[Atypical anorexia nervosa without body image distortion: based on a clinical case]. / Anorexia nerviosa atípica sin alteración de la imagen corporal: a propósito de un caso clínico.

Eating disorders presents a lower prevalence in males than in females. Despite being mentioned in 1689 in the first case described by Richard Morton, anorexia nervosa in males has been relatively ignored. The diagnostica criteria for males with anorexia nervosa are similar to those for females although the sociocultural environment differs from birth between the sexes. Men and women perceive fatness differently. They have different ideas of shape and they value slimness differently.

Factors influencing relapse in the long-term course of schizophrenia.

Highly effective neuroleptic drugs have been available for the past 40 years, but 50% of schizophrenic patients, under normal treatment conditions, relapse within 1 year after their latest episode, frequently spending 15-20% of their time in psychiatric institutions. The term relapse usually refers to a deterioration or recurrence of positive rather than negative features, and relapses appear to impair the course of the disease. Impairment is often longer than expected for those patients who discontinue antipsychotic medication and then relapse to their prediscontinuation clinical state of function. Drug therapy is an important defense against relapse. Marked differences in relapse rate between patients receiving placebo and neuroleptic drugs have been observed (approximately 69% after 1 year for the placebo group versus 26% for the neuroleptic group). First-year relapse rates can be reduced from 75% to 15% with prophylactic treatment with neuroleptics. Follow-up studies suggest that noncompliance with medication, pharmacological factors, psychosocial factors and alcohol and drug abuse contribute to setting off new psychotic episodes. The most important of these is noncompliance with medication. The overwhelming majority of schizophrenic patients who suffered a clinical exacerbation and required hospitalization (73%) did not comply with the treatment prescribed. The effect of new antipsychotic agents should be examined in patients who relapse despite maintenance treatment with conventional neuroleptics. We have found that the rate of current drug abuse among patients with schizophrenic relapse (44%) was significantly higher than that in schizophrenic patients who regularly attended outpatient clinics. Also, the rate of alcohol and substance abuse is higher in males (79%) than in females (21%). Psychiatric units should integrate addiction treatments with psychotic-relapse management.

Course of schizoaffective psychosis: further data from a retrospective study.

This study investigated the clinical course and outcome of 72 patients, diagnosed as suffering from schizoaffective psychosis (according to ICD-9 criteria) who also satisfied Research Diagnostic Criteria for schizoaffective disorder. The current overall functioning of these patients was related to the number and frequency of episodes, regardless of the duration of the illness: the lesser the number or frequency of relapses, the better the overall functioning. In addition, there were no statistically significant differences in psychosocial impairment between bipolar and unipolar schizoaffective disorder.

Course of schizoaffective psychosis: a retrospective study.

This study investigated the clinical course and outcome of 72 patients diagnosed as suffering from schizoaffective psychosis according to ICD-9 criteria who also satisfied RDC criteria for schizoaffective disorder. The results show a clear relationship between patients' overall functioning and premorbid personality: a better premorbid social adjustment indicates a better current state. Those who met DSM-III criteria for schizophrenic or schizophreniform disorder had an earlier age of onset and a higher frequency of relapse, followed by schizoaffective and affective patients. Patients who presented interepisodic psychotic symptoms differed from those who did not in that they showed more recurrences, an earlier age of onset and a premorbid personality with poorer social adjustment. The age of onset of the disease was significantly earlier in patients who had hyperthymic episodes. Schizoaffective disorders therefore are a heterogeneous group as regards premorbid personality, DSM-III diagnosis, and the presence or absence of interepisodic psychotic symptoms and hyperthymic episodes.

[Development of a probability index for suicide risk in depression]. / Desarrollo de un índice de probabilidad de riesgo suicida en las depresiones.

Authors have developed a Suicidal Risk Index for depressed. This index included: sex, duration of current phase, suicidal ideas presents in last months, attempts previous and a number of contacts with a psychiatrist. The predictive validity of index is good. Sensibility: 0.73; specificity: 0.91; probability pi: 0.93; false positives rate: 9%; Kw: 0.65.