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In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.

Object: Erethism describes severe cases of unprovoked aggressive behavior, usually associated with some degree of mental impairment and gross brain damage. The etiology can be epileptic, postencephalitic, or posttraumatic, or the condition can be caused by brain malformations or perinatal insults. Erethism is often refractory to medication, and patients must often be interned in institutions, where they are managed with major restraining measures. The hypothalamus is a crucial group of nuclei that coordinate behavioral and autonomic responses and play a central role in the control of aggressive behavior. Deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) has been proposed as a treatment for resistant erethism, although experience with this treatment around the world is scarce. The objective of this study was to examine the long-term outcome of PMH DBS in 6 patients with severe erethism treated at the authors' institution., Methods: Medical records of 6 patients treated with PMH DBS for intractable aggressiveness were reviewed. The therapeutic effect on behavior was assessed by the Inventory for Client and Agency Planning preoperatively and at the last follow-up visit., Results: Two patients died during the follow-up period due to causes unrelated to the neurosurgical treatment. Five of 6 patients experienced a significant reduction in aggressiveness (the mean Inventory for Client and Agency Planning general aggressiveness score was -47 at baseline and -25 at the last follow-up; mean follow-up 3.5 years). Similar responses were obtained with low- and high-frequency stimulation. In 4 cases, the patients' sleep patterns became more regular, and in 1 case, binge eating and polydipsia ceased. One of the 3 patients who had epilepsy noticed a 30% reduction in seizure frequency. Another patient experienced a marked sympathetic response with high-frequency stimulation during the first stimulation trial, but this subsided when stimulation was set at low frequency. A worsening of a previous headache was noted by 1 patient. There were no other side effects., Conclusions: In this case series, 5 of 6 patients with pathological aggressiveness had a reduction of their outbursts of violence after PMH DBS, without significant adverse effects. Prospective controlled studies with a larger number of patients are needed to confirm these results.

Background and Aim: To assess the prevalence and correlates of post-traumatic stress disorder (PTSD), major depression and anxiety disorders other than PTSD, among three samples with different level of exposure to the March 11, 2004 terrorist attacks in Madrid., Method: We sampled three groups of persons-those injured in the attacks, the residents of Alcala de Henares, and police officers involved with the rescue effort-with different exposure to the March 11, 2004 terrorist attacks, using random sampling from comprehensive censuses of all three groups. In person interviews were conducted with all three groups between 5 and 12 weeks after March 11, 2004. Questionnaire included assessment of socio-demographic characteristics, of PTSD using the Davidson trauma scale, and of a range of psychiatric illnesses using the mini international neuropsychiatric interview (MINI)., Results: The overall sample included 127 persons injured in the attack, 485 residents of Alcalá de Henares, and 153 policemen involved in rescue. Of all three groups 57.5%, 25.9% and 3.9% of persons, respectively, reported symptoms consistent with any assessed psychiatric disorder. The use of psychoactive medication before March 11, 2004 was consistently the main predictor of PTSD and major depression among those injured and of major depression and anxiety disorders others than PTSD among residents of Alcala., Conclusions: There was a substantial burden of psychological consequences of the March 11, 2004 terrorist attacks two months after the event. Persons with prior mental illness are at higher risk of post-event psychopathology, across groups of exposure.

A single nucleotide polymorphism (-1438 G/A) located 1438 base pairs upstream of the consensus start site of the 5-HT2A receptor gene has been reported. The hypothesis that this gene polymorphism may be a susceptibility factor in bulimia nervosa was explored in a female population of purgative bulimics. Bulimia nervosa patients who have suffered preceding anorexia nervosa episodes formed the so-called previous anorexia nervosa bulimic patient group. At variance with some previous reports, when the frequency distribution of genotypes and alleles was compared in patients and controls, no differences were detected regardless of whether the bulimia nervosa patients had suffered prior anorexia nervosa episodes.

Background: In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed., Patients and Method: A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study., Results: Consult request took place 10.6 days (on average) after the patients admission (<>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <>., Conclusions: The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <> is also emphasized.

Objective: Considerable controversies exist about the psychological impact of dentofacial deformities and the effects of treatment on body image. This research, which is a part of a longitudinal prospective study about a number of psychological aspects of adult patients with severe dentofacial deformities treated by orthognatic surgery, assesses the body image of a sample of patients before and after treatment., Method: Two subscales, general and facial-oclusal, of the modified Secord and Jourard test were used to evaluate body image of a sample of orthognatic surgery patients (N = 58). The questionnaires were completed at four time points: one week before surgery (T0), and one (T1), six (T6) and twelve months (T12) after surgery., Results: Despite the severity of dentofacial deformity, presurgical mean scores of both subscales of body image test were normal. T6 scores were significantly higher than normative levels in both subscales (p < 0.001). T6 scores were also significantly higher than T0 in both general (p < 0.05) and facial-oclusal subscales (p < 0.001). T12 measurements showed significant differences in both subscales with respect to normative levels but significant differences between T12 and T0 were only found in facial oclusal subscale (p < 0.001). No differences were found between T12 and T6 scores., Conclusion: The positive effect of orthognatic surgery on body image is encouraging, but longer follow up is needed to evaluate the persistence of results and the eventual occurrence of any late change.

The authors review the current literature on psychosocial aspects of duodenal ulcer. The initial simple psychosomatic approach, has evolved to a multifactorial schema in which stress and individual vulnerability plays an important role. Psychological features (personality, Type A behaviour, alexithymia, anxiety, depression) and socioenvironmental factors (stress, life events, coping, social support) are analyzed. Newer aspects like the probable stress influence on immunity and infection by Helicobacter pylori are considered.

In our study we have analyzed the influence of family environment on adjustment of renal patients to the HD as well as on the attitude towards kidney transplantation. The study included 57 patients (34 M, 23 F), mean age 52.3 years, and they had been on dialysis for an average of 34.5 months. We obtained information about adaptation and behavior in the care unit, and attitude and motivation towards renal transplantation. Biochemical variables were used to register disruption of medical compliance or dietetic transgression (K, PRC, BUN, weight gain, etc.). The patient's family climate was assessed through use of the Family Environment Scale (FES, Moos and Moos, 1981). The results showed that patients with aggressiveness and noncompliance during HD sessions tended to have high family conflict in family members. The most positive attitudes towards renal transplantation were found in the patients that came from families with the greatest degree of cohesion and expressiveness. In summary, family social climate is a variable influencing outcome of these patients. Its routine assessment would permit the prediction of adaptation to the therapeutic program as much as better efficacy of HD treatment.