[Neurology-psychiatry interface in central nervous system diseases]. / Interfase neurología-psiquiatría en pacientes hospitalizados por patologías del sistema nervioso central.

OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.

Interfase neurología-psiquiatría en pacientes hospitalizados por patologías del sistema nervioso central / Neurology-psychiatry interface in central nervous system diseases

Objetivo: Las enfermedades cerebrales condicionan con frecuencia alteraciones mentales y conductuales. Para analizar el área de interfase entre la neurología y la psiquiatría, analizamos todas las interconsultas neuropsiquiátricas realizadas en los servicios de Neurología, Neurocirugía, Terapia Intensiva Neurológica y Urgencias Neurológicas, en el Instituto Nacional de Neurología y Neurocirugía de México (2007-2009). Resultados: En 506 casos, la edad promedio fue 44.24 años (DE 17 años); 240 fueron mujeres (47.4 %). Las patologías neurológicas que generaron más interconsultas fueron neoplasias del sistema nervioso central (14.2 %), encefalitis viral (8.7 %), enfermedad vascular cerebral isquémica (7.1 %), epilepsia (6.5 %) y enfermedad vascular cerebral hemorrágica (4.7 %). Los trastornos mentales más frecuentes (de acuerdo con el DSM-IV) fueron delirium (38.5 %), trastorno depresivo (15 %), demencia (7.7 %), deterioro cognoscitivo, sin criterios de demencia (6.5 %), trastorno de ansiedad (6.9 %). El delirium fue la condición neuropsiquiátrica más frecuente independientemente de las categorías etiológicas. En las infecciones cerebrales hubo mayor frecuencia del síndrome catatónico (p < 0.001). En pacientes con enfermedad vascular cerebral se manifiesta más frecuentemente la risa y el llanto patológico (p = 0.012). Conclusiones: Este estudio muestra la relevancia clínica del delirium, la depresión, la ansiedad, la demencia, los síndromes frontales y la catatonia en pacientes hospitalizados con enfermedades neurológicas y psiquiátricas.

OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.

Baja frecuencia clínica de la demencia por cuerpos de Lewy en el Instituto de Neurología de México / Low clinical frequency of Lewy body dementia in the Institute of Neurology in Mexico

Objetivos: a) determinar la frecuencia clínica de los diferentes subtipos de demencia para conocer la frecuencia y el lugar que ocupa la demencia de cuerpos de Lewy en la población de consulta externa del Instituto Nacional de Neurología y Neurocirugía de México, y b) describir su relación con determinados factores de riesgo. Material y métodos: estudio retrospectivo observacional sobre los historiales, evolución clínica, pruebas neuropsicológicas y datos cualitativos de la resonancia magnética cerebral de todos los pacientes con deterioro cognitivo que asistieron a la consulta externa en el año 2004. Resultados: N: 237. La edad media fue de 66,0 años (desviación estándar [DE]: 12,6). El 65,0% mujeres. El 37,6% era originario del área metropolitana de México. Seguimiento medio en consulta: 31,3 semanas (DE: 44,2). Mini-Mental State Examination promedio: 18,5 puntos (DE: 7,3). Nivel educativo medio: 6,0 años (DE: 4,8). Tipos de demencia: Alzheimer 26,6%, vascular 21,1%, mixta 17,7%, frontotemporal 10,5%. Solamente se encontró un caso de demencia por cuerpos de Lewy difusos (0,4% de la muestra). La presencia de factores de riesgo vascular tiende a ser elevada, sobre todo en los subgrupos no degenerativos. Conclusiones: en nuestra población, los tipos de demencia con componente vascular se encuentran más representados a expensas de los degenerativos en relación con la casuística internacional. En los países subdesarrollados o en vías de desarrollo, la patología vascular podría modificar la presentación clínica de los procesos

Objectives: a) to determine the clinical frequency of the different subtypes of dementia in order to identify the frequency and place that Lewy body dementia occupies in the population attending the outpatient department of the National Institute of Neurology and Neurosurgery of Mexico, and b) to describe the association between dementia and specific risk factors. Material and methods: we performed a retrospective observational study of the clinical histories, clinical outcome, neuropsychological tests and qualitative data of cerebral magnetic resonance imaging of all patients with cognitive impairment attending the outpatient department during 2004. Results: N: 237. The mean age of the patients was 66.0 years (SD, 12.6). Sixty-five percent of the patients were women. A total of 37.6% were from the metropolitan area of Mexico. The mean time of follow-up in the outpatient department was 31.3 weeks (SD, 44.2). The mean Mini-Mental State Examination score was 18.5 points (SD, 7.3). The mean number of years of education was 6.0 (SD, 4.8). The types of dementia were distributed as follows: Alzheimer 26.6%, vascular 21.1%, mixed 17.7%, fronto-temporal 10.5%. Only one case of diffuse Lewy body disease (0.4% of the sample) was found. The presence of vascular risk factors tended to be high, especially in non-degenerative subgroups. Conclusions: in our population, vascular dementias are more frequent than degenerative subgroups and are also more frequent in comparison with international casuistics. In underdeveloped or developing countries, vascular disease could modify the clinical presentation of neurodegenerative processes, as occurred with Lewy body dementia in the present study