[Relevance of drug use in clinical manifestations of schizophrenia]. / Influencia del consumo de drogas en las manifestaciones clínicas de la esquizofrenia.

OBJECTIVES: To study the association between drugs use with schizophrenia clinical manifestations. MATERIAL AND METHODS: The sample consists of 82 out-patients with schizophrenia, between 18 and 45 years old. They were evaluated with Addiction Severity Index (ASI) and with Positive and Negative Syndrome Scale (PANSS). A 6 months follow up was carried out. RESULTS: 37,8% patients had lifetime drug dependence (including alcohol and others drugs except for tobacco). The prevalence of dependence for the different drugs were: opioids 9,8%, cocaine 11%, alcohol 29,3%, cannabis 24,4%, tobacco 68,3%, caffeine 15,9%. Drug dependent had more family and legal problems. At the multiple regression analysis it was observed that cannabis and tobacco dependence was associated with a decrease in the PANSS negative symptoms subscale, and on the contrary, alcohol dependence produces a similar intensity increase at that scoring. We don't detect any clinical relevance effects over positive symptoms. CONCLUSIONS: Cannabis and tobacco may improve schizophrenia negative symptoms or neuroleptic secondary effects or patients with few negative symptoms may have more predisposition to the use, on the contrary alcohol use can impairment those symptoms.

[Drug use and dependence in schizophrenia]. / Consumo y dependencia de drogas en la esquizofrenia.

Drug dependence is common in schizophrenia. Two main models explain this association: drugs precipitate psychosis in a vulnerable subject, and drugs use to self-medicate positive and negative symptoms and neuroleptics side effects. We investigated the prevalence of psychoactive substance use and dependence in schizophrenia and its association with the subtype of schizophrenia. The sample consisted of 56 outpatients with schizophrenia according to ICD-10, between 18 and 40 years, and a control group with 56 subjects with other different disorder. They were evaluated with Addiction Severity Index (ASI) and Positive And Negative Syndrome Scale (PANSS), sociodemographical, clinical and toxicological characteristics were evaluated too. Patients were classified in subtype negative, positive or mixed according to scoring in PANSS. Schizophrenics were reevaluates at six months of development. There were higher cocaine, alcohol, cannabis and nicotine use in schizophrenics. The patients with negative subtype of schizophrenia had more clinical severity, less scoring in alcohol and drugs subscales of ASI, lower prevalence of nicotine dependence and cocaine, amphetamines, cannabis and opioids use. Drugs use were associated with a poor compliance of treatment. Therefore, cannabis and cocaine dependence, regular alcohol use and tobacco use are more prevalent in schizophrenic than control group with other mental disorders. Negative subtype had lower drug use.

[Epilepsy and delinquent behavior]. / Epilepsia y conductas delictivas.

Many authors through medical history have established that epilepsy and violent behavior are related. Although not corroborated in all the studies focussing on this matter, prevalence data show an increase number or epilepsy patients between prisoners, and is also found altered electroencephalograms in some violent people. A relation between a specific type of epilepsy and these behavior it has not been discovered. This connection between epilepsy and antisocial behavior have been studied in the ictal and interictal period and explained through different ways. Specific criteria have been described by some authors, trying to evaluate if the fit and the crime are closely related, but no characteristic type of crime is related with epileptic patients. We have made a review of the literature on this topic, considering the legal aspects and with reference to various countries justice resolutions.

[Progress and therapeutic response in the obsessive-compulsive disorder]. / Evolución y respuesta terapéutica en el trastorno obsesivo-compulsivo.

The purpose of the present work was to analyze the outcome of patients diagnosed of Obsessive Compulsive Disorder (OCD) after Hospital discharge from our Unit, focusing on therapeutical efficacy immediately after discharge and in the follow up, searching for good evolution predictors. We have studied 42 patients (26 females and 16 males) diagnosed of OCD according to ICD-9 diagnostic criteria, all patients were hospitalized during a seven years period 1981 and 1988. Therapeutical response was evaluated through a (1-4 punctuation) of a Clinical Global Impression Scale considering the changes from the moment the patient was hospitalized, the day of discharge and in the follow up (mean 4.1 years). 73.8% and 71.4% were considered as treatment "responders" the day discharged and in the follow up respectively. Through a multiple logistic regression, treatment with serotonergic drugs and insidious onset of the illness were identified as short-term treatment response predictors, while the absence of a previous obsessive personality was a long-term therapeutical response predictor. Our results show the efficacy of serotonergic drugs and the tact that the presence of a previous obsessive personality could have a prognostic value in OCD.

[Psychiatry for cardiologists: psychological care for the coronary patient]. / Una psiquiatría para cardiólogos: la atención psicológica al paciente coronario.

During the different post-infarction stages, the coronary patient can show different profiles of adaptation, requiring adequate therapeutic approaches. In the acute phase, anxiety and irritability are a common response. The handling of information and the use of anxiolytics are the therapeutic alternatives that can best improve the possible psychic instability of the patient. During the rehabilitation phase, it is frequent to find the presence of denial mechanisms as a defence against anxiety or depression. The use of antidepressant drugs will depend on the clinical situation of each patient. It is also necessary in this phase to deal with problems such as possible sexual disorders, as well as with the control of risk factors and the reintegration into family life. It is a question, in short, of achieving a healthier lifestyle and a better quality of life. In the long term, the aim would be focused on the return to work and on the follow-up of the patient, so as to avoid that he may come back to the lifestyle he was leading before his disease. Nowadays, as clinical cardiology has lost importance, giving way to invasive cardiology, it is necessary to restore the humanistic and psychological role of the cardiologist, focused on the cardiologist-patient relationship. The object of this paper is to underline the importance of the cardiologist in the psychiatric-psychological attention of the coronary patient.

[Psychopharmacologic treatment of bulimia nervosa]. / Tratamiento psicofarmacológico de la bulimia nerviosa.

Since the inclusion of Bulimia Nervosa (BN) in DSM-III as a nosological entity, it has been a focus of attention in the literature. To the present day several therapeutical approaches have been developed, pharmacological, psychological either separated or combined with diverse results. We have studied 20 patients diagnosed of BN according to DSM-III-R diagnostic criteria, from a psychopathological, and evolution point of view, the therapeutical response to a fixed daily dose of Fluoxetine 80 mg., during three months, with evaluations on days: 0-14-30-90. The mean age of the sample was 19.5 years; in 70% at the onset of the illness the Anorexia Nervosa symptomatology was prominent; there was a predominance of affective-obsessive previous personality traits in 60%, 100% showed unsatisfied or altered body image. We want to point out the quick improvement of various parameters such as: the constant eating desire, the binge eating episodes, the vomiting, the misuse of laxatives and the affective and anxious symptomatology. We compare our results with previous studies and make a review of the literature on this topic, we also give an efficacy profile of the different psychopharmacological drugs used in the treatment of eating disorders and a clinical guide to identify those patients who could improve with a psychopharmacological treatment.