Posible especificidad de los síntomas tipo pánico inducidos por inhalantes: a propósito de un caso

La intoxicación aguda por inhalantes produce distintos síntomas psiquiátricos y se ha documentado daño orgánico cerebral por exposición crónica a los mismos. Describimos la aparición de un subgrupo específico de síntomas tipo pánico, tras la exposición a solventes volátiles, en una mujer de 36 años con historia de exposición profesional y adicción a los solventes volátiles que posteriormente desarrolló un trastorno de pánico comórbido con escasa respuesta al tratamiento antidepresivo. La paciente se evaluó mediante la administración del SCL-90-R, el WAIS y el test de Rorschach; también se le realizó RM de medio contraste. No se encontraron datos sólidos de daño cerebral, aunque sus síntomas de ansiedad cumplen criterios para el subtipo neurobiológico de trastorno de pánico no relacionado con miedo a asfixia. Este subgrupo de síntomas de ansiedad se atribuye al mecanismo de acción de los solventes volátiles, es decir, la neurotransmisión gabaérgica

Pre-existing Psychiatric Morbidity Is Strongly Associated to Takotsubo Syndrome. A Case-Control Study

BackgroundTakotsubo syndrome (TTS) is an emerging disease characterized by an acute and reversible myocardial dysfunction which may have an influence on clinical status and prognosis. Despite extensive research, its pathophysiology has not been completely elucidated; among other hypothesis, a heart-brain interaction has been proposed. MethodsThe aim of this study was to assess the impact of psychiatric disorders and of some personality types on the pathogenesis of TTS. We conducted a retrospective observational case-control study. We enrolled a total of 50 patients, 25 with a previous diagnosis of TTS and 25 patients with a history of acute coronary syndrome (ACS), that underwent a comprehensive lifetime psychiatric assessment. ResultsWe found no significant difference between TTS and ACS patients in cardiovascular risk profile. The frequency of lifetime psychiatric disorders was significantly greater in TTS. In particular, in the univariate analysis, TTS group showed a higher prevalence of mood disorders (Major Depressive Disorder, Bipolar Disorder, Dysthymia; 16 vs. 2, P < 0.001) and anxiety disorder (Generalized Anxiety Disorder, Panic Disorder, Agoraphobia; 20 vs. 8, P = 0.001) compared with ACS group. There was also a significant tendency in TTS patients to psychotropic medication use, substance abuse, and psychologist or psychiatrist consulting. However, there was no difference between the groups in previous stressful events and Type D personality. Moreover, the multivariate analysis showed that mood disorders were independently associated with TTS (OR 16.9, 95% CI, 2.2-127). ConclusionOur study demonstrated that pre-existing anxiety disorders and mostly mood disorders were significantly higher in TTS patients than in ACS group, suggesting the role of psychiatric disorders as possible pathophysiological substrate of TTS

Oxcarbazepine improves mood in patients with epilepsy

Celem niniejszej analizy była prospektywna ocena, czy leczenie okskarbazepiną jest skorelowane z ilościową poprawą nastroju oraz zmniejszeniem objawów lękowych u dorosłych pacjentów z padaczką z napadami częściowymi. Objawy depresji oraz lęku oceniono za pomocą Skali Depresji Hamiltona (HDRS), Skali Dystymii Cornella (CDRS), Skali Depresji Becka (BDI) i Skali Lęku Hamiltona (HARS). Do badania włączono grupę kontrolną, składającą się z 40 pacjentów cierpiących z powodu padaczki i leczonych innymi lekami niż okskarbazepina, oraz grupę 40 pacjentów, których leczono okskarbazepiną. W badaniu z zastosowaniem skali CDRS wykazano istotną poprawę nastroju w przebiegu 3-miesięcznego okresu leczenia okskarbazepiną. Stwierdzono również poprawę wyników w skalach HDRS i BDI w grupie pacjentów leczonych okskarbazepiną, ale wynik ten nie był istotny statystycznie. Ponadto, w grupie 28 spośród 40 pacjentów leczonych okskarbazepiną, którzy prezentowali cechy dystymii według kryteriów skali CDRS na początku badania (wynik &#8805; 20 pkt.), stwierdzono poprawę nastroju zgodną z efektem przeciwdepresyjnym stosowanego leczenia (wynik < 20 pkt.). Mimo że prezentowane wyniki nie dostarczają ostatecznych dowodów, które uprawniałyby do stosowania okskarbazepiny jako leku przeciwdepresyjnego, znamienne zmniejszenie objawów dystymicznych w wyniku podawania okskarbazepiny w porównaniu z grupą kontrolną potwierdza hipotezę, że okskarbazepina poprawia nastrój.This study prospectively examined whether continued add-on treatment with oxcarbazepine (OXC) is associated with quantitative improvement in mood and anxiety symptoms in adult patients with partial epilepsy. Depressive symptoms and anxiety were assessed by clinical interview using the Hamilton Depression Rating Scale (HDRS), the Cornell Dysthymia Rating Scale (CDRS), the Beck Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). Forty controls (patients with epilepsy treated with antiepileptic drugs other than OXC) and 40 OXC-treated patients were enrolled and completed the study. In our study, a significant improvement in affect, as measured by the CDRS, was demonstrated during the course of OXC treatment for 3 months. HDRS and BDI scores also declined in the OXC-treated group, but these decreases did not reach statistical significance. In addition, 28 of 40 OXC-treated subjects who were dysthymic by CDRS criteria on study entry (score P20) demonstrated affective improvement consistent with a treatment-related antidepressant effect (score < 20). Although our results do not provide conclusive evidence supporting the specific use of OXC as an antidepressant, the significant decline in dysthymic symptoms in OXC-treated subjects compared with controls lends support to the hypothesis that OXC improves mood

Manuale Clinico di Psichiatria Geriatrica

Questo manuale va incontro alle esigenze di clinici indaffarati che appartengono a varie specialità e sono coinvolti nella cura degli anziani... La nostra speranza è che questo maneggevole volume diventi una guida sul campo per quei professionisti oberati dai loro impegni, e costituisca un aiuto per orientare le cure dei pazienti vulnerabili. Auspichiamo peraltro che questo libro trovi posto sulle loro scrivanie o nelle loro tasche invece di rimanere nelle loro librerie. Gli autori dei capitoli di questo volume sono degli esperti nei loro rispettivi campi che hanno contribuito ad aggiornare e focalizzare il manuale su ciò che possiede maggiore rilevanza clinica. Nella trattazione vengono ricompresi una varietà di disturbi specifici, così come i principi generali del colloquio clinico con pazienti anziani, la psicofarmacologia dell'anziano, la pratica assistenziale in strutture residenziali. Una questione importante riguarda la transizione dal DSM-IV al DSM-5, avvenuta mentre questo manuale era in avanzata fase di pubblicazione. Abbiamo deciso di non sottoporre a ulteriore revisione l'intero manuale sulla base dei cambiamenti intervenuti fra le edizioni del DSM, continuando a riferirci in larga misura al DSM-IV

Psychological Distress Affects Performance during Exercise-Based Cardiac Rehabilitation

Background: It is known that psychosocial distress affects the morbidity and mortality of patients with cardiovascular disease of every age. The aim of this study was to produce novel information on how psychological distress can influence cardiovascular performance in patients after cardiac surgery undergoing multidisciplinary cardiac rehabilitation. Methods: Patients (n = 57) admitted after cardiac surgery for valvular or coronary disease underwent, within 5 days of admission, the Symptom Checklist-90-Revised (SCL-90-R) self-report questionnaire to measure psychiatric symptoms and the 12-item General Health Questionnaire (GHQ-12) to assess the level of psychological distress. The Positive Symptom Distress Index (PSDI) was measured to indicate the amplitude of symptom distress. Cardiovascular performance was assessed by a 6 min walking test (6MWT) at admission and discharge, and oxygen consumption (VO2 max) was derived. Results: Within the SCL-90-R score, somatic symptoms (47.4%), depressive and anxiety symptoms (36.8% and 33.3%, respectively), symptoms of phobic anxiety (21.1%), and psychoticism (24.6%) were over-represented. As for the GHQ-12, 75.4% of the sample reported an abnormally negative perception of their health status. An inverse correlation was shown between the variation in 6MWT and SCL depression (p = 0.048), PSDI (p = 0.022), and the GHQ-12 (p = 0.040). Similarly, an inverse correlation was shown between the variation in the VO2 max, GHQ-12 (p = 0.041), and the PSDI (p = 0.023). Conclusions: Post-cardiac surgery cardiac rehabilitation was associated with increased symptoms of psychological discomfort, as compared with the general population. The amplitude of psychological distress, depression, and hostility are associated with limited improvement in performance. These data strengthen the need for psychological support during cardiac rehabilitation programs

Psychological Distress Affects Performance during Exercise-Based Cardiac Rehabilitation

Background: It is known that psychosocial distress affects the morbidity and mortality of patients with cardiovascular disease of every age. The aim of this study was to produce novel information on how psychological distress can influence cardiovascular performance in patients after cardiac surgery undergoing multidisciplinary cardiac rehabilitation. Methods: Patients (n = 57) admitted after cardiac surgery for valvular or coronary disease underwent, within 5 days of admission, the Symptom Checklist-90-Revised (SCL-90-R) self-report questionnaire to measure psychiatric symptoms and the 12-item General Health Questionnaire (GHQ-12) to assess the level of psychological distress. The Positive Symptom Distress Index (PSDI) was measured to indicate the amplitude of symptom distress. Cardiovascular performance was assessed by a 6 min walking test (6MWT) at admission and discharge, and oxygen consumption (VO2 max) was derived. Results: Within the SCL-90-R score, somatic symptoms (47.4%), depressive and anxiety symptoms (36.8% and 33.3%, respectively), symptoms of phobic anxiety (21.1%), and psychoticism (24.6%) were over-represented. As for the GHQ-12, 75.4% of the sample reported an abnormally negative perception of their health status. An inverse correlation was shown between the variation in 6MWT and SCL depression (p = 0.048), PSDI (p = 0.022), and the GHQ-12 (p = 0.040). Similarly, an inverse correlation was shown between the variation in the VO2 max, GHQ-12 (p = 0.041), and the PSDI (p = 0.023). Conclusions: Post-cardiac surgery cardiac rehabilitation was associated with increased symptoms of psychological discomfort, as compared with the general population. The amplitude of psychological distress, depression, and hostility are associated with limited improvement in performance. These data strengthen the need for psychological support during cardiac rehabilitation programs