Scielo RSS <![CDATA[Revista chilena de neuro-psiquiatría]]> http://www.scielo.cl/rss.php?pid=0717-922720140003&lang=es vol. 52 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Código de Ética de la Sociedad de Neurología, Psiquiatría y Neurocirugía de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300001&lng=es&nrm=iso&tlng=es <![CDATA[<strong>Estudio comparativo del déficit neuropsicológico por medio de la Batería Luria-Nebraska en trastornos mentales</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300002&lng=es&nrm=iso&tlng=es Background: Neuropsychological deficits seems to be frequent in mental disorders. Objectives: This study reports the application of the Luria-Nebraska Neuropsychological Battery (LNNB) to four clinical groups and the results compared. Methods: Subjects were patients with first-episode schizophrenia, lucid alternating epileptic psychosis, acute alcoholic psychosis, and bipolar I. A cognitive profile was established for each group, and the profiles were compared. Results: The profiles for patients with schizophrenia, epileptic psychosis, and bipolar disorder are similar, while those with alcoholic psychosis show a different pattern of neuropsychological deficits. The specific LNNB scales with results in the abnormal range were also similar for the following pairs of groups of patients: bipolar disorder and schizophrenia; bipolar disorder and epileptic psychosis; schizophrenia and epileptic psychosis. Discussion: Neuropsychological deficit occurs frequently in various mental pathologies. In terms of functional abnormalities, the profiles of subjects with schizophrenia, epileptic psychosis, and bipolar disorder share similarities. The alcoholic psychosis group shows fewer similarities with the other three groups; the scales affected were different in comparison to the other subjects studied.<hr/>Contexto: El déficit neuropsicológico impresiona ser frecuente en los trastornos mentales. Objetivos: Este estudio muestra la aplicación de la Batería Neuropsicológica Luria Nebraska a cuatro grupos clínicos y sus resultados comparados. Método: Los pacientes corresponden a sujetos con esquizofrenia primer episodio, personas con psicosis lúcidas alternantes, con psicosis alcohólica aguda y bipolares I. Se obtuvo un perfil para cada grupo y fueron comparados entre sí. Resultados: El perfil para portadores de esquizofrenia, de psicosis epiléptica y de trastorno bipolar fueron similares, mientras que los sujetos portadores de psicosis alcohólicas mostraron un perfil diferente en los déficits neuropsicológicos. Las escalas deficitarias específicas en rango anormal fueron también similares para los siguientes grupos de pacientes: bipolares y esquizofrenia; bipolares y psicosis epiléptica; esquizofrenia y psicosis epiléptica. Conclusiones: Los déficit neuropsicológicos son frecuentes en variadas patologías mentales. En término de anormalidades funcionales, el perfil para pacientes con esquizofrenia, psicosis epilépticas y trastorno bipolar muestran semejanzas. El grupo con psicosis alcohólica muestra una menor similitud con las otras entidades clínicas estudiadas, pues las escalas afectadas fueron diferentes. <![CDATA[<strong>Manejo de la sialorrea en personas con enfermedad de Parkinson mediante terapia conductivo conductual y estimulación termo-táctil</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300003&lng=es&nrm=iso&tlng=es This study proposes a Speech Therapy treatment for individuals with sialorrhea (saliva production perceived by patient as excessive) as a consequence of Parkinson Disease (PD). Method: A prospective study in 18 individuals with PD diagnosis was taken and divided into two groups: A) received only Cognitive Behavioral Therapy (CBT) (swallowing process awareness), while B) received CBT plus Thermal Tactile Stimulation (TTS) (cold sensory stimulation to the pharyngeal anterior pillars and oral cavity). The intervention lasted 5 weeks. The purpose of this research was to prove the effectiveness of Speech Therapy in dealing with sialorrhea and to assess a significant difference between CBT and CBT plus TTS. A t-student parameter test and the Mann-Withney test were used. Resulted: The assessment by the Clinical Scale for Parkinson Sialorrhea (SCS-PD) prior to therapy was CBT group was 2.6 and 11.5 ± 9.4 ± 4.2 group difference was not statistically significant. After therapy was 3.5 ± 2.8 and 4.6 ± 3.5 both showed a statistically significant difference compared to baseline (p < 0.001), not having statistically significant difference between them. Conclusion: These tests showed that both treatments are effective to decrease sialorrhea perception in individuals with PD. Nevertheless, no statistical significant differences were noted between both treatments.<hr/>Introducción: Este estudio propone un tratamiento Fonoaudiológico para trabajar con personas que presentan sialorrea (producción de saliva que el paciente percibe como excesiva) producto de la Enfermedad de Parkinson (EP). Método: Dieciocho personas con diagnóstico de EP y sialorrea, las cuales se dividieron en dos grupos; A: recibió sólo Terapia Cognitivo Conductual (TCC) (concientización del proceso deglutorio), mientras el B: recibió TCC más Estimulación Termo Táctil (ETT) (se realiza estimulación sensorial con frío a los pilares faríngeos anteriores y cavidad oral), la intervención se realizó por 5 semanas. El objetivo de la presente investigación es evidenciar la efectividad de la terapia Fonoaudiológica en el abordaje de la sialorrea y evaluar si existe una diferencia significativa entre la TCC y la TCC más ETT. Se utilizó la prueba paramétrica t-student, y Test de Mann-Withney, se consideró significativo un p < 0,05. Resultados: La valoración mediante la Escala Clínica de la Sialorrea para Parkinson (SCS-PD) previo a la terapia en grupo con TCC 11,5 ± 2,6 y el grupo 9,4 ± 4,2 diferencia que no es estadísticamente significativa. Posterior a la terapia fue 3,5 ± 2,8 y 4,6 ± 3,5 ambos presentaron una diferencia estadísticamente significativa respecto a la basal (p < 0,001), no habiendo diferencia estadísticamente significativa entre ellas. Conclusión: Estas pruebas demostraron que ambos tratamientos son efectivos para disminuir la percepción de sialorrea en las personas con EP. Sin embargo, no se evidencian diferencias estadísticamente significativas entre ambos tratamientos. <![CDATA[<strong>Diagnóstico de la prevalencia de trastornos de la salud mental en estudiantes universitarios y los factores de riesgo emocionales asociados</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300004&lng=es&nrm=iso&tlng=es Introduction: In our country Chile it is estimated that approximately a third of the population would have had some psychiatric disorder during its life. Ifwe consider the university population, the evolutionary stage that it experiences and the psychosocial stress that affect them, we observe a group at risk to present psychiatric disorders. The aim of the present study was to estimate the prevalence of the principal mental disorders not psychotic in the population of students of the UACH, during the year 2008. Material and Method: The sample consisted of 804 undergraduate students, that answered individually the Patient Health Questionnaire (PHQ-9), the Scale of Beck's hopelessness (HBS), the Mood Disorder Questionnaire (MDQ), the Questionnaire of detection of problematic consumption of alcohol and drugs in teenagers (DEP-ADO), the questionnaire AUDIT, the Eating Disorder Diagnostic Scale (EDDS) and the Restrain Scale (RE). Results: 27% of the students fulfills with criteria for a depression, 10,4% deals with a bipolar disorder, 5,3% has a moderated risk to severe of committing suicide, 24,2% of the students presents a problematic consumption to alcohol and 15,3% it would have some type of disorder in his supplies when eating. Conclusions: Depression was significantly associated with a greater tendency to have abnormal eating behavior, harmful alcohol consumption and self-destructive behavior.<hr/>Introducción: Se estima que en Chile aproximadamente un tercio de la población ha tenido algún trastorno psiquiátrico durante su vida. Si tenemos en cuenta a la población universitaria, por la etapa evolutiva que experimenta y el estrés psicosocial asociado, ésta se constituye como un grupo en riesgo de presentar trastornos psiquiátricos. El presente estudio se propuso estimar la prevalencia de los principales trastornos mentales no psicóticos presentes en la población de estudiantes depregrado de la UACh, durante el año 2008. Método: La muestra estuvo compuesta por 804 estudiantes de pregrado, que respondieron de manera individual escalas de screening para la depresión (Patient Health Questionnaire-PHQ-9), para el riesgo de suicidio (Escala de desesperanza de Beck-HBS), para los trastornos bipolares (Mood Disorder Questionnaire-MDQ), para el consumo de alcohol y drogas (DEP-ADO y AUDIT), y para los trastornos de la conducta alimentaria (Eating Disorder Diagnostic Scale-EDDS; y Restrain Scale-RS). Resultados: Un 27% de los estudiantes cumple con los criterios diagnósticos para una depresión, un 10,4% estaría cursando con un trastorno bipolar, un 5,3% de los estudiantes tiene un riesgo moderado a severo de cometer suicidio; 24,2% de los estudiantes universitarios presenta un consumo problemático de alcohol y un 15,3% de la muestra tendría algún tipo de trastorno en la alimentación. Conclusiones: La depresión se asoció significativamente con una mayor tendencia a tener un comportamiento de alimentación anormal, el consumo nocivo de alcohol y el comportamiento autodestructivo. <![CDATA[<strong>Psicoterapias postestructuralistas y factores de cambio</strong>: <strong>posibilidades para una práctica efectiva</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300005&lng=es&nrm=iso&tlng=es The evidence in psychotherapy out come research points to the importance of the common factors in therapeutic change, which depend largely on patient participation. Models of post-structuralist orientation in systemic psychotherapy promote direct and explicitly change/common factors, as the therapeutic alliance, expectatives and extra-therapeutic factors, allowing the accommodation, relevant instance giving the consultant a decisive role for therapeutic change. The poststructuralist models are good instances formational, especially for the acquisition of skill stomobilize change factors.<hr/>La evidencia en investigación de resultados en psicoterapia señala la relevancia de los factores comunes en el cambio terapéutico, los cuales dependen en buena medida de la participación y protagonismo del paciente. Los modelos de orientación post-estructuralista en psicoterapia sistémica promueven de forma directa y explícita los factores de cambio/comunes, como la alianza terapéutica, las expectativas y los factores extra-terapéuticos, permitiendo la acomodación, instancia relevante que otorga al consultante un rol decisivo para el cambio terapéutico. Los modelos posestructuralistas son buenas instancias formativas, en especial para la adquisición de destrezas que movilicen factores de cambio. <![CDATA[<strong>Los cuestionamientos de Jean-Paul Sartre a Freud ¿son aún válidos?</strong>: <strong>Filosofía y psicoanálisis en el nuevo siglo</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300006&lng=es&nrm=iso&tlng=es The philosopher Jean-Paul Sartre carried out an ontological analysis of the underlying assumptions of Freud. He rejected the notion of the unconscious and replaced it by the conscious and added the concepts of freedom, original choice, and bad faith, to better understand the neurosis. These neurosis results from bad faith projects freely chosen but not genuinely assumed. In proposing the Existential psychoanalysis he contributed to a deepening of the theory and practice of Freudian psychoanalysis. Sartre's outline has been little studied and deepened. Binswanger, Heidegger, Ricoeur, and Boss have sought to continue the footsteps of Sartre albeit indirectly, supported by their respective metaphysical conceptions. Martín-Santos has been an exception and his contribution was focused on the basics of existential psychotherapy. We don't still have studies written by psychiatrists who creatively take advantage of the insights of Sartre and his detractors.<hr/>El filósofo Jean-Paul Sartre sometió a un análisis ontológico los supuestos implícitos de Freud. Rechazó la noción de inconciente y la sustituyó por el de conciencia y agregó los conceptos de libertad, elección originaria y mala fe para entender mejor las neurosis. Éstas resultan de proyectos de mala fe libremente escogidos aunque no asumidos. Al proponer el Psicoanálisis existencial intentó contribuir a una profundización en la teoría y práctica del psicoanálisis freudiano. Su esbozo ha sido poco estudiado y profundizado. Binswanger, Heidegger, Boss y Ricoeur han buscado proseguir los pasos de Sartre aunque de manera indirecta, apoyados en sus respectivas metafísicas. Martín-Santos ha sido la excepción y su aporte se centró en los fundamentos de la psicoterapia existencial. Todavía faltan análisis de psiquiatras que aprovechen creativamente las intuiciones de Sartre y sus detractores. <![CDATA[<strong>Investigaciones en rehabilitación cognitiva para pacientes con esquizofrenia (2004-2013)</strong>: <strong>una revisión temática en beneficio de propuestas para etapas iniciales del trastorno</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300007&lng=es&nrm=iso&tlng=es A thematic review of research in cognitive reabilitation of patients with schizophrenia is presented with the purpose of systematizing a contribution to the generation of intervention proposals for early stages of the disorder. Sudies are reviewed between 2004-2013 based on the "PubMed.gov" and "Scielo.org" search engines. Forty-two papers were found and 19 were selected, applying as inclusion criteria research with control groups that show positive results in the rehabilitation of attention, memory, and executive function. Furthermore, the aim is to get to know the cognitive rehabilitation program on which that research is based in order to appreciate its approach and its emphases. The results show a corpus of interventions which, in spite of their diversity, have a significant impact on the patients' cognitive and psychosocial functioning. The main predictors of good results are low age, low degree of cognitive deterioration, and low use of antipsychotic medication at the time of intervention. Improvement of executive functioning appears to be the best predictor of the patients' functionality in everyday activities. An impact is also seen of cognitive improvement on relevant clinical indicators: functioning in everyday activities, social adjustment, and clinical indices associated with a decrease of the observed symptoms. It is concluded that these results, together with research in which it is estimated that the alteration of the course of the schizophrenia requires early and multimodal work, imply the need to generate therapeutic proposals from the first episodes where the cognitive rehabilitation of the patient cannot be absent. <![CDATA[<b>Dr. Luis Alberto Pacheco Rivas (1958-2014)</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272014000300008&lng=es&nrm=iso&tlng=es A thematic review of research in cognitive reabilitation of patients with schizophrenia is presented with the purpose of systematizing a contribution to the generation of intervention proposals for early stages of the disorder. Sudies are reviewed between 2004-2013 based on the "PubMed.gov" and "Scielo.org" search engines. Forty-two papers were found and 19 were selected, applying as inclusion criteria research with control groups that show positive results in the rehabilitation of attention, memory, and executive function. Furthermore, the aim is to get to know the cognitive rehabilitation program on which that research is based in order to appreciate its approach and its emphases. The results show a corpus of interventions which, in spite of their diversity, have a significant impact on the patients' cognitive and psychosocial functioning. The main predictors of good results are low age, low degree of cognitive deterioration, and low use of antipsychotic medication at the time of intervention. Improvement of executive functioning appears to be the best predictor of the patients' functionality in everyday activities. An impact is also seen of cognitive improvement on relevant clinical indicators: functioning in everyday activities, social adjustment, and clinical indices associated with a decrease of the observed symptoms. It is concluded that these results, together with research in which it is estimated that the alteration of the course of the schizophrenia requires early and multimodal work, imply the need to generate therapeutic proposals from the first episodes where the cognitive rehabilitation of the patient cannot be absent.