Characteristics of particulate and non-particulate corticosteroids. Indications for their use in chronic pain treatments. / Características de los corticoides particulados y no particulados. Condicionantes para su uso en el tratamiento del dolor crónico.

Corticosteroids been used frequently in pain treatments since the middle of last century (1952). Due to a review of the complications as a result of their application in epidural injections, the United States of America Food and Drug Administration (FDA) issued an «alert controversy¼ requesting that a warning label should be added to injectable corticosteroids, where risks must be described (loss of sight, brain damage, paralysis and death) when administering by this route. It must be mentioned that there are different types of corticosteroids with diverse characteristics, which as a result, may produce different side-effects. Due to the aforementioned developments, the controversies that have arisen, and the lack of well-conducted studies on the use of steroids in epidural injections, we must begin by reviewing their indications in different pain conditions.

Respuesta a la TEC en un caso de trastorno explosivo intermitente refractario / Effect of ECT on a case of intermitent explosive disorder, refractory of pharmacological treatments

Introducción: El trastorno explosivo intermitente se manifiesta como una historia de episodios de pérdida de control de impulsos agresivos, con violencia o destrucción de la propiedad. El caso que presentamos tuvo una evolución atípica, por su gravedad clínica, la asociación con clínica obsesivo-compulsiva y su refractariedad a los tratamientos convencionales. Caso clínico: Se trata de un paciente varón de 35 años, que presentaba desde los 18 años crisis de agitación muy importantes, con destrucción de objetos, ante mínimas contrariedades. Presentaba, además, sintomatología obsesivo-compulsiva, con rituales de limpieza y perfeccionismo. El tratamiento farmacológico con potenciadores de la vía serotoninérgica, clozapina y diversos eutimizantes, resultó inefectivo. Finalmente, la asociación de la terapia electro-convulsiva logró controlar los episodios de agitación. Conclusiones: La literatura acerca del tratamiento con TEC de este síndrome se limita a series de casos. La gravedad clínica del caso motivó que se pautara dicha técnica, con buen resultado

Introduction: IED (intermittent explosive disorder) is a condition which makes people lash out violently for no reason; the person loses control suddenly and brakes or smashes something. The reported case showed atypical evolution due to its clinical condition such as an obsessive compulsive behavior and its resistance to common treatment. Clinical case: Since age eighteen, a thirty five-year old man had disproportionate reactions to any provocation, also showing obsessive compulsive symptoms characterized by repeated patterns of cleaning and perfectionism. He was treated pharmacologically with serotonin reuptake inhibitors (SRI), clozapine (antipsychotic) and other mood-stabilizers, thus resulting ineffective. Electro-convulsive therapy (ECT) finally controlled the violent outbursts. Conclusion: Information including ECT on this type of disorder limits to certain cases. The seriousness of the case encouraged specialists to employ this technique resulting in successful outcome (AU)

Traducción y adaptación de la Altman Self-Rating Mania Scale al ámbito español / Translation and adaptation in the Spanish environment of the Altman Self-Rating Mania Scale

Introducción. El objetivo del presente trabajo es la traducción, adaptación y validación en el ámbito español de una escala de autoevaluación de la manía, denominada Altman Self-Rating Mania Scale (ASRM), con lo que se trata de cubrir el vacío existente en nuestro ámbito en la autoevaluación de la manía. Métodos. Se tradujo la escala y a continuación se realizó la traducción inversa, que fue remitida al autor de la escala original. Fue aplicada a 74 pacientes con trastorno bipolar, que fueron divididos en dos grupos, uno formado por pacientes con sintomatología activa maníaca (n = 35) y otro constituido por pacientes asintomáticos (n = 39). Concurrentemente se aplicó la Escala para la Valoración de la Manía Administrada por Clínicos (EVMAC) y la Escala de Valoración Numérica. Resultados. Se encontró alta consistencia interna, alta y significativa correlación con la subescala de manía de la EVMAC, así como con la Escala de Valoración Numérica, y diferencias muy significativas entre los dos grupos en la puntuación de la escala. La curva COR indicó excelente ajuste de la escala al discriminar entre pacientes bipolares con y sin síntomas maníacos. El análisis factorial arrojó un solo factor, que explica el 62 % de la varianza total. Conclusiones. La Escala Autoaplicada de Manía de Altman demuestra ser un instrumento autoaplicado, fiable y válido para medir la presencia y gravedad de la sintomatología maníaca. Permite realizar valoraciones sencillas y rápidas del estado del paciente, pudiendo ser utilizada con fines de investigación, clínicos y como instrumento de cribado

Introduction. The aim of the present study is the translation, adaptation and validation in the Spanish environment of a self-rating of mania scale, the Altman Self-Rating Scale for Mania (ASRM), to fulfill a need in our environment in the self-rating of mania. Methods. The scale was translated, and then a back translation was done. This was sent to the author of the original scale. The scale was administered to a sample of 74 patients with bipolar disorder, divided into two groups, one formed by patients with acute mania (n = 35) and the other one constituted by asymptomatic patients (n = 39). Concurrently we applied the Clinician Administered Rating Scale for Mania (CARS-M) and the Numeric Evaluation Scale (NES). Results. High internal consistency, high and significant correlation with the CARS-M mania sub-scale, as well as with the NES and very significant differences between the two groups in the scale score were found. The ROC curve indicates excellent adjustment of the scale, when discriminating among bipolar patients with and without manic symptoms. The factorial analysis provided a single factor that accounts for 62 % of the total variance. Conclusions. The Altman Self-Rating Mania Scale is shown to be a reliable and valid self-rating instrument to assess the presence and intensity of manic symptoms. It makes it possible to carry out simple and quick assessments of the patient's state, can be used for research as clinical objectives and can also be a screening instrument

[Translation and adaptation in the Spanish environment of the Altman Self-Rating Mania Scale]. / Traducción y adaptación de la Altman Self-Rating Mania Scale al ámbito español.

INTRODUCTION: The aim of the present study is the translation, adaptation and validation in the Spanish environment of a self-rating of mania scale, the Altman Self-Rating Scale for Mania (ASRM), to fulfill a need in our environment in the self-rating of mania. METHODS: The scale was translated, and then a back translation was done. This was sent to the author of the original scale. The scale was administered to a sample of 74 patients with bipolar disorder, divided into two groups, one formed by patients with acute mania (n=35) and the other one constituted by asymptomatic patients (n=39). Concurrently we applied the Clinician Administered Rating Scale for Mania (CARS-M) and the Numeric Evaluation Scale (NES). RESULTS: High internal consistency, high and significant correlation with the CARS-M mania sub-scale, as well as with the NES and very significant differences between the two groups in the scale score were found. The ROC curve indicates excellent adjustment of the scale, when discriminating among bipolar patients with and without manic symptoms. The factorial analysis provided a single factor that accounts for 62% of the total variance. CONCLUSIONS: The Altman Self-Rating Mania Scale is shown to be a reliable and valid self-rating instrument to assess the presence and intensity of manic symptoms. It makes it possible to carry out simple and quick assessments of the patient's state, can be used for research as clinical objectives and can also be a screening instrument.

[Chinese Polarity Inventory: its adaptation to our setting]. / Inventario Chino de Polaridad: su adaptación a nuestro ámbito.

INTRODUCTION: The Chinese Polarity Inventory (CPI) is a self-report scale for bipolar disorder assessment, composed of two scales (mania and depression), with 20 items for each one. OBJECTIVES: Translate, adapt and validate the CPI to our context. MATERIAL AND METHODS: The questionnaire was applied to 123 patients: bipolar disorder in the manic phase (32), depressed (17), remission (30) and mixed state (3). We also established a control group with 30 patients without affective disorder. Internal consistency was assessed using Cronbach's alpha. On the other hand, validity was established using the Clinician Administered Rating Scale for Mania (CARS-M) in manic patients and the Hamilton scale in the depressed ones as a gold standard. RESULTS: This scale has good psychometrics qualities. Internal consistence index (Cronbach's alpha) for the manic scale was 0.90 and for depression scale was 0.92. The correlation coefficient between the manic scale and the CARS-M was 0.82 and between the depression scale and the Hamilton scale was 0.67. CONCLUSIONS: The CPI is an instrument of rapid and easy application that permits self-report of bipolar disorders. The best benefit for this scale is the possibility of application in the entire course of illness, for clinical and investigation activities and assessment of the treatment response.

Inventario Chino de Polaridad: su adaptación a nuestro ámbito / Chinese Polarity Inventory: its adaptation to our setting

Introducción. El Inventario Chino de Polaridad (CPI) es una escala autoaplicada para la valoración del trastorno bipolar, compuesta por dos subescalas (manía y depresión), con 20 ítems cada una. Objetivos. Traducir, adaptar y validar el CPI en nuestro medio. Material y métodos. El cuestionario fue aplicado a 123 pacientes: bipolares en fase maníaca (32), fase depresiva (17), remisión (30) y episodio mixto (3). Además se obtuvo un grupo control formado por 30 pacientes sin patología afectiva. Se analizó la consistencia interna de la escala mediante el alfa de Cronbach. Por otro lado se realizaron correlaciones con otras escalas ya validadas, la Escala de Valoración de la Manía Aplicada por Clínicos (EVMAC) para manía y la Escala de Hamilton para la depresión. Resultados. La escala presenta buenas características psicométricas con índice de consistencia interna (alfa de Cronbach) para la subescala de manía de 0,90 y para la de depresión de 0,92. La correlación de la subescala de manía con la EVMAC fue de 0,82 y la de depresión con la escala de Hamilton de 0,67.Conclusiones. El CPI es un instrumento sencillo y rápido de aplicar que permite la autovaloración de los pacientes bipolares. Su importancia radica la posibilidad de utilizarlo en el seguimiento a largo plazo, tanto para efectos clínicos como actividades de investigación, así como para evaluar la respuesta al tratamiento (AU)

¿Y qué si solamente tenemos 30.000 genes? / And so what if we only have 30.000 genes?

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A selective learning method to improve the generalization of multilayer feedforward neural networks.

Multilayer feedforward neural networks with backpropagation algorithm have been used successfully in many applications. However, the level of generalization is heavily dependent on the quality of the training data. That is, some of the training patterns can be redundant or irrelevant. It has been shown that with careful dynamic selection of training patterns, better generalization performance may be obtained. Nevertheless, generalization is carried out independently of the novel patterns to be approximated. In this paper, we present a learning method that automatically selects the training patterns more appropriate to the new sample to be predicted. This training method follows a lazy learning strategy, in the sense that it builds approximations centered around the novel sample. The proposed method has been applied to three different domains: two artificial approximation problems and a real time series prediction problem. Results have been compared to standard backpropagation using the complete training data set and the new method shows better generalization abilities.

Pharmacomanometric studies of colonic motility as a guide to the chemotherapy of schizophrenia.

Distal colon motility studies performed in 41 psychotic subjects demonstrated that 32 of them had hyperactivity of the noradrenergic system at this peripheral level, while the remaining nine cases showed hyperactivity of the dopaminergic system. The noradrenergic-hyperactive patients fulfilled the Research Diagnostic Criteria of schizophrenia, whereas the dopaminergic-hyperactive patients were diagnosed as having schizoaffective disorders. Noradrenergic-hyperactive subjects were successfully treated with clonidine, a drug which inhibits release of noradrenaline, while dopaminergic-hyperactive subjects were successfully treated with clonazepam, a drug which inhibits release of dopamine. The addition of sulpiride (a postsynaptic dopaminergic blocking agent) and of phentolamine (a postsynaptic noradrenergic blocking agent) to clonidine and clonazepam, respectively, induced further significant improvements in both types of psychotic patients.