Teoría y práctica psiquiátrica en Valencia a mediados del S. XIX

El trabajo que presentamos se inscribe en una de las líneas de investigación de la Cátedra de Historia de la Medicina de la Universidad de Valencia: la - de la historia de la Psiquiatría, que es quizás, una - de las más fecundas. Y no cabe duda que el interés que a la misma otorga el Profesor J.M. LOPEZ PINERO promueve su fertilidad. No es éste el lugar más apropiado para enumerar los estudios histéricos-psiquiátricos que se han gestado bajo la dirección de J.M. LOPEZ PINERO, si bien la mención de que su número supera la veintena, redunda en lo dicho. Dentro de dicha línea de investigación, diversos factores han hecho que el estudio de la psiquiatría española decimonónica, haya recibido un particular impulso. Fruto resultante de este son trabajos tan descollantes como el de J. ESPINOSA en el terreno de la asistencia y el de A. REY sobre los saberes psiquiátricos, por citar sólo estos dos

El papel de la pérdida en la génesis de los trastornos depresivos.

Introducción. En la investigación de la depresión, el papel de la pérdida ha sido examinado en detalle, puesto que constituye un aspecto central de la mayoría de los acontecimientos vitales que llevan a la depresión. Material y método. En el presente trabajo se realizó una revisión acerca de los estudios previos sobre la importancia de la pérdida centrándonos en diversos aspectos como sus diferentes tipos, la asociación con algunas enfermedades mentales, pérdida y pronóstico, relación entre desesperanza y pérdida, y variaciones de los acontecimientos de pérdida en función de diversos factores, considerando también la pérdida en la infancia. Resultados. La pérdida ejerce un papel clave en la aparición de muchos trastornos depresivos. Puede actuar como agente provocador, factor de vulnerabilidad o agente modificador de la forma, gravedad y curso de un cuadro depresivo. Diversos factores como el factor genético, el sexo o el momento de la vida en el que tiene lugar la pérdida pueden modular la influencia de los acontecimientos de pérdida

Attentional biases toward emotional images in the different episodes of bipolar disorder: An eye-tracking study.

Attentional biases toward emotional information may represent vulnerability and maintenance factors in bipolar disorder (BD). The present experimental study examined the processing of emotional information in BD patients using the eyetracking technology. Bipolar patients in their different states (euthymia, mania, depression) simultaneously viewed four pictures with different emotional valence (happy, neutral, sad, threatening for 20 s while their eye movements were monitored. A group of healthy individuals served as the control. The data revealed the following: (i) a decrease in attention to happy images in BD patients in their depressive episodes compared to healthy individuals, and (ii) an increase in attention to threatening images in BD patients (regardless of their episode) relative to the healthy controls. These biases appeared in the late stages of information processing and were sustained over the 20 s interval. Thus, the present findings reveal that attentional biases toward emotional information can be a key feature of BD, in that:(i) an anhedonic lack of sensitivity to positive stimuli during the bipolar depressive episode may be considered a maintaining factor of this clinical state, and (ii) the trait-bias toward threat, even in asymptomatic patients, may reflect a marker of vulnerability in BD

Nuevos eutimizantes y ciclo reproductivo

Introduction. The use of new mood stabilizers in the treatment of bipolar disorder has supposed a revolution, especially due to its more favorable profile in many aspects. Nevertheless, therapeutic decisions on treatment during pregnancy and the breastfeeding period are still being debated. Since these new anticonvulsants appeared in the decade of 1990, less naturalistic experience in its use exists during these periods than with other older anticonvulsants. Methods. A Medline and Embase search was conducted from 1970 to 2003 to review the articles published on the use of the new mood stabilizers during pregnancy and breastfeeding, and its effects on contraception. Neurology and psychiatry text chapters and abstracts of the Annual Meeting of the American Psychiatric Association (years 2001-2003) were also reviewed. Results. Although some recent articles suggest that new mood stabilizers could have a smaller risk of congenital defects, and therefore could be used with smaller risks in women in fertile age, most of articles reviewed indicate that there is not enough knowledge on the safety of the new mood stabilizers in pregnancy and breastfeeding. Conclusions. The risks and benefits of continuing with the new mood stabilizers during pregnancy and breastfeeding must be weighed carefully, and the severity of the disease and the previous answer to treatment should be taken into account

El punto de vista de los familiares de pacientes con trastorno bipolar.

Como consecuencia de la desinstitucionalización de los pacientes psiquiátricos, el papel de los cuidadores ha adquirido un interés relevante a lo largo de los últimos años. Con el objetivo de conocer el impacto de la enfermedad en los cuidadores, 88 familiares de pacientes diagnosticados de trastorno bipolar (DSM-IV) completaron un cuestionario autoadministrado que recogía información sobre variados aspectos clínicos, sociodemográficos, carga experimentada, actitudes y conocimientos acerca de la enfermedad, entre otras cuestiones. Encontramos que los familiares necesitaban con frecuencia ayuda psiquiátrica por el estrés generado por la enfermedad, ercibían afectación en los planos laboral, lúdico y económico, junto con la estigmatización social. Resultaban de gran ayuda en la cumplimentación terapéutica y la información recibida acerca de la enfermedad y los recursos destinados eran percibidos como insuficientes. También se obtuvo información de las parejas que describían afectación en las relaciones conyugales, sexuales y en la crianza. Es necesario, por tanto, identificar aquellos factores que contribuyen al estrés familiar. Intervenciones como los grupos psicoeducativos pueden mejorar el conocimiento de la enfermedad y mejorar las técnicas de afrontamiento

Is melatonin an adjunctive stabilizer?

MELATONIN (MLT) IS a main synchronizer of the sleep/wake cycle control. We performed a prospective naturalistic study that included 14 euthymic bipolar patients that suffered from insomnia (six type I, six type II and two schizoaffective disorder) according to DSM-IV-TR criteria.1 After giving their written consent, patients began the treatment with MLT. Evaluation tools used were: Oviedo Sleep Questionnaire (OSQ),2 Chinese Polarity Inventory (CPI),3 Numeric Evaluation Scale (NES),4 and Clinical Global Impressions Scale foruse in bipolar illness (CGI-BP-M).5 Side-effects and time until improvement of sleep were evaluated. Euthymia had to be confirmed by a score <30 on the CPI-Depression and <15 on the CPI-Mania. MLT was prescribed at bedtime, the dose was free, between 3-6 mgr/day and it was added to a stable regimen of medication. An analysis of the results' 'mirror-image' was performed, comparing the period of treatment with MLT, with the same period of time prior to the start of the treatment. Data analysis was performed with the statistical program spss v15.0 (spss, Chicago, IL, USA). The improvement of sleep disorders occurred in all patients, and the mean time until improvement was 3.6 weeks. The scores obtained in the OSQ were: 25.8 (prior to the treatment) versus 13.8 (after the treatment) (P = 0.001). MLT significantly improved the scores in the CPI-Depression (29.78 ± 16.25 vs 23.84 ± 13.16; P = 0.04) and in the CGIBP-M, both on the subscale for depression (2.49 ± 0.82 vs 1.88 ± 0.85; Z −2.857; P = 0.004) and for mania (1.23 ± 0.3 vs 1.05 ± 0.15; Z −2.375; P = 0.018). Improvement was also observed in the NES scores (42.43 ± 8.77 vs 44.39 ± 5.49). Visits were spaced from an average of 48.8 to 65.3 days. All patients experienced a sleep improvement in quantity and quality, and there was a reduction in the total score of the items that measured clinical depression. In one of the scales that assessed the manic pole, a reduction in the total score was observed. We know that melatonin M1 and M2 agonists, such as ramelteon or agomelatine, may also be effective for bipolar disorder and these results show that MLT can be a useful treatment as adjunctive therapy in bipolar patients with sleep alterations and helping in clinical stabilization

Síndrome de Munchausen en dos hermanos

Cartas al editor: Síndrome de Munchausen en dos hermanos

Nutrient Intake and Depression Symptoms in Spanish Children: The ANIVA Study

The aim of this study was to examine the relationship between nutritional intake and depressive symptoms in Valencian schoolchildren. The ANIVA (Antropometria y Nutricion Infantil de Valencia) study is a descriptive cross-sectional study. During academic year 2013–2014, 710 schoolchildren aged 6–9 years were selected from eleven primary schools in Valencia (Spain). Children’s dietary intake was measured on three-day food records, completed by parents/guardians; children completed the 20-item Center for Epidemiologic Studies Depression Scale for Children (CES-DC) Questionnaire to measure depressive symptoms. Weight, height, and body mass index (BMI), and z-scores were evaluated in all subjects. Nutrient adequacy was assessed using Spanish dietary recommended intakes (DRIs); 20.70% of the sample presented depressive symptoms. We identified a positive association between children with depressive symptoms and non-depressive symptoms for thiamin, vitamin K, and bromine (p < 0.05), and a negative association for protein, carbohydrates, pantothenic acid, biotin, vitamin B12 and E, zinc, manganese, cobalt, and aluminum (p < 0.05). Statistically significant differences were found between both groups according to the DRIs for intakes of total energy (p = 0.026), fiber (p < 0.001), vitamin C (p < 0.001), vitamin E (p = 0.004), magnesium (p = 0.018), and iron (p = 0.013). Our results demonstrated that carbohydrates were the most closely associated factor with depressive symptoms, and highlight the potential significant public health implications of inadequate nutritional intake on schoolchildren’s mental health.Peer reviewe

Differentiation of Self and Social Functioning in Severe Mental Disorders

Differentiation of self, which is understood to be the psychological individuation of a person from their parental figures, is considered a key factor in the origin of severe psychopathology. In this study, we aim to explore the ways in which the process of differentiation of self develops in people with various severe mental disorders, examining its impact on social functioning together with diagnosis, current symptoms, illness variables, and sociodemographic features. One hundred thirty patients (45 diagnosed with schizophrenia, 44 with bipolar disorder, and 41 with major depressive disorder) and 45 controls were assessed using the Differentiation of Self-Inventory-Revised, the Family of Origin Scale, the 90 Symptom Check List-Revised, and the Social Adaptation Self-Evaluation Scale. As for differentiation of self, patients showed lower I-position and poorer emotional reactivity than controls. Additionally, emotional reactivity was poorer for patients with schizophrenia and bipolar disorder than for those with major depressive disorder; and a poor emotional cutoff (remoteness) was evidenced only in schizophrenia. Individuals with schizophrenia and bipolar disorder had lower capacity for differentiation than controls, and those with schizophrenia were less differentiated than those with major depressive disorders. Among the main predictors of poor social functioning were low differentiation of self and low differentiation from the family of origin rather than any specific clinical diagnosis. These findings suggest a possible utility of using the concept of differentiation of self as a psychological marker to classify severe mental disorders. Critically, social functioning may improve with interventions focused on differentiation of self