No abstract

In this paper, we review the potential risks and benefits of discontinuing AP treatment in elderly demented patients with NPS and propose an algorithm to assist in decision-making regarding AP withdrawal.

Título: Trastorno obsesivo-compulsivo durante el período perinatal: epidemiología, fenomenología, etiopatogenia y tratamiento. Resumen: El objetivo de la presente revisión teórica es describir los principales hallazgos e investigaciones sobre el trastorno obsesivo-compulsivo (TOC) durante el período perinatal. Por una parte, los estudios epidemioló-gicos señalan que en esta etapa aumenta el riesgo de debut y/o exacerbación del TOC, especialmente en el puerperio. A nivel fenomenológico, predominan las obsesiones agresivas y de contaminación relacionadas con la figura del feto o neonato. En cuanto a su etiopatogenia, existen evidencias indirectas para postular la participación de variables neuroendocrinas (p.e. esteroides gonadales femeninos y oxitocina) y cognitivo-conductuales (p.e. hiperresponsabilidad, sobreestimación de la amenaza y control mental), siendo necesaria una mayor contrastación empírica de estos correlatos y/o factores de vulnerabilidad específicos. En el ámbito interventivo, se carece de ensayos clínicos aleatorizados con grupo control adaptados a las características idiosincrásicas de este subgrupo de sujetos con TOC. Así mismo, se destaca el papel de la terapia cognitivo-conductual (TCC) en el marco de la prevención primaria selectiva. Palabras clave: Trastorno obsesivo-compulsivo; período perinatal; prevención primaria; terapia cognitivo-conductual; estudio teórico. Abstract:The aim of this review is to describe the main theoretical findings and research conclusions about obsessive-compulsive disorder (OCD) in the perinatal period. On one hand, epidemiological studies show that the risk of OCD onset and/or exacerbation could increase in this period, particularly in the puerperium. Phenomenologically, in this stage aggressive and contamination obsessions are very common and are related to the fetus or newborn. On the other hand, regarding OCD pathogenesis in this period, there is indirect evidence to suggest the participation of neuroendocrine (e.g. female gonadal steroids and oxytocin) and cognitive behavioural variables (e.g. hyper-responsibility, threat overestimation, and mental control). In terms of research, more empirical studies are needed to contrast these specific vulnerability factors. Moreover, no empirically validated psychotherapeutic treatments (controlled trials) adapted to this OCD subgroup were found, although some studies highlight the role of cognitive behavioural therapy (CBT) as an effective intervention in the context of selective primary prevention.

No abstract

Background and aims:The risk of abuse/dependence of alcohol or drugs in schizofrenia have been estimed about 4 times the prevalence in general population. This fact difficults the treatment results and efficcacy: more relapses, more treatments withdrawal and poorer prognosis. The aims of our study is to evaluate the effect of Zyprasidone, an atypical antipsychotic with 5HT propierties, in patients with schizofrenia and comorbid substance use disorder in a single, open, prospective-naturalistic design.Method:36 outpatients were selected with Schizofrenic disorder diagnosis (DSMIV) and abuse/dependence of at least 1 substance in which Zyprasidone was recommended (inneficacy, intolerance of prior treatments,..). They were evaluated clinically and data about actual consum and craving were collected at inicial visit and follow-up monthly (3 to 6 months). Results were analized with SPSS pack.Results:The mean follow-up period was 3 month. 28 patients finished the evaluation showing a decrease in clinical measures (PANSS, ICG) with good tolerance (only 4 drop-outs associated to indesirable effects). The most frequent drug use disorder was tobacco followed by alcohol and cannabis.The results on number and frequency of drug use shows a slow tendency to reduce at the end of the evaluation as well the craving measures but no significant differences were found.Conclusions:Our exploratory study with Zyprasidone, althougt metodological limitations, suggests that clinical schizofrenic symptoms can improve but also drug pattern use. Naturalistic studies of schizofrenia with comorbid substance use disorder can be useful to show the efficacy of antipsychotics in real clinical practice