RESUMO
La acatisia es uno de los eventos adversos inducidos por antipsicóticos más prevalentes y puede generar severa angustia en quien lo experimente. Se caracteriza por inquietud psicomotora objetiva y subjetiva. Pertenece al gran paraguas de los "síntomas extrapiramidales", sin embargo, tiene sus particularidades clínicas lo que representa un desafío clínico, tanto en su diagnóstico como en su manejo específico. La presente revisión sintetiza la información disponible a la fecha y ofrece al clínico recomendaciones para prevenir, reconocer y manejar esta complicación frecuente de una de las familias de psicofármacos de mayor prescripción clínica en la actualidad.
Abstract. Akathisia is one of the most prevalent antipsychotic-induced adverse events and causes severe distress in those who experience it. It is characterized by objective and subjective psychomotor restlessness. Usually classified under the great umbrella of extrapyramidal symptoms; however, it has its own clinical peculiarities, which might represent a challenge for the clinician in diagnosis as well as specific management. This review synthesizes the information available to date on antipsychotic-induced akathisia and offers the clinician recommendations to prevent, recognize and treat this prevalent complication of one of the most widely prescribed psychotropic medications today.
Assuntos
Humanos , Antipsicóticos/efeitos adversos , Acatisia Induzida por Medicamentos/terapia , Guia de Prática ClínicaRESUMO
Telemedicina, se refiere a las prestaciones de salud a distancia. Existen muchos modelos de telemedicina descritos e implementados en distintos lugares del mundo. La telepsiquiatría (y telemedicina) que se está implementando hoy en Chile y el mundo, ya sea desde un marco institucional o privado, es directa hacia el paciente, esto implica que no es una "inter -o tele -consulta" donde hay un profesional presencial que se hace responsable de la indicación, en este caso la atención completa y directa médico-paciente se lleva a cabo a distancia, quebrando, de alguna manera, la regla de oro de la atención clínica que es la consulta presencial entre el médico y el paciente. Se revisan algunas sugerencias descritas en la literatura y otras que ha dado la experiencia. La idea de este artículo es discutir los desafíos clínicos, éticos y legales, junto con los beneficios y oportunidades de la telepsiquiatría en el contexto actual.Palabras claves: Telemedicina, telepsiquiatría, teleconsulta, médico-paciente, covid-19.
Summary. Telemedicine refers to remote health care. There are many telemedicine models described and implemented in different parts of the world. The telepsychiatry (and telemedicine) that is being implemented today in Chile and the world, either from an institutional or private framework, is directed towards the patient, this implies that it is not an "tele-consultation" where there is a another face-to-face professional who is responsible for the prescription of treatment. In our case, the complete and direct doctor-patient care is carried out at a distance, breaking in some way the golden rule of clinical care that is face-to-face consultation between the doctor and the patient. Some suggestions described in the literature are reviewed and we make other suggestions based on our experience. The idea of this article is to discuss clinical, ethical and legal challenges, along with the benefits and opportunities of telepsychiatry in the current context.Key words: Telemecine, telepsychiatry, tele-consultation, physician-patient, covid-19.
Assuntos
Humanos , Criança , Adolescente , Psiquiatria/métodos , Telemedicina/métodos , COVID-19 , Relações Médico-Paciente , Pandemias , Distanciamento FísicoRESUMO
BACKGROUND: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. AIM: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. PATIENTS AND METHODS: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. RESULTS: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. CONCLUSIONS: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.
Assuntos
Bradicardia/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Adolescente , Análise de Variância , Índice de Massa Corporal , Bradicardia/fisiopatologia , Criança , Estudos de Coortes , Ecocardiografia , Eletrocardiografia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Desnutrição/complicações , Desnutrição/fisiopatologia , Fatores de Risco , Estatísticas não Paramétricas , Redução de Peso/fisiologia , Adulto JovemRESUMO
Background: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. Aim: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. Patients and Methods: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. Results: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. Conclusions: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.
Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Bradicardia/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Bradicardia/fisiopatologia , Ecocardiografia , Redução de Peso/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Índice de Massa Corporal , Fatores de Risco , Análise de Variância , Estudos de Coortes , Estatísticas não Paramétricas , Desnutrição/complicações , Desnutrição/fisiopatologia , EletrocardiografiaRESUMO
BACKGROUND: In recent years, there has been an increasing interest in the determinants of subjecti ve well-being and happiness. In that context, life satisfaction is one of the measures used to assess subjective well-being, with emphasis in adult population. OBJECTIVE: Adapt and validate (cultu rally and linguistically) the Canadian "Satisfaction with Life adapted for Children" (SWLS-C) in Chilean adolescents, in order to assess their global judgement about their own lives. PATIENTS AND METHODS: Cross-sectional study, with adolescents between 10 to 18 years old, of both sexes and three socioeconomic levels in the Metropolitan region of Chile. After a process of translation and back translation, the scale SWLS-C was applied in 3 groups: cognitive interviews (n = 23) to evaluate se mantics, content, reliability and construct validity, a second group was used as pretest (n = 24) and a third for the validation of the test (n = 200). Factor analysis was performed and measurement of convergent and divergent validity. RESULTS: The internal consistency of the scale through Cronbach's alpha was 0.815, with item-total correlations between 0.51 and 0.7. The correlation between scale items varies between 0.390 and 0.607. In the main component analysis, all items met the require ment of a factor greater than 0.3. The inverse correlation between SWLS-C and CDI was significant, with a linear R2 of 0.465. CONCLUSIONS: The Chilean version of the SWLS-C shows adequate psycho metric properties, construct validity, confirming its unidimensional character and the need to keep each item of the Canadian version. SWLS-C, in its Chilean version, is suitable to be self-applied in adolescent population. Further studies are needed to provide further evidence.
Assuntos
Saúde do Adolescente , Indicadores Básicos de Saúde , Satisfação Pessoal , Psicologia do Adolescente , Qualidade de Vida/psicologia , Adolescente , Criança , Chile , Estudos Transversais , Cultura , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , TraduçõesRESUMO
Resumen: Introducción: El estudio del bienestar ha aumentado en las últimas décadas por su importancia en la salud mental de las personas. En ese marco, la evaluación de la satisfacción con la vida (SV) se ha utilizado para conocer el bienestar subjetivo (BS), con énfasis en población adulta. Objetivo: Adaptar y validar lingüística y culturalmente a Chile la "Satisfaction with Life adapted for Children" (SWLS- C) de origen canadiense, para conocer el juicio global del adolescente respecto a su propia vida. Pacientes y Método: Estudio transversal, con adolescentes entre 10 y 18 años, de tres niveles socioe conómicos, en la Región Metropolitana de Chile. Tras un proceso de traducción y retrotraducción, se aplicó la escala en 3 grupos: entrevista cognitiva (n = 23) para evaluar la validez semántica, de contenido, de constructo y confiabilidad del mismo; otro grupo como pretest (n = 24) y el tercero para la validación del test (n = 200). Se realizó análisis factorial y medición de validez convergente y divergente. Resultados: Consistencia interna presentó un alpha de Cronbach de 0,815, con correla ciones ítem-total entre 0,51 y 0,7. La correlación entre ítems varió entre 0,390 y 0,607. En la matriz de componentes principales, todos los ítems cumplieron con un factor mayor a 0,3. Significativa correlación inversa entre SWLS-C y el Inventario de Depresión Infantil (CDI), con un R2 lineal de 0,465. Conclusiones: Escala muestra adecuadas propiedades psicométricas, la validez de constructo, el carácter unidimensional y la necesidad de mantener cada ítem de la versión canadiense. SWLS-C, en la versión chilena, resulta adecuado para ser autoaplicado.
Abstract: Background: In recent years, there has been an increasing interest in the determinants of subjecti ve well-being and happiness. In that context, life satisfaction is one of the measures used to assess subjective well-being, with emphasis in adult population. Objective: Adapt and validate (cultu rally and linguistically) the Canadian "Satisfaction with Life adapted for Children" (SWLS-C) in Chilean adolescents, in order to assess their global judgement about their own lives. Patients and Methods: Cross-sectional study, with adolescents between 10 to 18 years old, of both sexes and three socioeconomic levels in the Metropolitan region of Chile. After a process of translation and back translation, the scale SWLS-C was applied in 3 groups: cognitive interviews (n = 23) to evaluate se mantics, content, reliability and construct validity, a second group was used as pretest (n = 24) and a third for the validation of the test (n = 200). Factor analysis was performed and measurement of convergent and divergent validity. Results: The internal consistency of the scale through Cronbach's alpha was 0.815, with item-total correlations between 0.51 and 0.7. The correlation between scale items varies between 0.390 and 0.607. In the main component analysis, all items met the require ment of a factor greater than 0.3. The inverse correlation between SWLS-C and CDI was significant, with a linear R2 of 0.465. Conclusions: The Chilean version of the SWLS-C shows adequate psycho metric properties, construct validity, confirming its unidimensional character and the need to keep each item of the Canadian version. SWLS-C, in its Chilean version, is suitable to be self-applied in adolescent population. Further studies are needed to provide further evidence.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Satisfação Pessoal , Qualidade de Vida/psicologia , Indicadores Básicos de Saúde , Psicologia do Adolescente , Saúde do Adolescente , Psicometria , Traduções , Chile , Estudos Transversais , Reprodutibilidade dos Testes , Análise Fatorial , CulturaRESUMO
El uso de psicofármacos en el ejercicio de la psiquiatría infantil es cada vez mayor en los últimos años. Su correcto uso requiere que el psiquiatra desarrolle a partir del diagnóstico, un tratamiento que incluya una monitorización adecuada en el caso de uso de psicofármacos, ya que esto nos permitirá tener los mejores resultados con menores efectos adversos, como también la mejor adhesión al tratamiento que se haya propuesto (1). En esta revisión encontraremos varios fármacos de uso común en el ejercicio de la profesión, asociado a efectos adversos endocrinológicos que se han descrito en la literatura, seguido de recomendaciones de manejo y seguimiento. Palabras Clave: Psicofármacos, endocrinología, efectos adversos, psiquiatría.
The use of psychotropic drugs in child psychiatry has increased in recent years. Its correct use requires that the psychiatrist develops from starting point of a diagnosis, a treatment that includes an appropriate monitoring of the use of psychotropic drug, since this will allow the patient to have the best results with fewest adverse effects, as well as the better adherence to the treatment (1). In this review we will discuss several drugs commonly used in the practice of the profession, associated with adverse endocrine effects that have been described in the literature, followed by recommendations for management and monitoring. Key Words: Psychotropics, drugs, psychiatry, endocrinology, advers effects.
RESUMO
OBJECTIVE: Emerging evidence suggests that autism spectrum disorder (ASD) can be diagnosed by age 18 months and that early intensive behavioral intervention positively affects ASD core deficits. This pilot randomized controlled trial examined the feasibility of using an adapted form of patient navigation, Family Navigation (FN), to improve timely diagnosis of ASD in low-income families from racial-ethnic minority groups. METHODS: Forty children referred for an ASD diagnostic assessment were randomly allocated to receive FN or usual care. The primary outcome, time to diagnostic resolution, was assessed with survival analysis. RESULTS: Nineteen of 20 FN children completed the diagnostic assessment, compared with 11 of 19 children receiving usual care (hazard ratio=3.21, 95% confidence interval=1.47-6.98, p<.01). In regard to engagement of participants, 17 of 20 families (85%) met with the navigator for the targeted three in-person visits (median=4, range 1-9). CONCLUSIONS: FN may be a promising intervention to address barriers that impede timely ASD diagnosis.
Assuntos
Transtorno do Espectro Autista/diagnóstico , Disparidades em Assistência à Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Navegação de Pacientes/métodos , Pré-Escolar , Feminino , Humanos , Masculino , Grupos Minoritários , Projetos Piloto , PobrezaRESUMO
Se explica los pasos seguidos para realizar una intervención en Salud Mental en la población de la zona costera de la I. Municipalidad de Licantén de la VII región de Chile posterior al terremoto/maremoto del 27 de Febrero del 2010 en la zona centro sur de Chile, por parte de la Unidad de Psiquiatría Infantil del Departamento de Pediatría de Clínica Alemana. Se destaca la importancia de la evaluación de la situación local, del trabajo en equipo, de la coordinación entre diversas entidades y la necesidad de generar (en los agentes de salud local y en la población) credibilidad, confianza y percepción de pertinencia de las acciones del equipo externo. Se muestra una intervención planificada con recursos mixtos privados, públicos y trabajo voluntario de profesionales. Se valoran también la capacidad de flexibilidad en la programación inicial, la constancia en las acciones y el plantear desde el inicio estrategias a corto, mediano y largo plazo.
Assuntos
Humanos , Criança , Desastres , Saúde Mental , Psiquiatria Infantil/organização & administração , Unidade Hospitalar de Psiquiatria/organização & administração , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Chile , Terremotos , TsunamisRESUMO
El Bullying (matonaje escolar) ha cobrado importancia creciente en Chile y el mundo, sin embargo existen pocos estudios que caractericen este fenómeno a nivel nacional. Objetivos: Describir la prevalencia y características del matonaje escolar en un grupo de adolescentes, de sus padres y profesores de 9 colegios de la comuna de recoleta. Método: Se aplicó el Cuestionario sobre preconcepciones de Intimidación y maltrato entre iguales (Preconcimei) versión para alumnos, para padres y profesores. La muestra estuvo compuesta por 835 alumnos de 7mo y 8vo básico, 177 padres y 32 profesores. El promedio de edad de los encuestados fue de 13 años y la distribución por sexo fue 53.5 por ciento hombres y 46.5 por ciento mujeres. Resultados: Del total de alumnos, un 16.5 por ciento resultó ser agresor, un 20.5 por ciento víctima y un 22 por ciento observador. Las formas más frecuentes de Bullying, fueron violencia sicológica (33,5 por ciento y maltrato físico (28,4 por ciento), mientras que los lugares más frecuentes en que estas situaciones se producen fueron la sala de clases (sin profesor: 46.9 por ciento y con profesor: 26.7 por ciento), el patio y los pasillos del colegio (33,3 por ciento y 28,3 por ciento respectivamente). La frecuencia de intimidaciones percibida fue en la mayoría a diario (27 por ciento). Con respecto a los padres el 58.9 por ciento piensa que en el colegio de su hijo existe matonaje escolar, el 55.9 por ciento refiere que su hijo nunca participaría en actos de matonaje escolar; el 85.4 por ciento de los padres piensa que si su hijo/a tuviera algún problema de matonaje escolar les contaría, el 78 por ciento de los padres están dispuestos a participar en alguna intervención con respecto a matonaje escolar. En relación a los profesores el 81.3 por ciento piensa que las agresiones y situaciones violentas NO son un grave problema en su colegio, el 34.4 por ciento de los profesores en ocasiones ha sido objeto de ataque del alumnado...
Bullying has become very important in the last years, however, only a few studies have characterized this phenomenon in our country. Objective: To describe the prevalence and characteristics of school bullying in a group of teenagers, and the perception of their parents and teachers about the same issue. Methods: We applied the version of the Questionnaire of preconceptions of Intimidation and Bullying (Preconcimei) for students, parents and teachers. The sample consisted on 835 eighth and seventh grade students from schools of the district of Recoleta, 177 parents and 32 teachers. The average age of the students was 13 years old and the gender distribution was 53.5 percent men and 46.5 percent women. Results: From the total of students, 16.5 percent was qualified as aggressor, 20.5 percent as victim and 22 percent as observer. The most frequent forms of bullying were: psychological violence (33.5 percent) and physical abuse (28.4 percent), while the most common sites in which these situations take place, were the classroom (without a teacher: 46.9 percent and with teacher present: 26.7 percent), the playground and the surroundings of the school (33.3 percent and 28.3 percent respectively). The frequency of bullying was perceived in most of the students daily (27 percent). With regard to parents, 58.9 percent think that bullying does exist in their childs school and 55.9 percent reported that their child would never participate in acts of school bullying. Eighty five percent of parents think that, if their child is taking part of school bullying, they would tell them and 78 percent of parents are interested in participating on interventions aimed to eradicate bullying. From the point of view of the teachers, 81.3 percent think that aggression is not a serious problem in school and 34.4 percent of the teachers had been victim of bullying from their students...
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Bullying/psicologia , Estudantes , Agressão/psicologia , Chile , Docentes , Maus-Tratos Infantis/estatística & dados numéricos , Maus-Tratos Infantis/psicologia , Grupo Associado , Prevalência , Pais/psicologia , Inquéritos e Questionários , Violência/estatística & dados numéricos , Violência/psicologiaRESUMO
Revisión bibliográfica extensa de literatura nacional e internacional acerca del fenómeno del bullying. Se analiza la definición y descripción del problema desde una mirada amplia y sistémica, considerando el contexto en el que ocurre: la violencia social. Se revisa la prevalencia de la violencia entre pares a nivel internacional y un acercamiento a las cifras disponibles en escolares chilenos, junto con una actualización de la información acerca de los distintos actores involucrados en la dinámica bullying: agresores, víctimas, víctimas/agresores y testigos, describiendo sus características psicológicas, familiares, psicopatología y consecuencias tanto para los niños y adolescentes como para la sociedad en general. Se revisan las estrategias de prevención e intervención sobre el bullying y la violencia en general desde una mirada sistémica y científica crítica. Se sintetizan los aspectos generales y específicos de prevención (primaria, secundaria y terciaria), de acuerdo a la etapa del ciclo vital y se analiza el rol que cumple el clínico, la familia y la escuela en detectar y prevenir la violencia entre pares. Nos focalizamos en las estrategias de intervención escolar y se realiza una exhaustiva revisión de los programas escolares de prevención secundaria que han sido implementados en otros países, y que tienen efectividad comprobada científicamente.
The following paper is an extensive bibliographic review of the bullying phenomenon in international and national literature. We analyze the definition and description of bullying within its broader context: social violence. The national and international reports of the prevalence of violence within peers are presented, along with an update of the information available on the actors involved in the dynamics of bullying: aggressors (bullies), victims, bully-victims and witnesses, describing their psychological features, family characteristics, psychopathology and the consequences for the children, adolescents, and society in general. We critically reviewed the existing information on prevention and intervention strategies for bullying with a systemic and scientific outlook. Some aspects of prevention are synthesized (general and specific primary, secondary and tertiary prevention), according to the developmental stage of those involved. We analyze the role that clinicians, family and school play in preventing and detecting violence against peers. We focused on school-level interventions and a thorough description is made of the school programs for secondary prevention that have been implemented in developed countries and their effectiveness verified by scientific studies. Finally, we discuss that bullying has become a serious mental health problem for our children and adolescents as a new form of social violence. It has severe consequences for the development of our youngsters and must be recognized and evaluated in its real dimension by the multiple social actors involved. It is very important to evaluate this problem in the broader context in which it presents It self and to focus on prevention and intervention strategies according to the developmental stages of childhood and adolescence, the families involved and the scientific evidence available.