Electrophysiological biomarkers in dual pathology.

INTRODUCTION: The co-occurrence of substance use disorder with at least one other mental disorder is called dual pathology, which in turn is characterised by heterogeneous symptoms that are difficult to diagnose and have a poor response to treatment. For this reason, the identification and validation of biomarkers is necessary. Within this group, possible electroencephalographic biomarkers have been reported to be useful in diagnosis, treatment and follow-up, both in neuropsychiatric conditions and in substance use disorders. This article aims to review the existing literature on electroencephalographic biomarkers in dual pathology. METHODS: A narrative review of the literature. A bibliographic search was performed on the PubMed, Science Direct, OVID, BIREME and Scielo databases, with the keywords: electrophysiological biomarker and substance use disorder, electrophysiological biomarker and mental disorders, biomarker and dual pathology, biomarker and substance use disorder, electroencephalography, and substance use disorder or comorbid mental disorder. RESULTS: Given the greater amount of literature found in relation to electroencephalography as a biomarker of mental illness and substance use disorders, and the few articles found on dual pathology, the evidence is organised as a biomarker in psychiatry for the diagnosis and prediction of risk and as a biomarker for dual pathology. CONCLUSIONS: Although the evidence is not conclusive, it suggests the existence of a subset of sites and mechanisms where the effects of psychoactive substances and the neurobiology of some mental disorders could overlap or interact.

Prevalence of Mild Cognitive Impairment in Southern Regions of Colombia.

Background: Recent reports suggest that by 2050 there will be an increase of around 310% of cases affected by dementia in Latin American countries. A previous study in a Southern region reported one of the highest prevalences of dementia in Latin America. Objective: To investigate the prevalence of mild cognitive impairment associated with low education, rurality, and demographic characteristics. Methods: A cross-sectional study recruited a community-dwelling sample of 823 adults from rural and urban areas of two Southern provinces of Colombia from 2020-2022. Participants were assessed with a neuropsychological protocol validated in Colombia. To obtain general and region-specific prevalence rates, age, sex, schooling, and socioeconomic level were considered and controlled for. Results: Most of the participants reported low education and socioeconomic level, the participation of women was higher. It was determined that the prevalence of mild cognitive impairment (MCI) was 53.6%, with 56.6% in the province of Caquetá followed by 51.9% in the province of Huila. The amnestic MCI represented 42.6%, the amnestic multi-domain was 39%, the non-amnestic 16.55%, and the non-amnestic multi-domain 1.81%. Our participants reported comorbidities such as diabetes and hypertension. We also observed a relationship between exposure to pesticides and MCI. Conclusions: We observed one of the highest prevalences of MCI in Latin America reported to date. Variables such as age, gender, and education proved risk factors for MCI in the explored regions. Our findings are very much in line with recent studies that highlight the influence of non-canonical risk factors of dementia in underrepresented countries from Latin America.

Potencial de disparidad o Mismatch negativity y P3a en pacientes con esquizofrenia / Mismatch negativity and P3a in patients with Schizophrenia

Resumen Antecedentes: la esquizofrenia es una enfermedad crónica que genera gran discapacidad, para la cual se han reportado biomarcadores potenciales, pero sin suficiente validez clínica. El mismatch negativity (MMN) y el P3a son potenciales relacionados con eventos que han demostrado ser indicadores neurofisiológicos del procesamiento auditivo pre-atencional y potenciales biomarcadores. Objetivo: evaluar el MMN y P3a en pacientes con diagnóstico de esquizofrenia y su relación con variables sociodemográficas y clínicas. Método: estudio cuantitativo transversal de 23 sujetos con esquizofrenia (ESQ) y 22 controles sanos (SN). Las amplitudes promedio y latencias del MMN/P3a para la condición infrecuente en duración y frecuencia fueron obtenidas mediante un paradigma oddball auditivo en un EEG de 32 canales. Resultados: se encontraron diferencias para la condición frecuencia en la amplitud del MMN (p=0.046; CI 95% 0.009; 0.87) y la amplitud del P3a (p=0.042; CI 95% 0.025; 1.24) entre los grupos; la amplitud del MMN fue menor en el grupo ESQ (-0.36 DE 0.51 µV) en comparación con los participantes del grupo de SN (-0.81 DE 0.89 µV), mientras que la amplitud del P3a fue menor en el grupo SN (0.18 DE 0.97 µV) versus el grupo ESQ (0.82 DE 1.05 µV). En relación con las variables sociodemográficas y clínicas, las asociaciones con el P3a fueron moderadas y con el MMN débiles. Conclusiones: la reducción de la amplitud del MMN a la condición frecuencia exhibe mayor utilidad que el P3a como medida de alta estabilidad en pacientes con esquizofrenia, lo que reitera su posible uso como biomarcador.

Abstract Background: schizophrenia is a chronic disease that generates great disability, which currently has potential biomarkers but without sufficient clinical validity. Mismatch negativity (MMN) and P3a are event-related potentials that have been shown to be neurophysiological indicators of pre-attentional auditory processing and potential biomarkers. Objective: to evaluate MMN and P3a in patients with a diagnosis of schizophrenia and their relationship with sociodemographic and clinical variables. Method: a quantitative cross-sectional study of 23 subjects with schizophrenia and 22 healthy controls was performed. The average amplitudes and latencies of the MMN/P3a for the condition infrequent in duration and infrequent in frequency were obtained using an auditory oddball paradigm on a 32-channel EEG. Results: differences were found for the frequency condition in the amplitude of the MMN (p=0.046; 95% CI 0.009; 0.87) and the amplitude of the P3a (p=0.042; 95% CI 0.025; 1.24) between the groups; MMN amplitude was lower in schizophrenia (-0.36 SD 0.51 µV) compared to healthy controls (-0.81 SD 0.89 µV), while P3a amplitude was lower in healthy controls (0.18 SD 0.97 µV) versus the group with schizophrenia (0.82 SD 1.05 µV). In regard to sociodemographic and clinical variables, the associations with P3a were moderate, and showed weak MMN. Conclusions: MMN amplitude reduction to the frequency condition exhibits greater utility than P3a as a measure of high stability in schizophrenia, restating its potential use as a biomarker.

Carta al editor / Letter to the Editor / Carta ao editor

El siglo XXI demanda importantes cambios en la formación del talento humano y generaciones preparadas para asumir los retos de la sociedad actual, resultado de la revolución del conocimiento, el desarrollo de las tecnologías de la información TIC, las telecomunicaciones y la globalización. Colombia, un país con grandes problemas sociales, acentuados por la desigualdad, el desempleo y la violencia, requiere que las Instituciones de Educación Superior propicien los más altos estándares de calidad en los procesos de formación de sus egresados, de forma que logren ser capaces de dar respuestas más eficaces e innovadoras a estas complejas problemáticas. Es pues fundamental para las Universidades, proporcionar la formación integral del estudiante en las dimensiones del ser, saber, hacer y convivir, desde las perspectivas científicas, técnica y ética, pero también una gran compresión de la realidad a la cual se enfrentarán como profesionales. No basta con la sólida formación en el campo disciplinar, requerirá una mirada amplia, integral, colaborativa con los otros saberes, que le permitan comprender, dialogar y actuar creativamente en el entramado y cambiante mundo.

The 21st century demands important changes in the training of human talent and generations prepared to take on the challenges of today's society, as a result of the knowledge revolution, the development of information technologies, ICTs, telecommunications and globalization. Colombia, a country with great social problems, accentuated by inequality, unemployment and violence, requires Higher Education Institutions to promote the highest quality standards in the training processes of their graduates, so that they are able to provide more effective and innovative responses to these complex problems. It is therefore fundamental for the Universities to provide the integral formation of the student in the dimensions of being, knowing, doing and living together, from the scientific, technical and ethical perspectives, but also a great understanding of the reality they will face as professionals. A solid training in the disciplinary field is not enough; it will require a broad, comprehensive and collaborative view with other knowledge, which will allow them to understand, dialogue and act creatively in the complex and changing world.

O século XXI exige mudanças importantes na formação de talentos humanos e de gerações preparadas para enfrentar os desafios da sociedade atual, como resultado da revolução do conhecimento, do desenvolvimento das tecnologias da informação, das TIC, das telecomunicações e da globalização. A Colômbia, um país com grandes problemas sociais, acentuados pela desigualdade, desemprego e violência, exige que as Instituições de Ensino Superior promovam os mais elevados padrões de qualidade nos processos de formação dos seus licenciados, para que estes possam dar respostas mais eficazes e inovadoras a estes problemas complexos. É, por isso, fundamental que as universidades proporcionem aos estudantes uma formação abrangente nas dimensões do ser, do saber, do fazer e do conviver, numa perspetiva científica, técnica e ética, mas também com uma compreensão profunda da realidade com que se irão confrontar enquanto profissionais. Não basta uma formação sólida no domínio disciplinar; será necessária uma visão ampla, abrangente e colaborativa com outros saberes, que lhes permita compreender, dialogar e agir criativamente no mundo complexo e em mudança.

Inclusión cultural de las personas con discapacidad: un derecho y un factor determinante en su realización humana / Cultural inclusion of persons with disabilities: a right and a determining factor in their human fulfillment / Inclusão cultural das pessoas com deficiência: um direito e um fator determinante da sua realização humana

La exclusión de las personas con discapacidad ha sido una constante en la historia de la humanidad; sin embargo, su destino ha cambiado en las diferentes sociedades, desde la aniquilación, la explotación y la marginalidad hasta el reconocimiento de sus derechos, gracias a los avances del conocimiento sobre sus causas, el desarrollo de apoyos médicos, tecnológicos, educativos y sociales, así como la comprensión sobre la vulnerabilidad que todos tenemos de padecerla, sumado al despliegue de los derechos humanos y los movimientos reivindicativos de este grupo poblacional, que ha llevado a la expedición de políticas y normas internacionales y nacionales orientadas a su plena inclusión. Dicha inclusión consiste en lograr la posibilidad real y efectiva de acceder y participar en la sociedad, junto con los demás ciudadanos, sin ninguna limitación o restricción por motivo de la discapacidad, entre estas, la inclusión cultural, por la cual se asumen los valores humanos, el conocimiento y las habilidades para desenvolverse en el contexto a través de la influencia educativa que acontece en la interacción social, es determinante en la adquisición de las potencialidades humanas de todos los individuos y en particular en las personas con discapacidad. El presente artículo realiza una reflexión sobre la importancia de la inclusión cultural de las personas con discapacidad, no solo como derecho, sino como un factor determinante en su realización humana.

The exclusion of people with disabilities has been a constant in the history of mankind; However, their fate has changed in different societies, from annihilation, exploitation and marginalization to the recognition of their rights, thanks to advances in knowledge about their causes, the development of medical, technological, educational and social support, as well as the understanding of the vulnerability that we all have to suffer from it, added to the deployment of human rights and the vindicatory movements of this population group, which has led to the issuance of international and national policies and standards aimed at their full inclusion. This inclusion consists of achieving the real and effective possibility of accessing and participating in society, together with other citizens, without any limitation or restriction due to disability. Among these, cultural inclusion, through which human values, knowledge and skills are assumed to develop in the context through the educational influence that occurs in social interaction, is a determining factor in the acquisition of human potentialities of all individuals and particularly in people with disabilities. This article reflects on the importance of cultural inclusion of people with disabilities, not only as a right, but also as a determining factor in their human fulfillment.

A exclusão das pessoas com deficiência tem sido uma constante na história da humanidade; No entanto, o seu destino mudou em diferentes sociedades, desde a aniquilação, exploração e marginalização até ao reconhecimento dos seus direitos, graças aos avanços no conhecimento das suas causas, ao desenvolvimento de apoios médicos, tecnológicos, educativos e sociais, bem como à compreensão da vulnerabilidade que todos temos de sofrer com isso, somado à implantação dos direitos humanos e aos movimentos de reivindicação deste grupo populacional, o que tem levado à emissão de políticas e regulamentos internacionais e nacionais que visam a sua plena inclusão. Esta inclusão consiste em alcançar a possibilidade real e efectiva de aceder e participar na sociedade, juntamente com os demais cidadãos, sem qualquer limitação ou restrição devida à deficiência, entre as quais se destaca a inclusão cultural, através da qual se assumem os valores, conhecimentos e competências humanas para se desenvolverem no contexto através da influência educativa que ocorre na interação social, sendo um fator determinante na aquisição do potencial humano de todos os indivíduos e em particular nas pessoas com deficiência. Este artigo reflecte sobre a importância da inclusão cultural para as pessoas com deficiência, não só como um direito, mas também como um fator determinante na sua realização humana.

Depresión y trastornos del sueño relacionados con hipertensión arterial: un estudio transversal en Medellín, Colombia / Depression and sleep disorders related to hypertension: A cross-sectional study in Medellín, Colombia

RESUMEN Introducción: Los factores psicosociales se han mostrado como potenciadores y desencadenantes de enfermedades cardiovasculares como la hipertensión arterial. El propósito del estudio es explorar la relación de los factores psicosociales con la presencia de hipertensión arterial en una muestra aleatoria poblacional en la ciudad de Medellín. Métodos: Estudio de tipo observacional de corte transversal con enfoque analítico. La variable respuesta (hipertensión arterial) se contrastó con las psicosociales y sociodemográficas mediante análisis bivariable, y posteriormente se realizó un análisis de regresión logística multivariable. Resultados: Tras ajustar por edad, sexo y eventos de vida estresantes, los factores psicosociales asociados con hipertensión arterial son la depresión (OR = 1,65; IC95%, 1,13-2,41) y los trastornos del sueño (OR = 1,41; IC95%, 1,00-1,98). Conclusiones: La depresión y los trastornos del sueño se relacionan con la hipertensión arterial. En Colombia hay estudios que relacionan factores psicosociales como la depresión con la hipertensión, pero se desconoce el impacto de los trastornos de sueño en la población.

ABSTRACT Introduction: Psychosocial factors have been shown to be potentiators and triggers of cardiovascular diseases such as hypertension. The purpose of the study is to explore the relationship between psychosocial factors and the presence of hypertension in a random population sample in the city of Medellin. Methods: Observational cross-sectional study with an analytical approach. The endpoint (hypertension) was contrasted with the psychosocial and sociodemographic endpoints by means of a bivariate analysis, and later a multivariate logistic regression analysis was carried out. Results: After adjusting for age, gender and stressful life events, depression (OR= 1.65; 95% CI: 1.13-2.41) and sleep disorders (OR= 1.41; 95% CI: 1.00-1.98) were found to be psychosocial factors associated with hypertension. Conclusions: Depression and sleep disorders are related to hypertension. In Colombia there are studies that correlate psychosocial factors such as depression with hypertension; however, the impact of sleep disorders on the population is unknown.

Salud mental en Colombia. Un análisis crítico / Mental health in Colombia. A critical analysis

Resumen Introducción: La Organización Mundial de la Salud declaró la importancia de la salud mental y estableció la necesidad de promover el bienestar, la prevención, el tratamiento y la rehabilitación de las personas con trastornos mentales. Colombia adoptó estos lineamientos, pero la crisis de la salud de los últimos años afectó la atención de los pacientes con enfermedad mental. Este estudio indaga aspectos históricos frente a la salud mental en Colombia, las principales limitaciones al actual sistema y las estrategias que podrían implementarse. Método: Búsqueda en bases de datos bibliográficos de artículos enfocados en la normatividad e implementación de políticas públicas de salud mental en Colombia. Resultados: Se han hecho importantes esfuerzos por promulgar leyes y políticas que acaben las brechas para el diagnóstico y el tratamiento y transformar la realidad de los colombianos que sufren trastornos mentales. Conclusión: La salud mental continúa siendo la cenicienta en las políticas públicas. Es evidente la falta de coherencia entre lo que se propone y lo que ocurre por la inadecuada implementación e interpretación de las normas. La normatividad en salud mental no ha logrado cumplir sus objetivos, lo cual hace que la atención en salud mental en Colombia aun sea muy deficiente.

Abstract Introduction: The World Health Organization declared the importance of mental health and established the need to promote the welfare, prevention, treatment and rehabilitation of people with mental disorders. Although these guidelines were adopted in Colombia, the health crisis of recent years affected the care of patients with mental illness. This study seeks to investigate historical aspects of mental health in Colombia, the main limitations to the current system and the strategies that could be implemented. Method: Search in bibliographic databases of articles focused on the regulation and implementation of public mental health policies in Colombia. Results: In Colombia, significant efforts have been made to enact mental health laws and policies that overcome the gaps in diagnosis and treatment and transform the reality of Colombians suffering from mental disorders. Conclusion: Despite the attempts, mental health continues to be ashen in public policies. It is evident the lack of coherence between what is proposed and what happens due to the inadequate implementation and interpretation of the norms. Mental health regulations have not met their objectives, which means that mental health care in Colombia is still very poor.

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital / Factores sociodemográficos y clínicos asociados a patología dual en un hospital psiquiátrico

Abstract: Introduction: Among patients with mental illness, dual disorders patients are characterized by a heterogeneous and more severe clinical presentation that is difficult to treat. Therefore, knowledge about the distribution of this disorder and the characteristics of these patients can be helpful to optimize and organize health resources. Objective: To explore the prevalence and socio-demographic and clinical factors associated with dual disorders patients who were hospitalized due to mental illness at a psychiatric unit in Colombia between January and June 2013; this data was collected and analyzed on the basis of the medical records of each patient. Method: Observational, quantitative, cross-sectional study of a secondary source. It included the analysis of 201 patients aged 18 to 65. Results: There were 201 patients analyzed; 45.3% had dual disorders, with a ratio of 2.24 men:women; there was a high frequency of single marital status (69.2%) and more than 90% had a low socioeconomic level. The factors significantly associated with dual disorders in order of importance were: age from 18 to 35 years (OR = 11.03; CI 95% [4.43, 27.46]), male (OR = 5.10, CI 95% [2.26, 11.50]), history of aggression (OR = 3.35; CI 95% [1.63, 6.91]), and readmission in the year after hospital discharge (OR = 2.23; CI 95% [1.08, 4.61]). Discussion and conclusion: Dual disorders prevalence in this study is similar to that found by other authors. The high prevalence of dual disorders requires specialized therapeutic programs for treatment. The more hospitals know about the associated variables in this study, the more they will be able to improve their approach to patients.

Resumen: Introducción: Dentro de los pacientes con trastornos mentales, el grupo con patología dual se caracteriza por una presentación clínica heterogénea, más grave y difícil de tratar, por lo que conocer la distribución de este trastorno y las características de estos sujetos puede ayudar a optimizar y organizar los recursos sanitarios. Objetivo: Explorar la prevalencia y los factores sociodemográficos y clínicos asociados a la patología dual en pacientes hospitalizados por trastorno mental en una unidad de psiquiatría general de Colombia entre enero a junio del 2013, analizando los datos recolectados a partir de las historias clínicas. Método: Estudio cuantitativo y observacional de corte transversal de fuente secundaria. Se incluyeron en el análisis 201 pacientes con edades entre los 18 a 65 años. Resultados: De los 201 pacientes analizados, el 45.3% presentaron patología dual, con una razón hombre-mujer de 2.24. La mayoría tenía como estado civil soltero (69.2%), y más del 90% presentaron un nivel socioeconómico bajo. Los factores que resultaron significativamente asociados a patología dual, por su orden de importancia, fueron la edad de 18 a 34 años (OR = 11.03; IC 95% [4.43, 27.46]), el sexo masculino (OR = 5.10; IC 95% [2.26, 11.50]), antecedente de heteroagresión (OR = 3.35; IC 95% [1.63, 6.91]) y la rehospitalización durante el año posterior al egreso (OR = 2.23; IC 95% [1.08, 4.61]). Discusión y conclusión: La prevalencia de patología dual en este estudio coincide con el rango encontrado por otros autores. Por la elevada prevalencia de la patología dual, es necesario disponer de programas terapéuticos especializados para su tratamiento. En la medida en que se conozcan las variables asociadas, el tratamiento de los pacientes mejorará considerablemente.