We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, neurobiological in origin, that begins in infancy but can continue into adolescence and adulthood.
Patients with this disorder may have difficulty paying attention, can be hyperactive and restless and/or may act impulsively.
The symptoms of ADHD manifest themselves in different activities and areas, such as school, work or any other social environment.
1) Inattention: difficulty paying attention, misunderstandings, lack of organisation and planning, losing or forgetting things, easily distracted.
2) Hyperactivity: excess movement, difficulty relaxing or sitting down, feeling of being driven by an internal engine, very chatty.
3) Impulsiveness: quick responses, difficulty waiting, constant interruptions. People with ADHD also present emotional instability, low self-esteem, academic failure, employment and family instability.
In general terms, the prevalence of ADHD is around 3-7%. 50% of children will continue having clinical symptoms throughout adolescence and into adulthood.
ADHD is more frequent in males than females among the general population, with a ratio of 2:1 in children and 1.6:1 in adults. Females have a greater tendency to mainly show inattention.
Diagnosis is CLINICAL. An appropriate clinical history needs to be conducted with the patient and/or relatives by a specialised healthcare professional. There are different scales to assess the severity of symptoms or associated comorbid disorders, and neuropsychological tests that evaluate attention difficulties and executive dysfunction.
ADHD needs to be tackled in various ways: Psychological education, psychological treatment and pharmacological treatment. In children, treatment includes educating parents and school intervention. There are several stimulant and non-stimulant drugs that have been proven to be effective and safe to control symptoms.
Clinical history. Psychological interview. Neuropsychological examination. Blood test, vital signs, weight and height.
Electroconvulsive therapy (ECT) consists of producing mild convulsive activity by administering a brief and controlled electric stimulus with variable frequency through electrodes that are placed on the surface of the brain. This convulsive activity produces biochemical changes in the brain that help to improve symptoms or cause them to go into remission.
ECT is a safe and effective medical treatment that is indicated above all in depressive disorders: Severe depression with psychotic symptoms or at high risk of suicide and serious physical deterioration. It is also indicated in certain psychotic disorders, acute mania and severe treatment-resistant mental health issues. ECT is also indicated in non-psychiatric pathologies within neurology, such as; refractory epilepsy, Parkinson's disease, neuroleptic malignant syndrome and late-onset dyskinesia.
Its application has evolved significantly. It is a pain-free technique that is performed under brief anaesthesia with muscle relaxation and artificial ventilation. Electric stimulation is induced with computer-assisted equipment that monitors the effect of a mild convulsion induced using brief-pulse waves on the brain’s electrical activity. This allows the minimum intensity of electrical stimulation to be administered, decreasing cognitive side effects and drastically reducing the complications associated with treatment. Nowadays, the technique is considered to have no contraindications whatsoever.
Some patients with psychiatric disorders that do not respond to conventional treatment have not, however, been treated with ECT despite its high level of safety and therapeutic predictability. This therapeutic inhibition could be due to the stigma based on outdated beliefs about the treatment.
The Psychiatry Department offers high quality clinical care to patients with mental health problems and addictions. We are also responsible for a significant amount of teaching linked to the Autonomous University of Barcelona, in addition to highly competitive research programmes at the Vall d'Hebron Research Institute.
At the Psychiatry Department, our mission is to serve as the reference health care resource in the Barcelona Nord healthcare district for people with mental health problems and addictions. We offer a comprehensive service that is both effective and efficient, based on the professional quality of our staff, our modern facilities and coordination with all the mental health resources in the sector.
The Neurology Teaching Unit at Vall d’Hebron University Hospital is provided by the Neurology Department with participation from Internal Medicine, Cardiology, Psychiatry, Neurosurgery, Neurophysiology, Neuroradiology, Paediatrics, and A&E.
Neurology training itinerary
Healthcare activity in neurology combines writing medical histories, diagnostic data collection, correct use of complementary exploratory procedures, and accurate clinical and aetiologic diagnosis, as well as choosing appropriate palliative treatments. We also emphasise the role of the relationship between resident doctors and patients in the basic areas of Neurology.
A large number of medical conditions and neurological illnesses can result in critical emergency situations, such as strokes and lupus. With this in mind, from the second year the duty shifts in neurological emergencies become a key aspect of residents’ work, and are always carried out under supervision. Neurologists are also required to carry out a rotation in neurological outpatient care.
Research studies are part of the practical work that neurologists must deepen and develop, with particular emphasis on ethical competence when carrying out research.
Neuroscience research should be done under supervision of a tutor , and requires solid training in scientific methodology as well as in bioethics and scientific communication.
Training itinerary in Psychiatry and Clinical Psychology
It is a chronic brain disorder that can affect people of any age. It is characterised by recurring convulsions caused by excessive electrical impulses in groups of brain cells. The consequences can be neurological, cognitive, psychological and social.
In 2005, epilepsy was defined as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures”. Epilepsy is therefore diagnosed when patients experience two or more seizures, separated by a period of time that can last from 24 hours to 10 years.
Epilepsy causes brief absence seizures, involuntary movements, repetitive reflexes such as sucking movements, loss of consciousness, and so on. It can originate in one area of the brain (focal seizure) or the brain as a whole (generalized seizure). Seizures are sometimes accompanied by loss of consciousness and/or loss of bowel control. Their frequency can vary from only just one over a ten year period to several per day.
Seizures (absence seizures, muscle contractions, etc.) are the main symptom and may vary depending where in the brain the epileptic seizure begins.
For example, in tonic-clonic seizures (GTCS), it is common to observe twitching, muscle contractions, jerking, etc. These movements are called “myoclonus” and may be symmetric or asymmetric and are accompanied by rolling of the eyes. They are followed by a spasm with clenching of the teeth, laboured breathing and an epileptic shout.
Epilepsy affects the entire population, regardless of age, from whilst still in the womb right up to people in their nineties. It is estimated that 8 in 1000 people have the condition.
Related factors:
In some cases the cause of epilepsy may be unknown, as although we can see an epileptic seizure occurring in the brain, current technologies do not reveal what causes them. Epilepsy may also be genetic.
It is the second most common neurological disorder (after stroke) seen in accident and emergency departments. An estimated 3,000 patients are seen in our centre every year. 3% of the population will attend a medical centre at some point during their lifetime to determine whether their symptoms are caused by epilepsy.
Diagnosis requires:
It is advisable to avoid all situations that may create:
When faced with a seizure, a series of recommendations should be followed to avoid injury to the person having the seizure.
Asperger’s syndrome is a neurodevelopmental disorder that falls within the spectrum of autism disorders. It is typified by social awkwardness, limiting interests and ongoing behaviours.
These symptoms make it difficult for patients to have a normal social life and they also affect family life. People with this disorder may appear normal and have a normal level of intelligence but find it hard to relate to others and communicate.
Children and teenagers with this disorder show the following symptoms:
It is a very common disorder (3-7 of every 1000 births). There are currently more recorded cases in boys than in girls, but this data is likely due to it not being recognised and diagnosed in girls as often.
Structured reliable clinical interviews help to define clinical symptoms at different ages. It is not currently possible to diagnose Asperger’s at birth as the necessary biological markers do not exist yet.
A differential diagnosis is very important to rule out other neurodevelopmental disorders such as foetal alcohol syndrome, and those with a genetic cause such as ADHD.
A mental health professional will prepare treatment, which should focus on teaching the patient social skills and competencies (for example, reading social situations, adjusting the tone of voice according to context, taking turns in conversation, etc.) They can also help patients organise their time and avoid periods of inactivity or excessive time spent on their limiting interests. A stable and planned environment with no abrupt change is essential for the patient's well-being.
It is not currently possible to prevent Asperger’s syndrome as it is probably of genetic origin, which implies multiple genes interacting with the environment.
Psychiatrics, General Hospital
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