ABSTRACT
Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)
Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Primary Health Care/trends , Depression/diagnosis , Psychiatry/trends , Signs and Symptoms , Somatoform Disorders/diagnosis , Citalopram/adverse effects , Citalopram/therapeutic use , Fibromyalgia/complications , Fatigue Syndrome, Chronic/complications , Fluoxetine/adverse effects , Fluoxetine/therapeutic use , Selective Serotonin Reuptake Inhibitors/adverse effects , Low Back Pain/complications , Cholinergic Antagonists/adverse effects , Medical Errors , Sertraline/adverse effects , Sertraline/therapeutic use , Depression/classification , Depression/complications , Depression/therapy , Depression/epidemiology , General Practice , Chronic Pain/complications , Venlafaxine Hydrochloride/adverse effects , Venlafaxine Hydrochloride/therapeutic use , Duloxetine Hydrochloride/adverse effects , Duloxetine Hydrochloride/therapeutic use , Serotonin and Noradrenaline Reuptake Inhibitors/adverse effects , Headache/complications , Amitriptyline/adverse effects , Amitriptyline/therapeutic use , Antidepressive Agents/administration & dosageABSTRACT
Objective:To explore social support and personality characteristic of patients with clinically chronic pains to provide a new idea for clinical psycho-intervention.Method:45 patients with clinically chronic pains were evaluated by the Symptom Checklist(SCL-90),EPQ and SSRS,and compared with the control group.Results:Somatization,interpersonal sensitivity,anxiety,fear and psychotic factors have significant differences from those of the control group when being compared(p