Search

Introduction: We know the coexistence of traumatic factors (loss of affective relationships, experiences of abuse, extreme risk situations, etc.) is common in psychiatric pathologies in which level of stress experienced exceeds normal capacity of the person, favoring the appearance of dissociative or excision mechanisms. A common mistake is to pathologize them and try to eliminate them. Objectives: The objective of this paper is to study trauma and defense mechanisms involved, in order to carry out a better approach. Methods: A bibliographic search was performed from different database (Pubmed, TripDatabase) about trauma, mechanisms involved and the construction of identity. Results: We know neural pathways mature asymmetrically in evolutionary development (functions related to attention, concentration and executive function having special importance) and thus, traumas occurred in moments of greatest vulnerability such as early childhood, can damage and interfere with the correct integration of neural processes, producing disproportionate and unnecessarily maintained alert responses (common basis for many pathologies such as borderline personality disorder or traumatic psychosis). In response to this, reactive mechanisms are produced (such as dissociation or cleavage) that are not necessarily pathological and therefore, we should not always intervene by eliminating them because they often function as a protective factor, allowing to preserve functioning and favoring recovery. Conclusions: In conclusion, we need a better understanding of mechanisms involved in trauma, executive function and the alarm system beyond anxiety reactions, trying to understand the function of symptom without eliminating it, but evaluating whether there are healthier alternatives can be promoted for the complete recovery of the patient. [ABSTRACT FROM AUTHOR]

Introduction: SARS-CoV-2 is having an important direct impact, and also due to treatments used such as corticosteroids. Among its effects, we have focused on psychosis. Objectives: The objective of this paper is to study, fromfollowing case, incidence of steroid-induced psychosis in context of COVID-19. Methods: A bibliographic search was performed from different database (Pubmed, TripDatabase) about psychiatric symptoms associated with use of corticosteroids during pandemic. 64-year-old woman with no psychiatric history, who is hospitalized for pneumonia secondary to SARS-Cov2 and treated with antibiotics, bronchodilators, and corticosteroids. At 4 days she began with injury and nihilistic delusions. The corticosteroids were progressively reduced, adding 2.5 mg Risperidone, resolving after ten days. Results: Corticosteroids are currently being used to treat the systemic inflammatory response associated with COVID-19, but they can produce other effects such as psychiatric symptoms (3-6%): 75% affective (mainly hypomanic symptoms); and 25% psychotic. Steroid-induced psychosis are characterized by confusion, delusions, and hallucinations, and they usually begin 3-4 days after onset, and resolve within a week. They are associated especially with oral systemic steroids and high doses: 1.3% with 40mg of prednisone, and 18% with 80mg; increased this incidence due to the greater use that is being made to treat COVID-19 and the higher doses used in severe cases (up to 120 mg). Conclusions: To conclude, we need to know characteristics of these episodes in order to be able to prevent and treat them properly (minimum effective dose and less time), since they will probably occur more frequently at this time. [ABSTRACT FROM AUTHOR]

Introduction: The need for preventive mechanisms in psychiatric pathology has been raised, therefore authors talk about primary, secondary and tertiary prevention. However, this emphasis on those preventive aspects has tended to ignore an essential part: quaternary prevention. Objectives: Reflecting the importance of avoiding ignoring iatrogenic forms of psychopathology by studying a clinical case and reviewing available literature. Methods: We will present a clinical case of a patient with residual schizophrenia who undergoes an escalation of pharmacological interventions that lead to functional deterioration after initiating behavioral alterations. We will also review available literature about quaternary prevention. Results: M. is an institutionalized patient who was taking a combination of three neuroleptics, anxiolytics and stabilizers for the treatment of behavior problems such as heteroaggressiveness. When the patient was referred to psychiatry consultations after being hospitalized, he could not move, had lost sphincter control and had serious communication problems. However, treatment was suspended and only one neuroleptic was maintained. The patient regained sphincter control and kept a residual but communicative delusional speech. Conclusions: It is important to see how sometimes we can get into therapeutic escalation without correcting the underlying problem by focusing on a symptom, because behavioral alterations will persist regardless of pharmacological treatment changes. Sometimes clinical fluctuations make us confuse basal state and decompensation, ignoring the fact that we lack the way to modify the course. Authors believe that a rational approach to treatment should take into account the balance between potential benefits and side effects applied to an individual patient. [ABSTRACT FROM AUTHOR]

Introduction: Concomitant presence of obsessive-compulsive symptoms(OCS)is relatively frequent in psychotic patients and there are different hypotheses trying to explain the origin of them as pathology evolution, comorbid disorder, defence mechanism, or even a medication side-effect, but it is difficult to make a precise evaluation of these symptoms and the mechanisms involved. SometimesOCS are the first manifestation toappear without any other areas affected, and psychotic disorder comes later with initial symptoms in that domain. Objectives: Evaluate the association between OCS and psychosis to document pathogenia of both entities. Methods: A bibliographic search was performed about this topic. We present two cases of patients that have been referred to our unit: A34year old man, a usual consumer of cannabis, who shows checking and organizing compulsions that interfere significantly with their life. Consumptions grew progressively until they became daily, trying to decrease partly this behaviour. He comes to an addiction unit where he achieves abstinence, but immediately shows an important functional-impairment, adding to the previous compulsions new ones, and also thought blocking, social retraction and personality change. He starts taking antidepressant and benzodiazepines to reduceOCS, and weeks later begins a manic episode with delusions as a bipolar-disorder debut. A29year old man, with a history of familiar obsessive personality, that begins to worry about physical appearance and starts compulsive behaviour focused on exercise preventing him fromdaily activities. No response to antidepressants, he started antipsychotics and develop referential-symptoms. Results: Both are atypical presentations of bipolar and schizophreniform disorders withOCS, where the beginning of treatment causes psychosis-symptoms not previously developed. Conclusions: Frequent doubts are what factors determine the eclosion. The triggers are not clear and neither the related-pathology. [ABSTRACT FROM AUTHOR]

Introduction: There are many authors that follow and develop Pinel-hypotheses about unitary psychosis, joining recent discoveries in neuropathology and neurochemistry, supporting the vision of mental illness as neurodevelop disorders. The classification they suggest, distinguishes early, late neurodevelop disorders, and those related to traumatic factors, what determine an evolutive vision of this pathology. In terms of anxiety symptoms/disorders, they have been usually associated with categorical pathology, and treated focus on symptoms, unfortunately relapses are very frequent. Objectives: Proving that the evolutive vision may ease a change on the intervention of anxiety disorders, that would propound different therapeutic alternatives. Methods: A bibliographic search was performed from different databases, showing throw aspects related to main etiopathogenic theories about anxiety disorders from an evolutive vision. Results: Evolutive-Psychology raises that anxiety is a concomitant process to development, that grows progressively and is necessary to induce changes in it. However a high level of anxiety might block that process or causes alterations. In that sense, anxiety-disorders may be related to an excess of anxiety that provoke a fault in present handling mechanisms. According to classic dynamic-theories, these mechanisms are associated with defence concept, but now we can link them to neurobiological development. From this point, there exists an asymmetric neurological maturation through childhood-adolescence that translates different manifestations of anxiety along development, initially more related with external contemption and relationship with caregiver, but later with hormonal pulses, physical changes and separation from family. Conclusions: The evolutive vision allows to understand development fluctuation of anxiety symptoms along the growth process, more accurately than categorical classic tendency. [ABSTRACT FROM AUTHOR]

Introduction: Thanks to advances in medicine, more diseases are being cured, but this benefit can become a problem when it causes a worsening of quality of life. Objectives: The objective of this paper is to analyze, regarding the following case, the convenience of treating or to limit the therapeutic effort (LTE) in psychiatric patients who are in situations at the end of life. Methods: 62-year-old woman begins with depressive symptoms from financial problems. In 4 months ago she makes four suicide attempts (drug overdose, cuts, self-stabbing, and precipitation), being hospitalized in ICU after latter because of multiple trauma and shock. During that time, she had a bad evolution with several complications that made LTE be evaluated. A bibliographic search was performed from different database (Pubmed, TripDatabase) about LTE and ethical implications. Results: Trying to prolong life by disproportionate means in a patient with a poor prognosis or poor quality of life is bad practice. We must assess the severity, quality of life, capacity and preferences of the patient to decide to treat or not, thus guaranteeing the principle of beneficence. It is also important to respect the principle of autonomy, accepting patients can refuse treatment. All this is equally applicable to psychiatric patients, whom we should not stigmatize but rather evaluate their ability to decide, as in any person. Conclusions: In conclusion, in situations of high suffering and near death, it is necessary a complete evaluation of the patient (psychiatric or not) is carried out in order to act in the most ethical way. [ABSTRACT FROM AUTHOR]

Introduction: In order to understand etiopathogeny of any mental illness, it is important to be aware of the sequential emergence of symptoms, having presentations, that appear before, after or simultaneously. We could understand mental pathology as the sumatory of different factors and vulnerable cerebral substrates. Adverse external factors influence over them, causing relapses, that would lead to the evolution of diagnosis through time. However, patients usually come when pathology is already developed. Interventions are delayed, what is insufficient to modify the course of the illness. Objectives: Proving that replacing classic clinical evaluation by an open access/multiintervention model, would determine a better prevention and reduction of relapse tendency. Methods: We have arranged a prospective descriptive study of 124 users along 2 years. The idea was to test a first sample which let us check the viability of our project. We adopted a qualitative approach, linking practice and research, which have implied to perform a structured clinical process based on a dynamic reevaluation performed for different professionals in various stages using Rodman's model. Results: MultiIntervention model reduces the prognosis factor of delayed treatment thanks to reaching a high risk group in the early stages. That model allows us to determine the way each factor relates to each other, what facilitates multiple-intervention that tries to eliminate the symptom and also the relapse. Conclusions: Late adolescence and early adulthood are stages in which many mental disorders start, however treatment delays some years. Rothman's model may be a useful tool, what means a multiintervention treatment that mixes biological and psychosocial interventions. [ABSTRACT FROM AUTHOR]

Introduction: Most mental disorders tend to relapse (severe or mild pathologies such as anxiety or dystima disorders), which are potentially recoverable and yet, tend to evolve poorly, persisting residual symptoms without achieving a complete recovery. Objectives: The objective of this paper is to analyze the factors that influence process of recurrence and chronification, among which are our own therapeutic interventions. Methods: A bibliographic search was performed from different database (Pubmed, TripDatabase) about the iatrogenic potential of our intervention (psychopharmacological or psychotherapeutic), analyzing influence and mechanisms involved, and the way to prevent them. Results: Anxiety is a necessary element for the development of people, both from a biological perspective (natural and adaptive psychological response that allows us to respond adequately to possible threats); as an evolutionary psychological (element involved in conflict resolution, in turn necessary for personal development). It would be a mistake to consider it as pathological and try to eliminate it through medication or psychotherapy, since we could interfere with the natural recovery processes, contributing to its chronification and preventing possibility of change. At times, anxiety can be pathological when it occurs disproportionately and exceeds ability to adapt, but we must not eliminate it but to study origin and factors involved, to achieve complete resolution. Conclusions: In conclusion, we must consider possible iatrogenesis of our therapeutic interventions in process of chronification of mental disorders and try to avoid them by adequately studying individual factors and characteristics, before intervening. [ABSTRACT FROM AUTHOR]

Introduction: Multiple studies have demonstrated that adopted children develop behavioral and we think that they have a more risk of develop of attention-deficit hyperactivity disorder (ADHD). Objectives: The objective of this paper is to study if there is a higher frequency of ADHD in adopted than non-adopted children and in that case, which risk factors increase the vulnerability. Methods: A bibliographic search was performed from different database (Pubmed, TripDatabase) about both populations, looking for vulnerability factors for the development of ADHD. Results: We found more ADHDon adopted children than children raised in their biological families. This finding might be because of risk factors related with adopted children, like prenatal alcohol exposure and a maintained state of deprivation (from no social or cognitive stimulation, to maltreatment). In addition, the prevalence and levels of ADHD symptoms are increased in children who have been institutionalized early life, because it can disturb the development of some brain regions, and children who have spent more time in these institutions (more than 6 months). We found that de prevalence of ADHD symptoms between adopted children with low level of deprivation were similar to the general population (5.6%), while individuals with high level of deprivation had over four times than the others (20%). Conclusions: In conclusion, adopted children have more risk to develop ADHD, especially if they have been exposed to a serious deprivation, on a earlier age and six months minimum. We should put more attention in this population to act early and supply an appropriate development. [ABSTRACT FROM AUTHOR]

Introduction: Affective instability is a present feature not only of affective disorders but also of personality ones, particularly on borderline disorder, where is often a difficult diagnosis because of their symptomatic overlap. Objectives: The objective of this paper is to evaluate whether bipolar disorder and borderline personality disorder are independent or represent different manifestations of the same disorder. Methods: A bibliographic search was performed from different databases (Pubmed, ScienceDirect) about both entities, from a case series report, showing throw aspects related to differential diagnosis and transition between both. Results: Onmany occasions has being proposed to talk about "bipolar spectrum" more than separated diagnostic categories. It would be relevant to propose a paradigm change to allow both entities to be more flexible, with the intention of improving diagnostic boarding and treatment. However there is no agreement between the distinction or the inclusion of Borderline in the Bipolar spectrum. Although mood symptoms are a prominent feature for both of them, the pattern is different. Borderline personality disorder is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. Studies have proved these disorders can be further distinguished by comparing their phenomenology, etiology and management. Conclusions: More studies are required to find a correct differentiation between both disorders, allowing a different initial boarding, because there will always be the question if we could modify the course with an early detection and attention. Guidelines for differential diagnosis are suggested and priorities for further research are recommended. [ABSTRACT FROM AUTHOR]