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RESÚMENES JUNIO 2004 |
Other Neuropsychiatric Disorders
Nathan Herrmann, Muhammad Mamdani, and Krista L. Lanctôt
Am J Psychiatry 161:1113-1115, June 2004
OBJECTIVE:
Randomized controlled trials have suggested that at least one
atypical antipsychotic may be associated with an increased risk of
stroke in older people with dementia. This study examined the
association between atypical antipsychotic use and stroke in the
elderly. METHOD: The authors conducted a retrospective
population-based cohort study of patients over the age of 66 by
linking administrative health care databases. Three cohorts—users of
typical antipsychotics, risperidone, and
olanzapine—were identified and compared. RESULTS: Subjects treated
with typical antipsychotics (N=1,015) were compared with those given
risperidone (N=6,964) and olanzapine (N=3,421).
Model-based estimates adjusted for covariates hypothesized to be
associated with stroke risk revealed relative risk estimates of 1.1
(95% CI=0.5–2.3) for olanzapine and 1.4 (95% CI=0.7–2.8) for risperidone. CONCLUSIONS: Olanzapine and risperidone use were not associated with a
statistically significant increased risk of stroke compared with
typical antipsychotic use.
An active and socially integrated lifestyle in
late life might protect against dementia
Laura Fratiglioni, Stephanie Paillard-Borg , and Bengt Winblad
The
recent availability of longitudinal data on the possible association of
different lifestyles with dementia and Alzheimer's disease (AD) allow some
preliminary conclusions on this topic. This review systematically analyses the
published longitudinal studies exploring the effect of social network, physical
leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the
limitations of the studies and the biological plausibility. For all three
lifestyle components (social, mental, and physical), a beneficial effect on
cognition and a protective effect against dementia are suggested. The three
components seem to have common pathways, rather than specific mechanisms, which
might converge within three major aetiological
hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular
hypothesis, and the stress hypothesis. Taking into account the accumulated
evidence and the biological plausibility of these hypotheses, we conclude that
an active and socially integrated lifestyle in late life protects against
dementia and AD. Further research is necessary to better define the mechanisms
of these associations and better delineate preventive and therapeutic
strategies.
Kindling
and status epilepticus models of epilepsy: rewiring
the brain
Kiyoshi
Morimoto, Margaret Fahnestock and Ronald J. Racine
Progress
in Neurobiology .Volume
73, Issue 1 , May 2004, Pages 1-60
This
review focuses on the remodeling of brain circuitry associated with epilepsy,
particularly in excitatory glutamate and inhibitory GABA systems, including
alterations in synaptic efficacy, growth of new connections, and loss of
existing connections. From recent studies on the kindling and status epilepticus models, which have been used most extensively
to investigate temporal lobe epilepsy, it is now clear that the brain
reorganizes itself in response to excess neural activation, such as seizure
activity. The contributing factors to this reorganization include activation of
glutamate receptors, second messengers, immediate early genes, transcription
factors, neurotrophic factors, axon guidance
molecules, protein synthesis, neurogenesis, and synaptogenesis. Some of the resulting changes may, in turn,
contribute to the permanent alterations in seizure susceptibility. There is
increasing evidence that neurogenesis and synaptogenesis can appear not only in the mossy fiber
pathway in the hippocampus but also in other limbic structures. Neuronal loss,
induced by prolonged seizure activity, may also contribute to circuit
restructuring, particularly in the status epilepticus
model. However, it is unlikely that any one structure, plastic system, neurotrophin, or downstream effector
pathway is uniquely critical for epileptogenesis. The
sensitivity of neural systems to the modulation of inhibition makes a disinhibition hypothesis compelling for both the triggering
stage of the epileptic response and the long-term changes that promote the epileptic
state. Loss of selective types of interneurons,
alteration of GABA receptor configuration, and/or decrease in dendritic inhibition could contribute to the development of
spontaneous seizures.
Patients'
preferences in the treatment of depression are important in clinical practice
and in research. Antidepressant medication is often prescribed, but adherence
is low. This may be caused by patients preferring psychotherapy, which is often
not available in primary care. In randomized clinical trials, patients'
preferences may affect the external validity. The aim of this article is to
study patients' preferences regarding psychotherapy and antidepressant
medication and the impact of these preferences on treatment outcome. A
systematic review of the literature was performed. The majority of patients
preferred psychotherapy in all available studies. Antidepressants were often
regarded as addictive and psychotherapy was assumed to solve the cause of
depression. Discussing and supporting preferences as part of a quality
improvement program of depression care, resulted in more patients receiving the
treatment that was most suitable to them. In two patient-preference trials,
preferences did not influence treatment outcome. It can be concluded that a
substantial percentage of well-informed patients prefer psychotherapy. Patients
with strong preferences, mostly for psychotherapy, are likely not to enter
antidepressant treatment or randomized clinical trials if their preferences are
not supported.
Efficacy of risperidone
for treating patients with behavioral and psychological symptoms of dementia.
Wancata J.
Int Psychogeriatr.
2004 Mar;16(1):107-15.
BACKGROUND:
Large randomized controlled trials have shown that risperidone
reduces the frequency and severity of behavioral and psychological symptoms of
dementia (BPSD) in patients with dementia. Since such trials are obliged to use
very strict inclusion and exclusion criteria, their information about the
efficacy is limited by the criteria used. Thus, the aim of the present study
was to investigate the efficacy of risperidone on
BPSD in a sample of patients routinely treated by their primary care
physicians. METHODS: A total of 938 elderly patients in
Anthony F. Jorm, Bryan Rodgers and Helen Christensen
International Psychogeriatrics (2004), 16:209-217
Background: There are no existing epidemiological
data on use of medications to enhance memory.
Method: A community survey was carried out in
Results: 2.8% of the sample reported using
medications to enhance memory, the main ones being gingko biloba,
vitamin E, bacopa (brahmi),
and folic acid/B vitamins. Users were more likely to be female, to have
subjective memory problems and to use other psychotropic medications. However,
they did not differ in memory performance, anxiety, depression or physical
health.
Discussion: Some older people are using
complementary medications to improve their memory or prevent memory loss,
despite the lack of strong evidence for their effectiveness. These people show
no objective evidence of memory impairment.
Personality disorders in a total population twin cohort
with eating disorders*1
K. Ilkjaer, L. Kortegaard, K. Hoerder, J. Joergensen, K. Kyvik and C. Gillberg
Comprehensive Psychiatry .Volume 45, Issue 4
, July-August 2004, Pages 261-267
Findings
regarding the occurrence of personality disorders (PDs)
in eating disorders (EDs) have been contradictory.
Most previous studies have been clinic-based. The aims of the current study
were to assess the prevalence of PD in ED in a population-based twin group and
to establish the distribution of PD in three subgroups of ED. A two-step
screening and diagnostic study of ED was performed in a large Danish twin
population. Axis I and axis II DSM-III-R and DSM-IV ED diagnoses were made on
the basis of results obtained at clinical investigations and interviews.
Forty-nine percent of the participants with ED had at least one PD, compared to
26% in those with no ED (P < .001). Cluster C PD was the most common type of
PD in all subgroups of ED, and cluster B PD was found only in participants with
bulimic symptoms. Genetic factors appeared to contribute significantly to the
variance of cluster C PD in ED, which was evaluated as a possibly important
background factor in ED.
Jack
Samuels, O. Joseph Bienvenu, Bernadette Cullen, Paul
T. Costa, Jr, William W. Eaton and Gerald Nestadt
Comprehensive Psychiatry .Volume 45, Issue 4
, July-August 2004, Pages 275-280
Previous
studies have implicated antisocial personality disorder in criminal behavior,
but little is known about the association between "normal"
personality dimensions and arrest. We investigated the relationships between
these personality dimensions and prior arrest in a sample of adults
participating in a longitudinal epidemiological study. Between 1993 and 1999,
psychiatrists re-examined subjects who were originally interviewed in
Gerald A Maguire; Benjamin P Yu; David L Franklin;
Glyndon D Riley
Expert Opinion on Pharmacotherapy .2004, vol.
5, no. 7, pp. 1565 - 1571
Stuttering is a speech disorder characterised
by frequent prolongations, repetitions or blocks of spoken sounds and/or
syllables. Stuttering is very common and is classified by the Diagnostic and
Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) as an Axis I
disorder. In spite of this, stuttering treatment is sporadically addressed by a
practicing physician, especially in the