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[Prospective evaluation of antidepressant discontinuation].

The authors prospectively assessed symptoms induced by the interruption of antidepressants in 16 patients (11 women and 5 men), aged from 33 to 85 years (mean = 52.4 +/- 16.4), treated with antidepressants since at least two weeks. All patients were free of alcohol abuse or dependence disorder and of other dependence to psychoactive substances. None of them presented medical illness. Diagnosis were made by separate evaluations by two authors and confirmed with a semistructered assessment instrument: the Schedule for Affective Disorders and Schizophrenia (Lifetime Version). All patients were submitted to a brutal discontinuation of their antidepressant agent. Patients were assessed twice, before the interruption of the antidepressant, and 72 hours later. Effects of antidepressant interruption were assessed by several means. Modification of anxiety and depression were evaluated using the Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Scale. Symptoms of withdrawal were assessed with Cassano and al.'s scale SESSH including an evaluation of anxiety, agitation, irritability, anergy, difficulty on concentrating, depersonalization, sleep and appetite disorders, muscle pains, nausea, tremor, sweating, altered taste, hyperosmia, paresthesias, photophobia, motor incoordination, dizziness, hyperacousia pain, delirium. Fourteen of the 16 patients (87.5%) presented modifications of their somatic or psychic state 3 days after the interruption of the antidepressant treatment. Most frequent symptoms were: increase in anxiety (31%), increase in irritability (25%), sleep disorders (19%), decrease of anergia and fatigue (19%). Mean scores of anxiety and depression were not significantly modified by the withdrawal. Following TCAs interruption (7 patients) most frequent symptoms were sleep disorders; increase in anxiety, nausea. Among patients withdrawn from SSRIs (6 patients), most frequent symptoms were increase in anxiety, increase in irritability, headache. Patients also presented a decrease of nausea, and of anorexia.

Adult↗
PubMed1998

[Psychopathological study on schizophrenic autism through the paintings of a case of simple schizophrenia].

Autism is the symptom which has the most specific features of schizophrenia. However, the content of pathological experience of the patients has not yet been clarified as it was never told by themselves. In the present study, a case of simple schizophrenia with a major symptom of autism is reported. Schizophrenic autism was studied psychopathologically by drawing tests. The analysis of drawings was summarized by the following characteristics. 1. The objects were drawn so as to be small at the center. The composition was further characterized by the overwhelmingly predominant empty space of its circumference, which we termed "reversed zoom lens effect". This seemed to show that the objects were isolated and removed from the patient. 2. The entire image of the theme was not drawn. 3. Lack of vitality was observed in all the drawings. On the basis of the above characteristics of these drawings and the clinical findings, the following were suggested as the pathology of the patient's experience: 1. The "reversed zoom lens composition" seen in the drawings suggested that the psychological distance between objects and the patient might be expanded. 2. The patient was alienated from the objective world to which he had once been accustomed as the object lacked vitality and familiarity. 3. The pathology of schizophrenic autism observed in the patient could be expressed as "alienation from objective experience." 4. It was considered that although akin to depersonalization, "alienation from objective experience" was the pathology characteristic of schizophrenia.

Adult↗
PubMed1998

[Differential diagnosis and prognosis of phobic disorders].

The paper presents differential-diagnostic signs of phobic disorders of different etiology. Acute episodes of depersonalization preceding phobias and fears arising during the first age crisis are considered as some diagnostic signs of endogenous phobias. The significant criteria for diagnosis of psychogenic phobias are anxious suspiciousness, affective instability, susceptibility, spontaneity of reactivity and the presence of personally important psychic trauma. An autonomic paroxysm caused by alcoholic situation in exogenic organic pathology (alcoholism) was transformed quite fast into some senestopathias, which themselves maintained the of fear. The relationships of phobias and depressions in endogenous disorders was different: in slow-progredient variations of the disease depression resulted in a decrease of the manifestations of the phobias, and vice versa; in shift-like variations depression is an independent syndrome in the depressive-phobic complex. Depressions and phobias are closely connected in psychogenic phobias, they complicated and developed in parallel. In exogenic-organic phobias both affective disorders and phobias had a paroxysmal character and transformed into dysphorias.

Depressive Disorder↗
PubMed1998

Contradictions between perceptions and practices of caring in long-term care of elderly people.

Care for elderly people in nursing homes is a subject of increasing interest as populations around the world age. Numerous studies have been reported in relation to caring, how it is defined and what it means to nurses and clients in different contexts. Nursing is equated with caring and yet reports of nursing home care frequently cite such uncaring practices as neglect, fostered dependency, infantilization and depersonalization. The contradictions are explored with the aim of improving care of elderly people through greater understanding of how caring is perceived and practised.

Aged↗
PubMed1998

[The prevalence of the burnout syndrome or professional exhaustion in primary care physicians].

OBJECTIVE: To find the prevalence of burnout syndrome in general practitioners of the Public Sanitary Service in a health area in Zaragoza (Spain) and compare the results with the original American and two Spanish samples (general practitioners and specialists). DESIGN: A descriptive, crossover population study. SETTING: General practitioners of the Public Sanitary Service in a health area in Zaragoza (Spain). PARTICIPANTS: A sample of 286 general practitioners was selected through random conglomerate sampling in 37 health centres (14 rural and 23 urban). RESULTS: We used an anonymous self-administered enquiry method. It included Maslasch Burnout Inventory (MBI), which values the three syndrome dimensions: emotional exhaustion (EE), depersonalization (DP) and lack of personal accomplishment (PA), and two own questionnaires related to the job and personal beliefs. 144 people (63 female and 81 male) between 29 and 69 years old were studied. 59.7% showed high levels of burnout on EE subscale, 36.1% on DP subscale and 31.2% on PA one. Comparing with the original American sample, we obtained significantly differences on EE and DP subscales whereas comparing with the Spanish general practitioners one we obtained significantly differences on EE and PA. Comparing with the Spanish specialists one we obtained significantly differences on DP and LP. CONCLUSIONS: There's a serious prevalence of burnout syndrome in general practitioners, particularly on EE subscale. There should be quick interventions in health policy in order to control and prevent this issue.

Adult↗