Antiepileptic drugs for the acute and maintenance treatment of bipolar disorder.

Both traditional and newer antiepileptic drugs have been considered for the acute and maintenance treatment of bipolar disorder. Although the psychotropic actions of these compounds have long been recognized, their specific mood-stabilizing properties have become evident only relatively recently. Carbamazepine and valproate are the antiepileptics most thoroughly studied for the treatment of bipolar disorder, but trials of the newer compounds such as lamotrigine, gabapentin, topiramate, and tiagabine have also begun to emerge. This article reviews the published research (including controlled trials, outcome reports, case series, and anecdotal observations) relevant to the efficacy of these agents in the acute and maintenance treatment of bipolar disorder. It also reviews the available information regarding clinical predictors of response. Despite considerable interest in these drugs, data are still limited. Comparison of clinical responses to the various mood stabilizers and determination of their mechanisms of action could help to improve treatment for bipolar disorder.

[Clinical use of new antidepressive agents with dual action (literature review)]. / Uso clínico de los nuevos antidepresivos que poseen un mecanismo de acción dual (revisión de la literatura).

The effective pharmacological treatment of depression started in 1958 with the introduction of iproniazide and imipramine. New agents quickly followed with more specific actions and a safer side effect profile. Very recently, fourth generation antidepressants with dual action have been introduced. These new agents pose a challenging dilemma. Is it better to develop drugs ever more selective towards specific monoamine receptor subpopulations, or drugs that act upon several monoamines in a more focused way? The priority seems to be the investigation of the interactions of the various monoaminergic systems. This paper reviews the clinical use of the new antidepressants that implement the notion of dual action as an important element for efficacy combined with receptor-specific action as a basis for tolerability.

Uso clínico de los nuevos antidepresivos que poseen un mecanismo de acción dual (revisión de la literatura) / Clinical use of new antidepressive agents with dual action (literature review)

The effective pharmacological treatment of depression started in 1958 with the introduction of iproniazide and imipramine. New agents quickly followed with more specific actions and a safer side effect profile. Very recently, fourth generation antidepressants with dual action have been introduced. These new agents pose a challenging dilemma. Is it better to develop drugs ever more selective towards specific monoamine receptor subpopulations, or drugs that act upon several monoamines in a more focused way? The priority seems to be the investigation of the interactions of the various monoaminergic systems. This paper reviews the clinical use of the new antidepressants that implement the notion of dual action as an important element for efficacy combined with receptor-specific action as a basis for tolerability.

Cerebral perfusion SPECT imaging in epileptic and nonepileptic seizures.

Patients with epileptic and nonepileptic seizures are commonly encountered in clinical practice, and they can pose a difficult diagnostic problem. We present two cases that show the difficult task of differentiating between true epileptic and nonepileptic or psychogenic seizures in some patients. The clinical presentations were complex and the use of video-monitored EEG alone was insufficient to make definitive diagnoses. Ictal and interictal Tc-99m HMPAO brain perfusion SPECT imaging examinations were used to help establish the correct diagnoses. This report describes the advantage of using the brain perfusion SPECT imaging examination. The injection of stabilized Tc-99m HMPAO during an ictal event followed by appropriate medical therapy provides a method of obtaining a reasonable image of relative perfusion (activity) during the seizure. These images can then be compared with interictal examinations and an epileptic or nonepileptic focus may be localized. The Tc-99m HMPAO brain perfusion SPECT imaging study was helpful in establishing the correct diagnosis in both cases.

Application of ictal brain SPECT for differentiating epileptic from nonepileptic seizures.

The authors report 2 clinical cases that illustrate the difficulties with video-monitored EEG and the advantages of brain SPECT in differential diagnosis of true epileptic seizures and nonepileptic seizures. Injection of [99mTc]HMPAO at the time of the ictal event provides a means to obtain a SPECT image postictally for comparison with interictal examinations so that an epileptic or nonepileptic focus may be localized.

Risperidone in the treatment of delusions of infestation.

OBJECTIVE: The aim of this study is to describe the efficacy and safety of risperidone, in the treatment of delusions of infestation. METHOD: The authors present a three-case series in which risperidone was used to treat delusions of infestation. RESULTS: All three patients responded to risperidone and experienced no extrapyramidal side effects. Two of our patients had failed treatment with haloperidol and another had failed treatment with pimozide. CONCLUSION: Risperidone was an effective and safe treatment in three cases of delusions of infestation. It is possible that 5-HT2 antagonism is essential for therapeutic benefit in this condition.

Development, reliability and validation of the Diabetes Emotional Adjustment Scale in Spanish: preliminary findings.

OBJECTIVE: The development of instruments to measure emotional maladjustment in diabetic Hispanic populations has received little attention. We present the development and validation of the Diabetes Emotional Adjustment Scale in Spanish. METHOD: An eighteen-item self-administered scale was construed to assess emotional adjustment in Spanish-speaking diabetic patients and the psychometric properties of the scale were assessed. The scale was applied to a sample of sixty patients and scale scores were correlated with scores on a battery of Spanish versions of established measures of psychological distress, to assess concurrent validity. Test-retest reliability was established four years later re-examining thirty-eight of the initial sixty-patients sample. RESULTS: Split-half reliability and test-retest reliability were satisfactory. There were significant correlations between the scale results and measures of depression, trait-anxiety, family adjustment, and locus of control of behavior. A principal component analysis with varimax rotation yielded a six-factor solution explaining 50.4 percent of the total variance. CONCLUSIONS: The scale is useful as a screening instrument, but the confirmation of factor structure stability and the correlation of the scale results with objective measures of metabolic control, require further investigation.

[The neurobiological bases of aggression: the pharmacotherapeutic implications]. / Bases neurobiológicas de la agresión: implicaciones farmacoterapéuticas.

The aim of this paper is to attempt a classification of aggressive behavior based on neurobiological mechanisms and to shed some light on the pharmacological treatment of this condition. Drugs that enhance serotonin transmission are indicated in conditions related to decreased serotonergic transmission. Dopamine blockers are useful in the acute control of aggression and the violence displayed by schizophrenic patients. Clozapine probably has an anti-aggressive effect independent of its antipsychotic action. Noradrenergic agents have been shown effective in chronic aggression of organic brain syndromes. Gabaergic drugs are effective in acute aggression and in organic brain syndromes.

Bases neurobiológicas de la agresión: implicaciones farmacoterapéuticas / The neurobiological bases of aggression: the pharmacotherapeutic implications

The aim of this paper is to attempt a classification of aggressive behavior based on neurobiological mechanisms and to shed some light on the pharmacological treatment of this condition. Drugs that enhance serotonin transmission are indicated in conditions related to decreased serotonergic transmission. Dopamine blockers are useful in the acute control of aggression and the violence displayed by schizophrenic patients. Clozapine probably has an anti-aggressive effect independent of its antipsychotic action. Noradrenergic agents have been shown effective in chronic aggression of organic brain syndromes. Gabaergic drugs are effective in acute aggression and in organic brain syndromes

[The Capgras syndrome: a clinical study of 9 cases]. / El síndrome de Capgras: estudio clínico de nueve casos.

The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects.

El síndrome de Capgras: estudio clínico de nueve casos / The Capgras syndrome: a clinical study of 9 cases

The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects

[The coexistence of the intermetamorphosis and Foley syndromes: an interhemispheric disconnection or a limbic hyperconnection?]. / Coexistencia de los síndromes de intermetamorfosis y de Foley: desconexión interhemisférica o hiperconexión límbica?

The case of a patient with both, the intermetamorphosis and the Foley syndromes is studied. Both of these syndromes are extremely infrequent and their coexistence in a single patient points up to a common etiopathogenic mechanism. The relevant literature is discussed and a limbic hyperconnection syndrome is proposed to explain the clinical findings as well as the positive response to valproic acid.

[Identification of emotional disturbances in the diabetic patient]. / Identificación del desajuste emocional en el paciente diabético.

The Emotional Adjustment Scale for Diabetics (EAD) and the Brown Scale (SB) were used to evaluate 60 diabetic patients. The aim of the study was to compare the clinicians' ability to diagnose the emotional maladjustment with the results of a standardized instrument. A battery of psychosocial tests was also applied. The results showed that SB has low sensibility, specificity and positive predictive value which suggests that clinicians has less ability to diagnose emotional maladjustment than a standardized instrument. The analysis of tests results helped to identify predictive variables for the results of SB (personality factors) and the results of EAD (locus of control of behavior, age, escolarity and scales D and F of the Minimult). The findings are discussed in the light of the relevant literature.

[Community intervention during economic disasters]. / Intervención comunitaria durante un desastre económico.

A political conflict forced banks to close down in Panama during March 1988. Thus, thousand of families were unable to meet their most basic needs during that lapse of time. This paper describes a community intervention program that was set up in the midst of such an economic disaster. That program emphasized mental health consultation techniques to help devising an effective organizational action as well as developing standards to determine needs, and a clear-cut two-way communication with the affected families. The incidence of emotional disorder was assessed with the Self Report Questionnaire, and crisis intervention was offered to any people who should apply for it. Cognitive responses, coping behaviors, and social supports were also assessed. Results showed that those individuals excluded from a full participation in their culture were much more likely to develop emotional disorders. Finding that affected people showed a scarce self-help behavior was interpreted as a feature of the transcultural transaction between affected people, and professionals.