Depresión y crisis de pánico en acné tratado con isotretinoína / Depression and panic attack in acne treated with isotretinoin

Isotretinoína es un fármaco de uso frecuente en los adolescentes con acné severo. Se han descrito varios efectos secundarios producidos por esta sustancia, entre ellos alteraciones psíquicas. Presentamos el caso de una paciente de 17 años, diagnosticada de episodio depresivo moderado y crisis de pánico en relación con el uso de este producto. Debido a la escasa frecuencia de aparición de reacciones adversas psiquiátricas, está claramente justificada la prescripción de isotretinoína en adolescentes. Pero debe informarse siempre adecuadamente a los pacientes y familiares, reevaluando con frecuencia la conveniencia de continuar con el tratamiento. El médico de atención primaria debe tener en cuenta la influencia, a veces no detectada por otros especialistas, de numerosos fármacos en la aparición de síntomas psiquiátricos como ansiedad o depresión (AU)

Isotretinoin is a drug often used in adolescents with severe acne. Several side effects of this substance, including mental disorders, have been reported. We report the case of a 17 years old patient who was diagnosed with moderate depressive episode and panic attacks in relation to the use of this product. Due to the low frequency of psychiatric adverse reactions, the prescription of isotretinoin in adolescents is clearly justified. But patients and relatives should always be properly informed, with frequent re-assessments on whether to continue with treatment. The primary care physician must take into account the influence, sometimes not detected by other specialists, of many drugs at the onset of psychiatric symptoms, such as anxiety or depression (AU)

[Depression and panic attack in acne treated with isotretinoin]. / Depresión y crisis de pánico en acne tratado con isotretinoína.

Isotretinoin is a drug often used in adolescents with severe acne. Several side effects of this substance, including mental disorders, have been reported. We report the case of a 17 years old patient who was diagnosed with moderate depressive episode and panic attacks in relation to the use of this product. Due to the low frequency of psychiatric adverse reactions, the prescription of isotretinoin in adolescents is clearly justified. But patients and relatives should always be properly informed, with frequent re-assessments on whether to continue with treatment. The primary care physician must take into account the influence, sometimes not detected by other specialists, of many drugs at the onset of psychiatric symptoms, such as anxiety or depression.

[Welcome and I'll see you again, or hello and goodbye?: Communication behaviour of medical residents at the beginning and the end of consultations]. / Bienvenido y hasta luego u hola y adiós?: Conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas.

OBJECTIVES: To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. DESIGN: Descriptive observational study. SETTING: Primary care clinics. PARTICIPANTS: Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. RESULTS: The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). CONCLUSIONS: The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.