Diagnóstico automatizado de las psicosis mediante imagen cerebral / No disponible

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First-episode psychosis is characterized by failure of deactivation but not by hypo- or hyperfrontality.

BACKGROUND: It is not known whether first-episode psychosis is characterized by the same prefrontal cortex functional imaging abnormalities as chronic schizophrenia. METHOD: Thirty patients with a first episode of non-affective functional psychosis and 28 healthy controls underwent functional magnetic resonance imaging (fMRI) during performance of the n-back working memory task. Voxel-based analyses of brain activations and deactivations were carried out and compared between groups. The connectivity of regions of significant difference between the patients and controls was also examined. RESULTS: The first-episode patients did not show significant prefrontal hypo- or hyperactivation compared to controls. However, they showed failure of deactivation in the medial frontal cortex. This area showed high levels of connectivity with the posterior cingulate gyrus/precuneus and parts of the parietal cortex bilaterally. Failure of deactivation was significantly greater in first-episode patients who had or went on to acquire a DSM-IV diagnosis of schizophrenia than in those who did not, and in those who met RDC criteria for schizophrenia compared to those who did not. CONCLUSIONS: First-episode psychosis is not characterized by hypo- or hyperfrontality but instead by a failure of deactivation in the medial frontal cortex. The location and connectivity of this area suggest that it is part of the default mode network. The failure of deactivation seems to be particularly marked in first-episode patients who have, or progress to, schizophrenia.

[Thought disorders in obsessive-compulsive disorder]. / Trastornos del pensamiento en el trastorno obsesivo-compulsivo.

Obsessions are typical thought disorders in the obsessivecompulsive disorder (OCD), as defined in the DSM-IV and ICD-10. From obsessive ideas, overvalued ideas to delusional ones, there is a seriousness spectrum that is defined by the presence or absence of disease insight. Absence of disease insight can include global or partial functioning of the individual, but only the latter is contemplated in the DSM-IV since the fi rst case is diagnosed as <> or <>. This article reports four cases with OCD diagnosis with the aim to illustrate a possible classification of this disease in relationship to disease insight.

Trastornos del pensamiento en el trastorno obsesivo-compulsivo / Thought disorders in obsessive-compulsive disorder

En el trastorno obsesivo compulsivo se presentan alteraciones del pensamiento características como son las obsesiones, tal y como están definidas en los manuales diagnósticos más utilizados. Desde ideas obsesivas, ideas sobrevaloradas hasta ideas delirantes hay un espectro de gravedad que viene definido por la presencia o ausencia de conciencia de enfermedad. La ausencia de conciencia de enfermedad puede abarcar la globalidad del funcionamiento del individuo o bien afectarlo de forma parcial; solamente este último aspecto está contemplado en el DSM-IV, ya que si sucede el primer caso se diagnostica de trastorno psicótico no especificado o trastorno delirante. El objetivo de la presente comunicación es la descripción de cuatro casos clínicos para ilustrar una posible clasificación de este trastorno en relación a la conciencia de enfermedad. (AU)