RESUMEN
INTRODUCTION: Studies published in other countries indicate that 1.6-3% of spinal cord injuries are acquired due to suicide attempt, the majority being produced by precipitation in patients with previous psychiatric disorders. AIMS: To determine the frequency of attempted suicide as a cause of spinal cord injuries in a neurorehabilitation hospital and to describe the characteristics of these patients in psychiatric terms and functional disability. PATIENTS AND METHODS: Retrospective study in which all patients with spinal cord injuries due to suicide attempt in a period of 15 years in a neurorehabilitation hospital were reviewed. RESULTS: Suicide attempt caused 2% (n = 61) of spinal cord injuries in our population. Although 93% of the patients were diagnosed with psychiatric pathology, 60% were linked to mental health facilities and only three consulted for emergency the days before the precipitation. Six attempts were made in the context of psychiatric services and 26% of patients had made previous attempts. The most frequent medical diagnosis was paraplegia associated with fractures in the lower extremities and chest trauma. CONCLUSIONS: Precipitation due to suicide attempt causes 2% of spinal cord injuries, with depression and psychotic disorders being the most prevalent psychiatric disorders. After the rehabilitation period, this population requires special attention from the mental health teams since they combine risk factors to commit suicide such as the history of previous attempts and the presence of a chronic disabling condition.
TITLE: Lesion medular por intento de suicidio, perfil psiquiatrico y discapacidad funcional.Introduccion. Estudios realizados en otros paises señalan que el 1,6-3% de las lesiones medulares se adquieren por intento de autolisis, y la mayoria se producen por precipitacion. Objetivos. Determinar la frecuencia de intento de suicidio como causa de lesion medular en un hospital de neurorrehabilitacion y describir las caracteristicas de estos pacientes en terminos psiquiatricos y de discapacidad funcional. Pacientes y metodos. Estudio retrospectivo en el que se revisaron todos los pacientes con lesion medular por intento de autolisis en un periodo de 15 años en un hospital de neurorrehabilitacion. Resultados. El intento de autolisis ocasiono el 2% de las lesiones medulares en la muestra (n = 61). El 93% de los pacientes estaba diagnosticado de patologia psiquiatrica y el 26% habia realizado tentativas previas. Aunque el 60% estaba vinculado a salud mental, solo tres consultaron por urgencias dias antes de la precipitacion y seis realizaron la tentativa en el contexto de servicios psiquiatricos. El diagnostico mas frecuente fue la paraplejia asociada a fracturas en las extremidades inferiores y traumatismos toracicos. Conclusiones. La precipitacion por intento de autolisis provoca el 2% de las lesiones medulares, y la depresion y los trastornos psicoticos son las patologias psiquiatricas previas mas prevalentes. Tras el periodo de rehabilitacion, esta poblacion requiere especial atencion por parte de los equipos de salud mental, ya que combina factores de riesgo para cometer suicidio, como la historia de tentativas previas, y la presencia de una condicion cronica discapacitante.
Asunto(s)
Trastornos Mentales/complicaciones , Traumatismos de la Médula Espinal/psicología , Intento de Suicidio/psicología , Adolescente , Adulto , Depresión/complicaciones , Depresión/psicología , Evaluación de la Discapacidad , Femenino , Humanos , Conducta Impulsiva , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Paraplejía/epidemiología , Paraplejía/etiología , Paraplejía/psicología , Paraplejía/rehabilitación , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores Socioeconómicos , España/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/rehabilitación , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicología , Adulto JovenRESUMEN
UNLABELLED: Neurobehavioral disorders are common consequences of traumatic brain injury (TBI) that should be objectively assessed in this population. The use of scales allows us to unify terms both in clinical practice and investigative work; it also constitutes a useful guide in clinical interviews and makes it possible to see outcome changes in patients with or without intervention. The aim of this study is to review the most frequently neurobehavioral scales used to measure the non-cognitive disorders of conduct in TBI patients. METHOD: A systematic and descriptive literature review was done in Medline, without time limit, which focused on scales applied to behavioral disorders in moderate and severe TBI patients. RESULTS: Ninety articles were selected for the final review and thirty-seven different scales were identified. Seven of these instruments represent sixty-five percent of all behavioral scales applied in the studies collected and were selected for the present review. There are scales that are more general and include a wide range of neurobehavioral symptoms, like the Neurobehavioral Rating Scale and the Neuropsychiatric Inventory. On the opposite, there are questionnaires that focus on specific symptoms like aggressiveness, agitation and apathy such as the Agitated Behavior Scale or the Apathy Evaluation Scale. The forms for caregiver or staff were the most prevalent in our review. The most representative behavioral scales applied to moderate and severe TBI patients were analyzed using clinical useful, covered domains, item descriptions, administration procedures and psychometric properties.
Asunto(s)
Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/psicología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto , Cuidadores/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Persona de Mediana Edad , Psicometría/métodos , Psicometría/normas , Encuestas y Cuestionarios/normas , Adulto JovenRESUMEN
AIM: To review and correlate the most common cognitive disorders secondary to traumatic brain injuries (TBI), the neurobiology of these deficits and their possible modulation by neuropharmacological means. DEVELOPMENT: As of a complex cascade of injuries to the brain, patients with TBI may experience alterations that affect the cognitive domain on different levels and to varying degrees, the most common being alteration of the level of alertness; slowing of the speed at which information is processed; attention, memory and learning deficits; language and communication disorders; and impaired executive functions. Brain damage may be caused by a range of pathological mechanisms, such as focal bruising, diffuse axonal damage, cytotoxic damage and neurotransmitter excitotoxicity. Certain pharmacological agents have an effect on the cognitive functions. Pharmacological agents that improve cognitive performance include dopaminergic agents, psychostimulants, some antidepressants and cholinesterase inhibitors. CONCLUSIONS: Studies into the pharmacological neuromodulation of the cognitive disorders secondary to TBI are currently in the early stages. The information we have available on the neurochemical bases of cognition and cognitive disorders due to TBI suggest that the most important goals of pharmacological intervention in this group of patients are the stimulation of the catecholaminic and cholinergic functions.
Asunto(s)
Lesiones Encefálicas/complicaciones , Estimulantes del Sistema Nervioso Central/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Trastornos del Conocimiento/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Trastornos de la Memoria/tratamiento farmacológico , Animales , Anticonvulsivantes/efectos adversos , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Daño Encefálico Crónico/tratamiento farmacológico , Daño Encefálico Crónico/etiología , Catecolaminas/fisiología , Trastornos del Conocimiento/etiología , Trastornos de la Conciencia/tratamiento farmacológico , Trastornos de la Conciencia/etiología , Humanos , Trastornos del Lenguaje/tratamiento farmacológico , Trastornos del Lenguaje/etiología , Discapacidades para el Aprendizaje/tratamiento farmacológico , Discapacidades para el Aprendizaje/etiología , Trastornos de la Memoria/etiología , Neurotransmisores/fisiología , Psicotrópicos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricosRESUMEN
Revisar y correlacionar las alteraciones cognitivas más comunes secundarias al traumatismo craneoencefálico(TCE), la neurobiología de estos déficit y la posible modulación neurofarmacológica. Desarrollo. A partir de una compleja cascada de daños a nivel cerebral, el paciente con TCE puede experimentar alteraciones en diferentes niveles y grados del dominio cognitivo, de las cuales las más comunes son: alteración del nivel de alerta, disminución de la velocidad delprocesamiento de la información, déficit de atención, memoria y aprendizaje, alteraciones del lenguaje y de la comunicación, y alteración de la función ejecutiva. Los mecanismos patológicos causantes del daño cerebral son diversos, como contusiones focales, daño axonal difuso, daño citotóxico y excitotoxicidad neurotransmisora. Existen fármacos que interfieren en las funcionescognitivas. Entre los medicamentos que mejoran el rendimiento cognitivo están los dopaminérgicos, psicoestimulantes, algunos antidepresivos e inhibidores de la colinesterasa. Conclusiones. El estudio de la neuromodulación farmacológica delas alteraciones cognitivas secundarias al TCE se encuentra en una etapa inicial. La información de que disponemos sobre las bases neuroquímicas de la cognición y de las alteraciones cognitivas debidas al TCE sugieren que la estimulación de funciones catecolaminérgicas y colinérgicas son los objetivos más importantes en la intervención farmacológica en este grupo depacientes
To review and correlate the most common cognitive disorders secondary to traumatic brain injuries (TBI), the neurobiology of these deficits and their possible modulation by neuropharmacological means. Development. As of a complex cascade of injuries to the brain, patients with TBI may experience alterations that affect the cognitive domain on different levels and to varying degrees, the most common being alteration of the level of alertness; slowing of the speed at which information is processed; attention, memory and learning deficits; language and communication disorders; and impaired executive functions. Brain damage may be caused by a range of pathological mechanisms, such as focal bruising, diffuse axonal damage, cytotoxic damage and neurotransmitter excitotoxicity. Certain pharmacological agents have an effect on the cognitive functions. Pharmacological agents that improve cognitive performance include dopaminergic agents, psychostimulants, some antidepressants and cholinesterase inhibitors. Conclusions. Studies into the pharmacological neuromodulation of the cognitive disorders secondary to TBI are currently in the early stages. The information we have available on the neurochemical bases of cognition and cognitive disorders due to TBI suggest that the most important goals of pharmacological intervention in this group of patients are the stimulation of the catecholaminic and cholinergic functions
Asunto(s)
Humanos , Traumatismos Craneocerebrales/complicaciones , Trastornos del Conocimiento/tratamiento farmacológico , Neurotransmisores/farmacología , Trastornos del Conocimiento/etiología , Agonistas de Dopamina/farmacología , Inhibidores de la Colinesterasa/farmacología , Neurotoxinas/farmacologíaRESUMEN
Introducción. El presente estudio evalúa diferentes patologías psiquiátricas asociadas a lesiones de origen traumático; su frecuencia de presentación, y la forma como se correlacionan según se trate de un traumatismo craneoencefálico o de zonas diferentes al cráneo. Métodos. Se trata de un estudio de cohorte prospectiva con una muestra de 249 pacientes: 122 con traumatismo craneoencefálico y 127 con lesiones de otras zonas corporales. Se entrevistaron al ingreso en el centro, con seguimiento a los 6 y los 12 meses de la lesión. Resultados. La incidencia de depresión y trastornos de ansiedad fue similar a la obtenida en estudios previos, sin diferencia significativa entre los pacientes con traumatismos craneoencefálicos comparados con los traumatismos generales. En ambos grupo hubo un descenso significativo de la calidad de vida, así como un incremento en los problemas con el alcohol al año del traumatismo. Entre los lesionados cerebrales se detectó con mayor frecuencia el cambio orgánico de la personalidad con síntomas de apatía. Conclusiones. La incidencia de trastornos psiquiátricos en el paciente con lesiones traumáticas es alta y contribuye de forma importante a un deterioro en el estado de salud y la calidad de vida del enfermo. Los pacientes con lesiones cerebrales tienen mayor probabilidad de desarrollar un cambio orgánico de la personalidad
Introduction. This study evaluates the presentation of different psychiatric pathologies secondary to traumatic injuries; assessing the presentation frequency and how it correlates with whether it is a brain injury (TBI) or one in a different corporal area. Methods. The study group consisted of 249 patients, 122 with TBI and 127 with injuries from different body areas. The patients conditions were evaluated at baseline and at 6 and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. Results. Depressive and anxiety disorders were observed in frequencies similar to prevoius reports; without significant differences between TBI and non-TBI groups. The organic change of personality was significantly more frequent among patients with TBI than among the non-TBI with apathy features. There was a significant decrease in quality of life one year after the traumatism in both groups. Conclusions. Psychiatric disease is a frequent complication of injured patients; and it is associated with deterioration of general health and quality of life. TBI patients have more probability of developing an organic change of personality
Asunto(s)
Humanos , Trastornos Mentales/epidemiología , Lesiones Traumáticas del Encéfalo/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Escala de Coma de Glasgow , Trastornos Mentales/diagnóstico , Lesiones Traumáticas del Encéfalo/diagnósticoRESUMEN
INTRODUCTION: This study evaluates the presentation of different psychiatric pathologies secondary to traumatic injuries; assessing the presentation frequency and how it correlates with whether it is a brain injury (TBI) or one in a different corporal area. METHODS: The study group consisted of 249 patients, 122 with TBI and 127 with injuries from different body areas. The patients conditions were evaluated at baseline and at 6 and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. RESULTS: Depressive and anxiety disorders were observed in frequencies similar to previous reports; without significant differences between TBI and non-TBI groups. The organic change of personality was significantly more frequent among patients with TBI than among the non-TBI with apathy features. There was a significant decrease in quality of life one year after the traumatism in both groups. CONCLUSIONS: Psychiatric disease is a frequent complication of injured patients; and it is associated with deterioration of general health and quality of life. TBI patients have more probability of developing an organic change of personality.