IntroductionThe personality disorders are defined according to the DSM-5 like “an enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's cultures. These patterns develop in adolescence and the beginning of adulthood, and are associated with significant distress or disability”. The personality disorders can be a risk factor for different processes of the psychiatric pathology like suicide. The personality disorders are classified in 3 groups according to the DSM-5:– cluster A (strange subjects): paranoid, schizoid and schizotypal;– cluster B (immature subjects): antisocial, bordeline, histrionic and narcissistic;– cluster C (frightened subjects): avoidant, dependent and obsessive-compulsive.AimsTo describe the influence of personality disorders in suicide attempts.MethodologyExhibition of clinical cases.ResultsIn this case report, we exhibit three clinical cases of suicide attempts which correspond to a type of personality disorder belonging to each of the three big groups of the DSM-5 classification, specifically the paranoid disorder of the cluster A, the disorder borderline of cluster B and the obsessive compulsive of cluster C.ConclusionsThe personality disorders have a clear relation with the suicide attempts, increasing this influence in some of them, especially the borderline personality disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionThe side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.ObjectivesTo estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.MethodologyTransversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.ResultsTwenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).ConclusionsThe high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Presentamos un caso de patología dual de un paciente de 37 años, de profesión enfermero, cuestión a tener en cuenta por el acceso y el conocimiento en relación a los intentos autolesivos y la exposición de situaciones vivenciales estresantes dentro del ámbito laboral. Antecedentes: Primer contacto con salud mental en 2005 por trastorno adaptativo. 2 ingresos en 2018 (autointoxicación medicamentosa con cortes en yugular derecha y muñeca) y 2019 (compra de fentanilo por internet con toma de 60 comprimidos), todos ellos por intentos autolíticos severos en relación a ruptura sentimental y dificultades en el ámbito laboral. Diagnóstico de Trastorno límite de la personalidad y trastorno depresivo severo. Hábitos tóxicos: Tabaco. Consumo crónico y diario de 3 cigarros de cannabis desde los 16 años. Enfermedad actual: Acude al servicio de urgencias tras intento autolítico. Al comenzar a trabajar en un centro hospitalario de pacientes en estado crítico, sufre empeoramiento anímico, ideas de minusvalía y de desesperanza. Cristaliza esta angustia primero con autoadministración de inyectable de midazolan y al día siguiente con cloruro potásico con intencionalidad autolítica. Exploración psicopatológica: Consciente, orientado, parcialmente colaborador. Aspecto delgado y abandono del autocuidado. Humor depresivo, apatía, anhedonia, pérdida de apetito y clinofila. Rasgos de pensamiento obsesivo e impulsivo. Continúa trabajando, aunque siente incapacidad de desempeñarlo a pesar de que refiere ser su mayor disfrute. Ideación autolítica aún presente de manera flotante, aunque no estructurada. Tratamiento: Citalopram 40mg Olanzapina 20mg Alprazolam 4mg Lormetazepam 2mg Objetivo y Comentario del caso: Con la exposición de este caso queremos reflejar la importancia no solo de la asistencia psiquiátrica continuada en pacientes con patología dual y de su riesgo suicida, sino también, del completo manejo en pacientes conocedores de los medios de alta letalidad que trabajan dentro del ámbito sanitario y de la exposición de factores estresantes que esto supone.
Objetivo Evaluar la eficacia en mantenimiento de la abstinencia a opiáceos y evolución de una muestra de pacientes tratados ambulatoriamente con buprenorfina/naloxona durante más de 12 meses. Material/métodos Estudio descriptivo, retrospectivo de una muestra de pacientes tratados ambulatoriamente con buprenorfina/naloxona en Unidad de Tratamiento de Toxicomanías (UTT) del área sanitaria VII de Asturias. Los datos se recogieron en febrero/2020. Todos los pacientes eran mayores de edad, cumplían criterios CIE-10 de dependencia a opiáceos (F11.22); Llevaban al menos 12 meses a tratamiento con buprenorfina/naloxona y fueron evaluados periódicamente antes y durante la fase de mantenimiento. Se registraron variables sociodemográficas: sexo, edad, formación académica, situación laboral, antecedentes legales, convivencia con familiares consumidores; y variables clínicas y toxicológicas: infección por VHB, VHC y/o VIH, comorbilidad con enfermedades psiquiátricas y somáticas, años de dependencia a opioides, consumo de otros tóxicos, participación en programas de desintoxicación previos, dosis de buprenorfina/naloxona de mantenimiento, periodo de abstinencia y efectos secundarios entre otros. Resultados y conclusiones Se incluyeron 16 pacientes [edad media=47.87 (SD=6.16); mujeres= 6(37.5%)], del Área Sanitaria VII de Asturias. Hubo una alta prevalencia de antecedentes de adicción a otras sustancias (cocaína, etanol, BZD): 12 (75%), baja de comorbilidades psiquiátricas: 4(25%) y 8(50%) pacientes tratados previamente con metadona. Durante el tratamiento de mantenimiento con buprenorfina/naloxona [dosis media=7.63 (SD=1.27)] recayeron en consumo de heroína 7(44%) pacientes y no se comunicaron efectos secundarios. Nuestros datos muestrales avalan la eficacia de buprenorfina/naloxona en el mantenimiento de abstinencia y reducción de craving con un perfil óptimo de seguridad. Puede ser un tratamiento de mantenimiento de primera elección para pacientes con consumo bajo-moderado y una opción para pacientes en tratamiento con metadona y buena evolución . Planteamos como una potencial causa de recaídas en nuestros pacientes el tratamiento con dosis inferiores a la recomendada (16mg). Son necesarios más estudios con diseño prospectivo.
IntroductionSchizoaffective disorder is a psychotic disorder of controversial nosological entity. Affective symptomatology and psychotic features of varying intensity coexist simultaneously in him throughout evolution. The lack of consensus on the existence of this entity determines its diagnostic delay and the absence of specific treatment guidelines.ObjectivesTo review the diagnostic criteria for schizoaffective disorder and the published scientific evidence on the efficacy and safety of the different therapeutic options available. To analyze the efficacy of a multidisciplinary treatment plan implemented in an intensive follow-up program, presenting the evolution of a clinical case.MethodsTo review the psychiatric history and psychopathological evolution of a patient diagnosed with schizoaffective disorder from the beginning of an intensive follow-up program in a day center to the present. Review the existing scientific evidence on the usefulness of the treatments used in this nosological entity.ResultsThis is a longitudinal and retrospective study of a clinical case in which the areas for improvement are analyzed before implementing a multidisciplinary therapeutic program and the favorable results obtained today. Currently, the patient is euthymic and attenuated and chronic positive and negative symptoms persist that do not interfere with his functionality.ConclusionsFrom the implementation of an individualized, personalized and multidisciplinary maintenance treatment plan, an overall improvement in psychopathological stability and functional recovery is observed. Among the psychopharmacological options in this patient, Paliperidone Long Acting Injection (PLAI) stands out for its long-term efficacy and safety.
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