La estimulación magnética transcraneal (EMT) es una técnica novedosa, no invasiva, que utiliza la fuerza electromagnética para alterar la excitabilidad neuronal. De manera que al contrario que el TEC (terapia electroconvulsiva) no requiere anestesia y el paciente permanece despierto y monitorizado clínicamente; y al contrario que en la estimulación del nervio vago o que en la estimulación cerebral profunda los electrodos no se insertan en el cerebro. Hasta la fecha se ha utilizado en el tratamiento de distintos trastornos neuropsiquiátricos y desde el 2008 ha sido aprobada por la FDA para el tratamiento de la depresión resistente sin síntomas psicóticos.
La experiencia en esquizofrenia y otras psicosis es menor y como siempre hay muchos menos estudios en la población infantil y juvenil, pero como clínicos sabemos que el inicio de la patología psiquiátrica más grave ocurre en la infancia y la adolescencia y que la mitad de todos los trastornos mentales se inician antes de la mitad de la adolescencia. En pacientes tan jóvenes es especialmente importante encontrar tratamientos más efectivos y menos dañinos.
La EMT representaría una alternativa interesante, ya que puede activar algunas regiones mientras que al mismo tiempo inhibe otras; de manera que hay estudios que explican mejoría de la sintomatología negativa de la esquizofrenia mediante la estimulación del córtex frontal dorsolateral. La eficacia en el tratamiento de las alucinaciones auditivas mediante la inhibición del córtex temporal izquierdo será revisada en este artículo.
IntroductionPrevious studies of prescribing in psychiatric services have identified the relatively frequent use of combined antipsychotics in schizophrenia.Aims– To analyze the proportion of patients treated with more than one antipsychotic;– to study clinical as sociodemographic variables associated with types of prescription.MethodsRetrospective descriptive study of treatment prescribed to psychiatric inpatients treated in an acute care unit of Psychiatry Service in a large teaching hospital during a period of 3 years. Consecutively admitted inpatients receiving concurrent antipsychotics were compared with those treated with a single antipsychotic. Prescription drug records at discharging were revised, n = 263.ResultsFrom the total sample, 61% received more than one antipsychotic. The most common types of combinations were atypical plus a typical antipsychotic followed by two atypical antipsychotics, being less frequent combination of three or more antipsychotics. There were 19 different drug combinations. Concurrent antipsychotics were most frequently prescribed in schizophrenia and schizoaffective disorder. Patients with more previous episodes of illness received more frequently concurrent antipsychotics than patients with low number of previous episodes of illness (P < 0.03). Patients with longer time of hospitalization, and age between 30 and 50 years were treated more frequently with several antipsychotics. Analysis with other variables is presented in the study.ConclusionsThere is a significant difference in the strategies of treatment with antipsychotics depending on diagnosis and number of previous episodes of illness. The concurrent use of multiple antipsychotics in psychiatric inpatients appears to be a response to treatment resistance and is frequent in schizophrenic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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