RESUMO
The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as "I do not have a heart," "my heart is not beating," "I can not breathe," "I am breaking apart," "I have no head" (ideas of negation) and statements about the patient being responsible for the "death of the whole world" (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.
RESUMO
UNLABELLED: Human parvovirus B19 (PVB19) is the etiologic agent of erythema infectiosum (fifth disease), a common childhood exanthema. Immunocompromised patients risk developing chronic infections leading to pure red blood cell aplasia. Herein we have reported our experience with two pediatric renal transplant recipients who had severe pure red cell aplasia in the early period after surgery, accompanying PVB19 infection. FIRST CASE: A 6-year-old boy underwent pro emptive living-related renal transplantation in September 2006. On day 4, he developed abdominal discomfort and diarrhea. After transplantation, he began an asymptomatic drop in hematocrit without reticulocytosis, which was unresponsive to recombinant erythropoietin. Diarrhea also persisted. Polymerase chain reaction (PCR) was positive for cytomegalovirus (CMV) in the gastrointestinal tract. PVB19 was confirmed by PCR on a bone marrow sample. He was transfused with packed red cells and treated with ganciclovir and intravenous immunoglobulin (IVIG). His hematocrit increased and diarrhea ended. Six months later anemia recurred requiring a second infusion of IVIG. Subsequently he has done well. SECOND CASE: A 15-year-old boy received a living-related renal transplant in October 2006, after 2 years on automated peritoneal dialysis. One month later he developed a progressive, nonregenerative anemia. A bone marrow aspirate confirmed a PVB19 infection by PCR. He received a blood transfusion and IVIG with a favorable response. CONCLUSIONS: The presence of persistent anemia in immunocompromised hosts with a low reticulocyte count suggests PVB19 infection. IVIG therapy is effective to treat chronic PVB19 infections.
Assuntos
Anemia/etiologia , Ganciclovir/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Transplante de Rim/efeitos adversos , Infecções por Parvoviridae/diagnóstico , Infecções por Parvoviridae/tratamento farmacológico , Parvovirus B19 Humano , Adolescente , Antivirais/uso terapêutico , Criança , Creatinina/sangue , Hematócrito , Humanos , Masculino , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/isolamento & purificação , Reação em Cadeia da PolimeraseRESUMO
Vibrio parahaemolyticus es una de las principales bacterias Gram-negativas causantes de toxiinfecciones alimentarias y gastroenteritis aguda en humanos. En peces causa septicemia hemorrágica y ulceraciones de la piel, conviertiéndose en una de las principales causas de pérdidas en las explotaciones piscícolas. El presente trabajo documenta el establecimeinto de un protocolo de identificación de Vibrio parahaemolyticus por la técnica de acción en cadena de la polimerasa (PCR). Se realizaron caracaterizaciones genómicas de 24 aislados de Vibrio sp. obtenidos del cepario del laboratorio de Bacteriología de Sanidad Animal CENIAP-INIA en Maracay, estado Aragua, Venezuela. En la identificación genética los aislados fueron caracterizaciones mediante la PCR, siguiendo la metodología descrita por Lee y col. (1) con modificaciones en la extracción del ADN, que se realizó con DNAzol. Los iniciadores utilizados para tal fin fueron: 5`-GCGAATTCGATAGGGTGTTAACC-3` y 5`-CGAATCCTTGAACATACGCAGC-3`. De los 24 aislados analizados por PCR se obtuvieron 7 amplificados, que se identificaron como V. parahaemolyticus
Assuntos
Humanos , Animais , Protocolos Clínicos , Vibrio parahaemolyticus , Microbiologia , VenezuelaRESUMO
Un importante patógeno humano es vibrio cholerae, causante de diarreas profusas (cólera) y otros desórdenes. Su transmisión está asociada con el consumo de alimentos marinos contaminados. En el presente estudio se realizaron caracterizaciones fenotípicas de 24 aislados de Vibrio sp. obtenidos por necropsia y del cepario del laboratorio de Bacteriología de Sanidad Animal CENIAP-INIA en Maracay, estado Aragua; entre los cuales fue aislado vibrio cholerae proveniente de lisas y tilapsias. Las técnicas de identificación bacteriana se basan en sus características fenotípicas y metabólicas, desarrollo de colonias en medios de cultivos, morfología microscópica y reacciones tintoriales y características bioquímicas basadas en la utilización de sustratos. En los ejemplares de tilapia estudiados se identificó vibrio cholerae no-O1 y en las lisas, predominaron vibrio parahaemolyticus y vibrio cholerae no-O1. Este hallazgo es de gran importancia sanitaria, ya que los peces son de consumo humano, lo que constituye un riesgo en salud pública
Assuntos
Humanos , Animais , Perciformes , Saúde Pública , Vibrio cholerae , Microbiologia , VenezuelaRESUMO
BACKGROUND: Smoking is the main single avoidable cause of death in our country. Little research in the treatment of such disorder has been made. AIM: To report the results of a prospective follow up for one year of outpatients from our "Smoker's Clinic" at the Department of Psychiatry of the Catholic University. PATIENTS AND METHODS: One hundred twenty-seven patients (84 male, aged 21 to 70 years old), with DSM-IV criteria for nicotine dependence, were included in a total of 18 groups. Each group received an intensive treatment program of 10 sessions with cognitive-behavioral relapse prevention techniques and nicotine replacement. Patients with active psychiatric diseases were not included in the program. RESULTS: Eighty-seven percent of subjects were abstinent at the first month and 50% were still abstinent after twelve months of follow up. We did not find differences in gender, age, previous psychiatric disease, number of cigarettes and breath carbon monoxide level between abstinent and non abstinent patients after 12 months of follow up. CONCLUSION: This intensive nicotine dependence treatment in seriously dependent patients, proved to be successful, regardless of the previous psychiatric history.
Assuntos
Psicoterapia de Grupo , Tabagismo/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Estudos Prospectivos , Resultado do TratamentoRESUMO
Genetic epidemiologic studies have provided evidence that genetic factors contribute to familial aggregation of schizophrenia. However, the precise mode of inheritance has not been elucidated. The majority of such studies have been carried out in Caucasian populations. The present study was performed in Santiago, Chile, whose population stems from the admixture of Amerindians with Spaniards. The sample consisted of 44 randomly ascertained schizophrenic probands (22 males and 22 females) with ages ranging between 20 and 48 years. The diagnosis was made according to DSM-III-R criteria. Both probands and relatives were interviewed using a structured interview (CIDI) and the DSM-III-R checklist. Complex segregation analysis was carried out using the computer program POINTER. The non-transmission model (Q = H = 0) was rejected as well as the recessive single locus (H = 0, Z = 1). The multifactorial, the single codominant, the non-major locus component, the non-polygenic component transmission model and the non-transmission of a major effect could not be rejected. The model that best fits the data of the present study is that of a mixed model with a great environmental component (93.12%). The frequency of the major gene was estimated at 0.000155. Our results are similar to previous reports in ethnically different populations.
Assuntos
Saúde da Família , Modelos Genéticos , Esquizofrenia/epidemiologia , Esquizofrenia/genética , Adulto , Distribuição de Qui-Quadrado , Chile/epidemiologia , Chile/etnologia , Efeito de Coortes , Suscetibilidade a Doenças , Meio Ambiente , Saúde da Família/etnologia , Feminino , Genes Dominantes , Genes Recessivos , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Linhagem , Estudos de Amostragem , Distribuição por SexoRESUMO
Intolerancia a la ambigüedad es un constructo de la personalidad y un modelo cognitivo que ha recibido un creciente interés en investigación psicopatológica. En un estudio transcultural se examina la intolerancia a la ambigüedad en una muestra de pacientes hospitalizados con trastornos depresivo unipolar, bipolar, esquizofrénico (DSM III-R) y un grupo control de las clínicas psiquiátricas de la Universidad de Heidelberg y de la Universidad de Chile respectivamente. El grupo de depressivos mayores unipolares de ambos países revelan valores significativamente mayores que los del grupo control, medidos con la escala de Kischkel. En la muestra alemana los unipolares se diferenciaron de los esquizofrénicos y en la chilena de los bipolares. Se encontró una asociacón íntima entre intolerancias a la ambiqüedad y el constructo "Rigidez" de la personalidad primórbida. El significado y las implicancias teóricas y clínicas de estos hallazgos se discuten finalmente.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Comparação Transcultural , Transtornos do Humor , Personalidade , EsquizofreniaRESUMO
Intolerancia a la ambig³edad es un constructo de la personalidad y un modelo cognitivo que ha recibido un creciente interés en investigación psicopatológica. En un estudio transcultural se examina la intolerancia a la ambig³edad en una muestra de pacientes hospitalizados con trastornos depresivo unipolar, bipolar, esquizofrénico (DSM III-R) y un grupo control de las clínicas psiquiátricas de la Universidad de Heidelberg y de la Universidad de Chile respectivamente. El grupo de depressivos mayores unipolares de ambos países revelan valores significativamente mayores que los del grupo control, medidos con la escala de Kischkel. En la muestra alemana los unipolares se diferenciaron de los esquizofrénicos y en la chilena de los bipolares. Se encontró una asociacón íntima entre intolerancias a la ambiq³edad y el constructo "Rigidez" de la personalidad primórbida. El significado y las implicancias teóricas y clínicas de estos hallazgos se discuten finalmente. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos do Humor , Esquizofrenia , Personalidade , Comparação TransculturalRESUMO
BACKGROUND: Genetic epidemiological studies indicate that genetic factors contribute to a familial aggregation of schizophrenia. The form of inheritance has not been elucidated but most studies have been done in Caucasian populations. AIM: To study the form of inheritance of schizophrenia in an urban population of Santiago, Chile, containing an admixture of Spanish origin individuals with Southamerican aborigines. SUBJECTS AND METHODS: Forty four randomly selected schizophrenic probands, 22 female, aged 28 to 48 years old, were studied. From them, an extensive genealogical reconstitution was performed. Probands and relatives were interviewed using the structured interview CIDI and DSM-III-R check-list. Schizophrenia was diagnosed using DSM-III-R criteria. Complex segregation analysis was done using Pointer program. RESULTS: The hypothesis of a multifactorial inheritance, without the participation of major genes, could not be rejected. Likewise, the major dominant and co-dominant gene forms of transmission could not be rejected. CONCLUSIONS: Our results show the participation of a major dominant locus and a multifactorial component in the inheritance of schizophrenia, as has been reported elsewhere.
Assuntos
Esquizofrenia/genética , Adulto , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Probabilidade , Fatores de Risco , População Urbana , População BrancaRESUMO
This study examines premorbid personality traits from a self-reported and family-reported perspective on a group of unipolar major depression (n = 27), bipolar (n = 21), and schizophrenic (n = 16) recovered inpatients, and a control group (n = 21). Using the Munich Personality Test (MP-T Scales) of von Zerssen for self-reporting and family-reporting personality traits, and the Kischkel scale for the measurement of "intolerance of ambiguity," we found more "rigidity," less "esoteric tendencies," and more "intolerance of ambiguity" among unipolar depressive patients. Schizophrenic patients showed more esoteric tendencies and less "extraversion." Results confirm the hypothesis supported by many authors regarding a particular personality structure in unipolar major depression characterized by rigidity and ambiguity intolerance. This personality pattern for unipolar depressives seems to be different from the depressive personality disorder proposed by DSM-IV. Schizophrenic individuals differ by means of their self- and family-reported extraversion. Clinical and theoretical implications of these findings are discussed.
Assuntos
Transtorno Bipolar/psicologia , Transtorno Depressivo/psicologia , Personalidade , Psicologia do Esquizofrênico , Adulto , Estudos de Casos e Controles , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Comportamento SocialRESUMO
This study tries to determine the relationship between intolerance of ambiguity and different psychiatric disorders classified according to DSM-III-R criteria in two different countries. Inpatients from the psychiatric department of the Universidad de Chile and the psychiatric department of the University of Heidelberg (Germany) with uniplar, bipolar or schizophrenic disorders, as well as normal controls in both cultures completed the Kischkel Intolerance of Ambiguity Scale. The group of unipolar depressive inpatients showed significantly higher scores in both samples. Among the Chilean schizophrenic patients, differences between unipolar and bipolar disorders were seen only in the Chilean sample. Differences between unipolar depressive and schizophrenic patients were evident in the German sample only. The psychopathological and nosological significance of these findings in unipolar depressives is discussed.
Assuntos
Transtorno Bipolar/etnologia , Comparação Transcultural , Mecanismos de Defesa , Transtorno Depressivo/etnologia , Esquizofrenia/etnologia , Psicologia do Esquizofrênico , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Chile , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Inventário de Personalidade/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Esquizofrenia/diagnósticoRESUMO
Aiming to know the frequency of mental disorders among patients consulting a general hospital emergency ward, 2834 medical records of such patients were retrospectively reviewed. 8.4% of consultations were due to mental disorders. Sixty four percent of patients consulting for mental disorders were women. Anxiety disorders comprised 57.6% of consultations due to mental disorders and intoxications 7.6%. Eighty percent of the latter were consequence of suicidal attempts, being the most common method the use of benzodiazepines. A low percent of these patients were referred to psychiatry. The low frequency of psychiatric referrals and the importance of psychiatric advice in emergency rooms is discussed.