We report a series of 46 children who were treated for one of the diverse forms of cranium bifidum during a period of 22 years. The purpose of the survey was to investigate pathogenetic factors involved in the development of cranial dysraphism and to analyze clinical and pathological factors that influence the patients' outcome. We also investigated the existence of associated intracranial anomalies, in a systematic way, using modern methods of neuroimaging, and related the findings to the patients' final results. The lesions were classified as encephalocele (n = 15), cranial meningocele (n = 3), atretic cephalocele (n = 26), cranium bifidum occultum (n = 1), and exencephaly (n = 1). There was an excess of the atretic form of cephaloceles in our series, a fact that probably reflects geographical variations described for cephaloceles in general. The location of the lesions was occipital in 29 children, parietal in 16, and temporal and frontobasal in one case each. In seven cases there was parental consanguinity. A familial history of malformations of the central nervous system was encountered in eight instances. Associated systemic abnormalities were present in 23 patients, while central nervous system anomalies were found in 36 children. Cephalocele repair was undertaken on 35 occasions. There were no surgical fatalities in the series. The mean follow-up time was of 7 years. Overall mortality for the whole group was of 17/46 or 36%. Twenty of the 29 survivors had no neurological sequelae, but only 18 children exhibited a competitive intelligence level. A good outcome was found to correlate well with: an average head size at birth, a normal initial neurological condition, operability of the lesions, and an absence of disorders of the neuronal migration. Neurological outcome depended also on the occurrence or not of hydrocephalus, while the intelligence level was mainly related to the absence of cerebral tissue within the sac of the malformation.

Resumen: Los menores expuestos a condiciones estresantes graves, tales como negligencia, abuso emocional y/o físico en las relaciones familiares primarias, pueden desarrollar traumas cuyos síntomas no se incluyen en el trastorno por estrés postraumático (TEPT). Las consecuencias del trauma complejo afectan el desarrollo psicológico, y las características se diagnostican en la actualidad en la categoría de trastorno por estrés postraumático extremo no especificado (disorders of extreme not otherwise specified, DESNOS) (Pelcovitz et al., 1992), cuyas alteraciones afectan a: a) regulación de los afectos e impulsos, b) memoria y atención; c) autopercepción, d) relaciones interpersonales, e) somatizaciones, y f) sistema de significados. Estos síntomas se incluyen en la propuesta de una nueva categoría diagnóstica: el trastorno por estrés postraumático complejo o extremo. Las características específicas de este trastorno en menores que presentan trauma complejo están siendo estudiadas (Cook et al., 2005). Se aportan datos sobre sintomatología del trauma complejo en menores maltratados.Palabras clave: reacciones postraumáticas, TEPT, trauma complejo, DESNOS, maltrato infantil. Maltreatment of children and adolescentes and traumatic reactionsAbstract: Serious stressful conditions in children, like neglect, emotional or sexual abuse within the family can result in traumas with symptoms that are currently not included in post-traumatic stress disorder (PTSD). The consequences of this complex trauma affect psychological development, and their characteristics are actually diagnosed in the category of non-specific extreme posttraumatic stress disorder (DESNOS, Pelcovitz et al., 1992), alterations of which include: a) emotional regulation and impulse control; b) memory and attention; c) self-perception; d) interpersonal relationships; e) somatization, and f) system of meanings. These symptoms are included in the proposal of a new diagnostic category: extreme or complex posttraumatic stress disorder (CPTSD). The specific characteristics of this disorder in minors that present complex trauma are being investigated (Cook et al., 2005). Data are presented on the symptomatology of complex trauma in maltreated minors.

Two cases are reported of subdural hematoma of the posterior fossa in normal-weight full-term newborn infants. The most salient factors in these cases were the lack of specific symptoms and signs indicating the nature and location of the lesion, the importance of computerized tomography for diagnosis, and the good results obtained with early surgical treatment.

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Several studies assess mental health in older adults, but relatively few do so from a multi-informant perspective. In this work, discrepancies in self-perception and   third-person perception of the mental health of older adults were analyzed in two age groups and differentiated by sex and place of residence. Relationships between different scales that measure psychopathology and psychosocial competencies were also analyzed. A sample of 288 older people aged between 60-95 years old (154 women, 53.47%) belonging to 12 municipalities in the Region of Murcia was employed, and the Older Adult Self-Report (OASR) questionnaire was used to measure the psychopathology of older people and the Older Adult Behavior Checklist (OABCL) instrument to find out the family's perception of these problems. Outcomes show different perceptions of mental health among older people and their families, which worsen with increasing age, psychosocial risk status and female gender. This reflects the need to develop specific treatment protocols for each gender and psychosocial risk situation, in order to address the differential mental health needs in older people. Son numerosos los trabajos que evalúan la salud mental de las personas mayores, pero relativamente escasos los que lo hacen desde una perspectiva multi-informante. En este trabajo se analizaron las discrepancias en la autopercepción y la percepción que tienen otros de la salud mental de las personas mayores, en dos franjas de edad, diferenciando por sexos, lugar de residencia y se analizaron las relaciones entre diferentes escalas que miden psicopatología y competencias psicosociales. Se empleó una muestra de 288 personas mayores entre 60-95 años (154 mujeres, 53.47%) pertenecientes a 12 municipios de la Región de Murcia, y se empleó el cuestionario OlderAdultSelf-Report (OASR) para medir la psicopatología de las personas mayores y el instrumentoOlderAdultBehaviorChecklist (OABCL) para conocer la percepción de la familia de estos problemas. Los resultados reflejan que existen diferentes percepciones de la salud mental entre personas mayores y sus familiares, que empeoran al aumentar la edad, la situación de riesgo psicosocial y el género femenino. Esto refleja la necesidad de desarrollar protocolos de tratamiento específicos para cada género y situación de riesgo psicosocial, con el fin de atender las necesidades diferenciales de salud mental de las personas mayores.