RESUMEN
Resistance to treatment in psychiatry can arise from a variety of causes, and here we look at two strategies that can improve this problem. First, we discuss the role of patients' relatives; in addition to family therapy interventions, setting up groups of relatives makes it possible to increase their skills in helping their sick relative and to help each other in this process. And finally, we look at the option of interventional psychiatry. These methods, which have been greatly enriched in recent years, are now available in the interventional psychiatry unit recently opened in the new Cery psychiatric hospital in Lausanne.
La résistance au traitement en psychiatrie peut découler de multiples causes ; deux stratégies pouvant améliorer ce problème sont abordées dans cet article. En premier lieu, le rôle des proches des patients ; au-delà d'interventions de thérapie de famille, la mise en place de groupes de proches permet d'augmenter leurs compétences à aider leur proche malade et de s'entraider dans cette démarche. Et enfin, l'option que peuvent constituer les approches de psychiatrie interventionnelle. Ces méthodes se sont grandement enrichies au cours des dernières années et sont maintenant accessibles dans l'Unité de psychiatrie interventionnelle récemment ouverte dans le nouvel hôpital psychiatrique de Cery, récemment inauguré à Lausanne.
Asunto(s)
Psiquiatría , Humanos , Hospitales PsiquiátricosRESUMEN
BACKGROUND: There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder. CASE PRESENTATION: A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance. CONCLUSIONS: Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.
Asunto(s)
Trastornos Fingidos , Trastornos Somatomorfos , Femenino , Humanos , Adulto , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Trastornos Somatomorfos/terapia , Trastornos Fingidos/diagnóstico , Trastornos Fingidos/psicología , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/psicología , Trastornos Disociativos/terapia , Errores DiagnósticosRESUMEN
Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.
RESUMEN
Introducción. La esclerosis múltiple (EM) es la segunda causa más importante de discapacidad de origen neurológico en los adultos jóvenes. Tanto la sintomatología física como la psiquiátrica (trastornos afectivos y psicóticos) impactan de manera negativa en la calidad de vida relacionada con la salud de los pacientes con EM. Objetivo. Elucidar de modo crítico la prevalencia y la patogenia de los síntomas afectivos y psicóticos presentes en la EM. Desarrollo. Se incluye una actualización de los estudios publicados más significativos que han analizado la prevalencia y la patogenia de la sintomatología afectiva y psicótica en los pacientes con EM. Para explorar la asociación entre los síntomas afectivos y psicóticos con la EM se ha revisado la evidencia disponible hasta el momento. Conclusiones. La depresión es el trastorno psiquiátrico más frecuente en la EM. Es necesaria más investigación para elucidar los mecanismos subyacentes que pueden provocar síntomas afectivos y psicóticos en la EM. El control de dichos síntomas en los pacientes de EM podría mejorar su calidad de vida relacionada con la salud (AU)
Introduction. Multiple sclerosis (MS) is the second most important cause of disability of a neurological origin in young adults. Both the physical and the psychiatric (affective and psychotic disorders) clinical signs and symptoms have a negative impact on the patients health-related quality of life. Aim. To shed light on the prevalence and pathogenesis of the affective and psychotic symptoms present in MS. Development. This review includes an update of the most significant studies published in the literature that have analysed the prevalence and pathogenesis of affective and psychotic signs and symptoms in patients with MS. The evidence available to date was reviewed in order to explore the association between the affective and psychotic symptoms of MS. Conclusions. Depression is the most frequent psychiatric disorder in MS. Further research is needed to clarify the underlying mechanisms that can trigger affective and psychotic symptoms in MS. Controlling those symptoms in patients with MS could improve their health-related quality of life (AU)
Asunto(s)
Femenino , Humanos , Masculino , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/prevención & control , Trastornos Psicóticos Afectivos/epidemiología , Trastornos Psicóticos Afectivos/psicología , Calidad de Vida , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/psicología , Trastornos Psicóticos Afectivos/fisiopatología , Práctica Clínica Basada en la Evidencia/métodos , Encefalomielitis/complicaciones , Encefalomielitis/tratamiento farmacológicoRESUMEN
INTRODUCTION: Multiple sclerosis (MS) is the second most important cause of disability of a neurological origin in young adults. Both the physical and the psychiatric (affective and psychotic disorders) clinical signs and symptoms have a negative impact on the patients' health-related quality of life. AIM: To shed light on the prevalence and pathogenesis of the affective and psychotic symptoms present in MS. DEVELOPMENT: This review includes an update of the most significant studies published in the literature that have analysed the prevalence and pathogenesis of affective and psychotic signs and symptoms in patients with MS. The evidence available to date was reviewed in order to explore the association between the affective and psychotic symptoms of MS. CONCLUSIONS: Depression is the most frequent psychiatric disorder in MS. Further research is needed to clarify the underlying mechanisms that can trigger affective and psychotic symptoms in MS. Controlling those symptoms in patients with MS could improve their health-related quality of life.
TITLE: Trastornos afectivos y psicoticos en la esclerosis multiple.Introduccion. La esclerosis multiple (EM) es la segunda causa mas importante de discapacidad de origen neurologico en los adultos jovenes. Tanto la sintomatologia fisica como la psiquiatrica (trastornos afectivos y psicoticos) impactan de manera negativa en la calidad de vida relacionada con la salud de los pacientes con EM. Objetivo. Elucidar de modo critico la prevalencia y la patogenia de los sintomas afectivos y psicoticos presentes en la EM. Desarrollo. Se incluye una actualizacion de los estudios publicados mas significativos que han analizado la prevalencia y la patogenia de la sintomatologia afectiva y psicotica en los pacientes con EM. Para explorar la asociacion entre los sintomas afectivos y psicoticos con la EM se ha revisado la evidencia disponible hasta el momento. Conclusiones. La depresion es el trastorno psiquiatrico mas frecuente en la EM. Es necesaria mas investigacion para elucidar los mecanismos subyacentes que pueden provocar sintomas afectivos y psicoticos en la EM. El control de dichos sintomas en los pacientes de EM podria mejorar su calidad de vida relacionada con la salud.
Asunto(s)
Trastornos del Humor/etiología , Esclerosis Múltiple/psicología , Trastornos Psicóticos/etiología , Antiinflamatorios/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Trastorno Depresivo/fisiopatología , Humanos , Modelos Neurológicos , Modelos Psicológicos , Trastornos del Humor/tratamiento farmacológico , Trastornos del Humor/epidemiología , Esclerosis Múltiple/tratamiento farmacológico , Prevalencia , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/epidemiología , Psicotrópicos/uso terapéuticoRESUMEN
INTRODUCTION: The type of diet has been related with the inflammatory process that forms part of multiple sclerosis. In recent years, different lines of research have generated a large body of knowledge about the role played by diet in the pathogenesis of multiple sclerosis. AIM: To conduct a critical examination of the evidence suggesting the existence of a relationship between different types of diets and foods and multiple sclerosis. DEVELOPMENT: The work includes an update of the most significant studies that have analysed the role played by diet in the pathogenesis and treatment of multiple sclerosis. In order to explore the association between diet and the risk of multiple sclerosis, the authors examined the currently available evidence, which ranged from observation-based studies to intervention studies. CONCLUSIONS: Further research on nutrition as a risk factor is needed, as it could be related with the disease and controlling it could lead to a significant reduction in the incidence or progression of the disease.
TITLE: Dieta y esclerosis multiple.Introduccion. El tipo de dieta se ha relacionado con el proceso inflamatorio que forma parte de la esclerosis multiple (EM). En los ultimos años, distintas lineas de investigacion han generado una gran cantidad de conocimiento sobre la participacion de la dieta en la patogenesis de la EM. Objetivo. Elucidar de modo critico las evidencias que relacionan distintos tipos de dietas y alimentos con la EM. Desarrollo. Se incluye una actualizacion de los estudios publicados mas significativos que han analizado el papel de la dieta en la patogenesis y en el tratamiento de la EM. Para explorar la asociacion entre la dieta y el riesgo de EM se ha revisado la evidencia disponible hasta el momento, pasando por estudios observacionales hasta terminar con estudios de intervencion. Conclusiones. Se necesita mas investigacion sobre la nutricion como factor de riesgo, ya que podria tener relacion con la enfermedad, y el control de esta podria llevar a una disminucion significativa de la incidencia o progresion de la patologia.
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Dieta/efectos adversos , Esclerosis Múltiple/dietoterapia , Esclerosis Múltiple/etiología , Consumo de Bebidas Alcohólicas/efectos adversos , Animales , Antioxidantes/uso terapéutico , Butirofilinas , Restricción Calórica , Bovinos , Dieta con Restricción de Grasas , Grasas de la Dieta/efectos adversos , Encefalomielitis Autoinmune Experimental/dietoterapia , Europa (Continente)/epidemiología , Fatiga/prevención & control , Ácidos Grasos/efectos adversos , Aceites de Pescado/uso terapéutico , Proteínas Ligadas a GPI/inmunología , Humanos , Inflamación , Glicoproteínas de Membrana/efectos adversos , Glicoproteínas de Membrana/inmunología , Ratones , Leche/efectos adversos , Leche Humana , Modelos Biológicos , Imitación Molecular , Esclerosis Múltiple/epidemiología , Proteínas de la Mielina/inmunología , Estudios Observacionales como Asunto , Aceite de Oliva , Aceites de Plantas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Vitaminas/uso terapéuticoRESUMEN
Introducción. El tipo de dieta se ha relacionado con el proceso inflamatorio que forma parte de la esclerosis múltiple (EM). En los últimos años, distintas líneas de investigación han generado una gran cantidad de conocimiento sobre la participación de la dieta en la patogénesis de la EM. Objetivo. Elucidar de modo crítico las evidencias que relacionan distintos tipos de dietas y alimentos con la EM. Desarrollo. Se incluye una actualización de los estudios publicados más significativos que han analizado el papel de la dieta en la patogénesis y en el tratamiento de la EM. Para explorar la asociación entre la dieta y el riesgo de EM se ha revisado la evidencia disponible hasta el momento, pasando por estudios observacionales hasta terminar con estudios de intervención. Conclusiones. Se necesita más investigación sobre la nutrición como factor de riesgo, ya que podría tener relación con la enfermedad, y el control de ésta podría llevar a una disminución significativa de la incidencia o progresión de la patología (AU)
Introduction. The type of diet has been related with the inflammatory process that forms part of multiple sclerosis. In recent years, different lines of research have generated a large body of knowledge about the role played by diet in the pathogenesis of multiple sclerosis. Aim. To conduct a critical examination of the evidence suggesting the existence of a relationship between different types of diets and foods and multiple sclerosis. Development. The work includes an update of the most significant studies that have analysed the role played by diet in the pathogenesis and treatment of multiple sclerosis. In order to explore the association between diet and the risk of multiple sclerosis, the authors examined the currently available evidence, which ranged from observation-based studies to intervention studies. Conclusions. Further research on nutrition as a risk factor is needed, as it could be related with the disease and controlling it could lead to a significant reduction in the incidence or progression of the disease (AU)
Asunto(s)
Humanos , Grasas de la Dieta/efectos adversos , Esclerosis Múltiple/fisiopatología , Dieta con Restricción de Grasas , Esclerosis Múltiple/dietoterapia , Estudios de Casos y Controles , Proteínas de la Leche/efectos adversos , Antioxidantes/uso terapéutico , Vitaminas en la Dieta/uso terapéutico , Consumo de Bebidas Alcohólicas/efectos adversos , Sustancias Protectoras/farmacocinéticaRESUMEN
INTRODUCTION: The main effects of vitamin D have to do with the homeostasis of calcium and phosphorous, and also with the regulation of bone remodelling. Yet, in recent years, different lines of research have given rise to a large body of knowledge about its role in the pathogenesis and the treatment of multiple sclerosis (MS). AIM. To carry out a critical review of the evidence that relates vitamin D with MS from an epidemiological, genetic, immunological and therapeutic point of view. DEVELOPMENT: The work includes an update of the most significant studies that have analysed the role played by vitamin D in the pathogenesis and the treatment of MS. In order to explore the association between concentrations of vitamin D and the risk of MS, the authors examined the available evidence, which included both observation-based studies and intervention studies. CONCLUSIONS: Observation-based studies have shown a consistent inverse relationship between concentrations of vitamin D and the risk of MS. The intervention studies (basically randomised double-blind placebo-controlled trials), however, offer data that are not conclusive. The current context opens up the possibility of conducting prospective and intervention-based studies in the future that will settle the nature of this association in a more convincing manner.
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Esclerosis Múltiple/etiología , Vitamina D/fisiología , Humanos , Esclerosis Múltiple/sangre , Esclerosis Múltiple/tratamiento farmacológico , Vitamina D/sangre , Vitamina D/uso terapéuticoRESUMEN
Introducción. Los principales efectos de la vitamina D se relacionan con la homeostasis del calcio y del fósforo y con la regulación de la remodelación ósea. Sin embargo, en los últimos años, distintas líneas de investigación han generado una gran cantidad de conocimiento sobre su participación en la patogénesis y en el tratamiento de la esclerosis múltiple (EM). Objetivo. Elucidar de forma crítica las evidencias que relacionan la vitamina D con la EM desde un punto de vista epidemiológico, genético, inmunológico y terapéutico. Desarrollo. Se incluye una actualización de los estudios publicados más significativos que han analizado el papel de la vitamina D en la patogénesis y el tratamiento de la EM. Para explorar la asociación entre las concentraciones de vitamina D y el riesgo de EM, se revisa la evidencia disponible hasta el momento, pasando por estudios observacionales y terminando con estudios de intervención. Conclusiones. Los estudios observacionales han demostrado una asociación consistente e inversa entre las concentraciones de vitamina D y el riesgo de EM. Sin embargo, los estudios de intervención (fundamentalmente los ensayos aleatorizados doble ciego controlados con placebo) presentan datos no concluyentes. El actual contexto abre la posibilidad de desarrollar futuros trabajos prospectivos y de intervención que permitan clarificar de manera más contundente esta asociación(AU)
Introduction. The main effects of vitamin D have to do with the homeostasis of calcium and phosphorous, and also with the regulation of bone remodelling. Yet, in recent years, different lines of research have given rise to a large body of knowledge about its role in the pathogenesis and the treatment of multiple sclerosis (MS). Aim. To carry out a critical review of the evidence that relates vitamin D with MS from an epidemiological, genetic, immunological and therapeutic point of view. Development. The work includes an update of the most significant studies that have analysed the role played by vitamin D in the pathogenesis and the treatment of MS. In order to explore the association between concentrations of vitamin D and the risk of MS, the authors examined the available evidence, which included both observation-based studies and intervention studies. Conclusions. Observation-based studies have shown a consistent inverse relationship between concentrations of vitamin D and the risk of MS. The intervention studies (basically randomised double-blind placebo-controlled trials), however, offer data that are not conclusive. The current context opens up the possibility of conducting prospective and interventionbased studies in the future that will settle the nature of this association in a more convincing manner(AU)
Asunto(s)
Humanos , Masculino , Femenino , Vitamina D/uso terapéutico , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/terapia , Factores Inmunológicos/genética , Factores Inmunológicos/uso terapéutico , Esclerosis Múltiple/metabolismo , Esclerosis Múltiple/fisiopatología , Estudios de Cohortes , Vitamina D/efectos adversos , Efecto PlaceboRESUMEN
BACKGROUND: An association between multiple sclerosis (MS) prevalence as well as MS mortality and vitamin D nutrition has led to the hypothesis that high levels of vitamin D could be beneficial for MS. The purpose of this systematic review is to establish whether there is evidence for or against vitamin D in the treatment of MS. METHODS: Systematic literature searches were performed to locate randomized, placebo-controlled, double-blind trials measuring the clinical effect of vitamin D on MS in human participants. Data were extracted in a standardized manner, and methodological quality was assessed by the Jadad score. RESULTS: Five trials were located that met the selection criteria. Of the 5 trials, 4 showed no effect of vitamin D on any outcome, and 1 showed a significant effect, namely by a reduction in the number of T1 enhancing lesions on brain magnetic resonance imaging. Three studies commented on adverse effects of vitamin D, with gastrointestinal adverse effects being the most frequently reported. The literature is limited by small study sizes (ranging from 23 to 68 patients), heterogeneity of dosing, form of vitamin D tested (vitamin D3 in 4 trials and vitamin D2 in 1) and clinical outcome measures. Therefore, a meta-analysis was not performed. CONCLUSIONS: The evidence for vitamin D as a treatment for MS is inconclusive. Larger studies are warranted to assess the effect of vitamin D on clinical outcomes in patients with MS. We further encourage researchers to also test the effect of vitamin D on the health-related quality of life experienced by patients and their families.