serious OCD resistant to various antidepressant and antipsychotic treatments (including clozapine). The patient had clinically significant improvement (measured by decrease in the score of the Yale-Brown Obsessive Compulsive (Y-BOCS) and the Clinical Global Impression (CGI) scales) in the four weeks alter switching from clozapine to ziprasidone, improvement that was subsequently maintained. The pharmacodynamic characteristics of ziprasidone could make this drug more effective than other antipsychotics as coadjuvant treatment in OCD

Topiramato en el tratamiento de la impulsividad en enfermos mentales ambulatorios / Topiramate in the treatment of poor impulse control in psychiatric outpatients

OBJETIVOS: En el presente estudio se evalúa el efecto del topiramato para el control de la impulsividad en pacientes psiquiátricos ambulatorios. PACIENTES Y MÉTODO: Estudio abierto y prospectivo en el que se incluyó a 101 pacientes con distintos diagnósticos de trastorno mental cuya característica común era un nivel de impulsividad clínicamente significativo. Se evaluó el efecto del fármaco durante 6 meses mediante la administración repetida del cuestionario de impulsividad de Barratt y la valoración clínica global de la eficacia y la tolerancia. RESULTADOS: Se observó una disminución clínicamente significativa del grado de impulsividad durante el estudio medida por las puntuaciones repetidas de la escala de Barratt, asociada también con una percepción clínica de mejoría y una valoración de tolerancia buena o muy buena. CONCLUSION: A pesar de las limitaciones del estudio, creemos que el presente trabajo presenta datos que avalan la utilidad del topiramato en el control de la impulsividad en pacientes psiquiátricos

OBJECTIVES: To assess the effect of topiramate in the treatment of poor impulse control in psychiatric outpatients. PATIENTS AND METHOD: An open-label, prospective study including 101 patients with various psychiatric diagnoses and clinically significant impulse control symptoms was performed. The effect of the drug was evaluated over 6 months by repeated administration of the Barratt Impulsiveness Scale and by global clinical evaluation of the drug’s efficacy and tolerability. RESULTS: A statistically significant improvement was seen in impulse control throughout the study as evaluated by repeated Barratt scale scores and clinical impression. Subjective evaluation of tolerability was good or very good. CONCLUSION: Despite the study’s limitations, we believe that the data support the usefulness of topiramate in impulse control in psychiatric patients

A system of patient classification in long-term psychiatric inpatients: Resource Utilization Groups T-18 (RUG T-18).

This paper shows the application of a 'case mix' system (Resources Utilization Groups T18 or RUG-T18) to a Spanish long-term inpatient psychiatric sample. OBJECTIVE: To examine the capacity of RUG-T18 to predict patient resource use (spent time of care) in a long-term psychiatric sample. SUBJECTS AND RESEARCH DESIGN: Data included an assessment of 163 patients' characteristics, corresponding to groups of the RUG-T18, and detailed measurement of nursing staff care over a 24-h period. RESULTS: 'Severe behavioural problems' was the most frequent RUG-T18 category. There were significant differences in the spent time of care in the different groups and high variability in the distribution of time of care within groups and in the total sample. CONCLUSIONS: The RUG T-18 system should be improved to become a useful case mix system in long-term psychiatric inpatients. The high variance intragroups could be minimized improving the psychopathological aspects of the system.

Utilización de medidas coercitivas en pacientes ingresados en una unidad de hospitalización psiquiátrica de agudos / Coercitive measures in an psychiatric inpatient unit

Introducción: el presente trabajo trata de conocer las pautas de utilización de distintos tipos de medidas coercitivas en una Unidad de Hospitalización Psiquiátrica. Material y métodos: se estudiaron de forma prospectiva 170 episodios de ingreso, valorando la aplicación de las siguientes medidas: internamiento forzoso, contención mecánica, aislamiento, medicación forzosa y restricciones para la salida de la unidad y para la comunicación. Resultados y discusión: en el 60 por ciento de los episodios de ingreso se aplicó alguna medida coercitiva. La medida más frecuentemente utilizada fue la restricción para la salida de la planta, y tras ella la contención mecánica. Se observó mayor frecuencia de contención mecánica en mujeres; más ingresos forzosos en jóvenes; más medicaciones forzosas en jóvenes; y más restricciones a la comunicación en trastornos de personalidad. Se plantea la pertinencia de considerar la frecuencia de utilización de medidas coercitivas como indicador de calidad asistencial (AU)

[Primary pancreatic hydatid cyst and primordial familial dwarfism]. / Quiste hidatídico pancreático primitivo y enanismo primordial familiar.

A 10 years and 7 months old male, was studied for a pathologic, primordial hipogrowing disease, probably due to a recessive and autosomic transmission, because he has got a sister with the same illness, and he was diagnostified of a pancreatic cyst, whind was found in an echographical exploration and established by scanner as intraglandular cyst. There are no others cysts found detected in a complete body-check. The chirurgic findings was a solitary hydatidic intrapancreatic cyst whid was extirpated. The patient's and sister's facial characteristics (big nose, long and thin neck, large forehead), the normal hormonal study in this case, the observation of small bone defects (first finger of the foot thicker than usual, cone epifisis in hands), a normal intelligence and the not accordance between them and the usual in literature described kind, suggest to be a different form the congenital autosomic, recessive dwarfism, not according to the usual one.

[Ehlers-Danlos syndrome: apropos of three cases]. / Síndrome de Ehlers-Danlos: a propósito de tres casos.

3 children, 2 male and one female, affected by Ehlers-Danlos syndrome, types I or dangerous, III or mild familiar hypermobility, and (II or V)? or intermediate. The types I and (II or V)? normally affect the skin and the lower extremities, in the form of breakable skin, hyperelasticity... The type III predominantly attacks the joints and tends to dislocate bones. In the dermic distant zones, the skin is thin with excessive folds. The importance of early detection is due to prevention or control or the complications (depending on the type of illness), and inform about the genetic risk, based in a correct typification, this has clinics difficult because there are intermediary forms and it is necessary a specialized laboratory in collagen's studies.