The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

No abstract

No abstract

Resumen: En este trabajo se presenta un caso clínico de tricotilomanía, cuyo objetivo es presentar en detalle el procedimiento seguido en un contexto de sanidad pública, utilizando técnicas cognitivo-comportamentales, para profundizar en el conocimiento de la efi cacia de estos procedimientos de tratamiento y mostrar la viabilidad de su aplicación. Los resultados obtenidos muestran mejorías importantes en distintos aspectos clínicos: en primer lugar, desapareció completamente la conducta de arrancamiento del cabello, además disminuyó considerablemente la ansiedad y se normalizó el estado de ánimo. Todo ello nos permite llegar a la conclusión de que la intervención resultó satisfactoria.Palabas clave: Tricotilomanía; tratamiento psicológico cognitivo conductual; diseminación tratamientos psicológicos; estudio de caso. Psychological treatment of trichotillomania: A case studyAbstract: This paper presents a clinical case of trichotillomania, thus aims to present in detail the procedure followed in a public health context, using cognitive-behavioral techniques, in order to deepen the knowledge of the effi cacy of these treatment procedures and demonstrate the feasibility of their use. The results obtained showed signifi cant improvements in different clinical aspects: fi rst, the hair pulling behavior disappeared completely; moreover, anxiety diminished signifi cantly and mood normalized. This allows us to conclude that the intervention was successful.Keywords: Trichotillomania; cognitive behavioral psychological treatment: psychological treatment dissemination; case study. IntroducciónEste problema fue descrito por primera vez por el médico francés Francois Henri Hallopeau (1989). Etimológicamente proviene del griego Trichos (pelo), tylos (estirar) y manía impulso. La tricotilomanía en el DSM-IV estaba dentro de los Trastornos de control de impulsos, ahora se denomina Trastorno de tricotilomanía o de arrancarse el pelo, y se incluye en el DSM-5 dentro de los trastornos obsesivo -compulsivos y relacionados (American Psychiatric Association, 2014) que establece los siguientes criterios: arrancamiento del pelo de forma recurrente, lo que da lugar a su pérdida; este arrancamiento del pelo causa malestar clínicamente signifi cativo o deterioro en lo social, laboral u otras áreas importantes del funcionamiento y existen intentos repetidos de disminuir o dejar de arrancarse el pelo.La característica esencial de la tricotilomanía es el arrancamiento recurrente del cabello que da lugar a una pérdida perceptible de pelo. Puede haber arrancamiento del pelo en cualquier región del cuerpo donde este crezca (incluyendo las regiones axilar, púbica y perirrectal), pero los sitios más frecuentes son la cabeza, existiendo predilección por las regiones coronales o parietales, en el 80-90% de los casos, (Hallopeu, 1989; Papadopoulos, Janniger, y Schwartz, 2003), las cejas y las pestañas (pueden llegar a desaparecer por completo). Una perso-

Depressive symptoms in schizophrenia patients are not usually the primary therapeutic goal, as the psychiatric evaluation of the schizophrenia is generally based in the assessment of the positive and negative syndrome. However, direct approach of the pure depressive symptoms in schizophrenia is of capital importance from both prognostic and therapeutical perspective. This paper reviews the recently published evidence on the treatment of depressive symptoms in schizophrenia patients, with a special emphasis on the efficacy of different pharmacological families. It also includes studies on the antidepressant effect and pharmacological profile of second-generation antipsychotics. Finally, it addresses the possible confusion between depressive and negative symptoms/extrapyramidal side effects of antipsychotic treatment.