ABSTRACT
INTRODUCTION: Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice. MATERIAL AND METHODS: The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations. RESULTS: The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources. CONCLUSIONS: Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.
ABSTRACT
INTRODUCTION: The aim of this study was to evaluate whether there are any differences in the clinical features of depression, personality and the G factor among women with and without premenstrual exacerbation (PE) of depression. MATERIAL AND METHODS: Ninety-nine outpatients diagnosed with major depression (DSM-IV) were interviewed twice. At baseline, the patients were not taking medication. The 74 patients who achieved remission (Hamilton rating scale for depression ≤7) after 16 weeks were evaluated again through the 16-personality factor (16-PF) questionnaire (5(th) edition) and the D48 (or Dominos) test. RESULTS: No differences in clinical characteristics or prognosis were found between the two groups of women, except for the greater presence of seasonal features among women with PE. Women with PE also scored higher for self-control on the 16-PF and scored lower on the D48 (Domino) test. The logistic analysis showed that higher self-control scores increased the risk for PE in 51.3% of the sample, while higher scores on the D48 test decreased the risk in 8.6%. CONCLUSIONS: There were no differences between the two groups in the clinical features or prognosis of depression, except for the higher rates of seasonal features in the PE group. In contrast, differences were found in personality traits and the D48 between the two groups.
ABSTRACT
Mujer de 17 años de edad, sin antecedentes de interés, que ingresó en la unidad de psiquiatría por un cuadro de 4 semanas de evolución, que cursaba con mutismo, agitación e insomnio. Había sido tratada con maprotilina, risperidona y lorazepam. Durante los primeros días del ingreso se modificó el tratamiento, pero continuó el empeoramiento psíquico y físico, ya que se negaba a alimentarse. Todos los estudios complementarios estuvieron dentro de la normalidad. A las 2 semanas del ingreso se observó fiebre de 38 °C en tres ocasiones. Se cambió el tratamiento a quetiapina, y según mejoraba su estado, aparecieron una paresia de la extremidad superior derecha y disartria. Ante la posibilidad de que se tratara de un efecto adverso a la quetiapina, se decidió su retirada. Antes de alcanzar la suspensión total, su estado empeoró de nuevo, con agitación, mutismo, tricotilomanía y fiebre. Se aumentó la dosis de quetiapina (600 mg/día) y volvió a mejorar. Al alta hospitalaria fue diagnosticada de catatonia letal (CL). La evolución desde entonces ha sido muy favorable, lo que ha permitido la suspensión progresiva del tratamiento. Durante los 4 meses previos a la última consulta se ha mantenido estable sin precisar tratamiento alguno (AU)
A 17-year-old woman, without antecedents of interest, was admitted to the psychiatric ward due to a clinical disorder consisting of mutism, agitation and insomnia for the previous 4 weeks. The patient had been unsuccessfully treated with maprotiline, risperidone and lorazepam. For the first 2 weeks after admission, the treatment was modified but the patient¿s psychic and physical status worsened, since she refused to eat. The results of all complementary investigations were normal. Two weeks after admission, the patient developed a fever (38 °C) on three separate occasions. The treatment was switched to quetiapine and the patient improved, but then dysarthria and right arm paralysis were observed. Given the possibility that these symptoms were adverse effects of quetiapine, the dose of this drug was reduced. However, before complete withdrawal, the patient developed agitation, mutism, trichotillomania and fever. The dose of quetiapine was increased to 600 mg/day with symptom remission. On discharge, the patient was diagnosed with lethal catatonia. Since then, the patient has remained asymptomatic, allowing quetiapine to be slowly reduced. During the 4 months before the last visit, the patient has remained stable and has required no treatment. Based on this case, we believe that atypical antipsychotics may be useful in the treatment of some patients with lethal catatonia. The difficulties that can be encountered in the differential diagnosis between lethal catatonia and neuroleptic malignant syndrome and the nosologic classification of these entities are discussed (AU)
Subject(s)
Humans , Female , Adolescent , Antipsychotic Agents/therapeutic use , Catatonia/drug therapy , Treatment OutcomeABSTRACT
En las últimas décadas, se ha evidenciado la importancia de la anhedonia como síntoma fundamental en diversos trastornos neuropsiquiátricos, como la depresión y esquizofrenia. Sin embargo, la confusión terminológica y conceptual sobre la anhedonia como síntoma seguir la evolución que ha seguido el concepto de anhedonia desde su creación hasta psiquiátrico es notable, precisándose en primer lugar una revisión histórica que permita nuestros días; en segundo lugar, una recalibración conceptual de la anhedonia en el marco de un modelo del síntoma que permita generar hipótesis sobre su formación en distintas patologías psiquiátricas; y, en tercer lugar, la creación de un instrumento de medida que permita testar las hipótesis que genere dicho modelo. Estas tres tareas son las que se abordan en el presente trabajo (AU)
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Subject(s)
Humans , Mood Disorders/psychology , Depressive Disorder/psychology , Schizophrenic Psychology , Affective Symptoms/diagnosis , Schizophrenia , Psychiatric Status Rating Scales , Psychometrics/instrumentationABSTRACT
Objetivo. Evaluar la calidad de vida relacionada con la salud (CVRS) y funcionalidad social de los pacientes esquizofrénicos tratados en monoterapia con olanzapina en condiciones de práctica clínica habitual. Métodos. Se reclutaron pacientes ambulatorios diagnosticados de esquizofrenia que iniciasen tratamiento en monoterapia con olanzapina, quetiapina, risperidona o antipsicóticos típicos orales. Se recogieron las variables sociodemográficas del paciente. En cada visita (basal, 3, 6, 12 meses) se administró el cuestionario genérico de CVRS EuroQoL-5D (EQ-5D) y la Escala de Funcionamiento Social. Resultados. Se siguieron un total de 1.198 pacientes. La edad media (DE) era de 38,6 (13,3) y un 62,9 % era hombres. Según el cuestionario EQ-5D basalmente las dimensiones más afectadas fueron ansiedad/depresión (76 %) y actividades cotidianas (73,6 %). A los 12 meses la cohorte tratada con olanzapina presentó una mejor CVRS en la dimensión de cuidado personal respecto al resto de tratamientos (p < 0,05) y un porcentaje menor en las dimensiones de dolor/malestar, ansiedad/ depresión y actividades habituales respecto al grupo tratado con quetiapina o risperidona (p < 0,05). Según la Escala Visual Analógica (EVA) del cuestionario EQ-5D la cohorte tratada con olanzapina presentó mejor estado de salud a los 12 meses que los tratados con quetiapina o risperidona (p<0,05). La Escala de Funcionamiento Social demostró una mejora a los 12 meses en los pacientes tratados con olanzapina en las tres dimensiones estudiadas: aislamiento y relaciones sociales respecto a los tratados con risperidona (p<0,05), comunicación interpersonal respecto a los tratados con risperidona o quetiapina (p < 0,05) e independencia de ejecución respecto al resto de tratamientos (p<0,05). Conclusión. La mejora en la CVRS y funcionamiento social al año de seguimiento es mayor en aquellos pacientes tratados con olanzapina que con otros antipsicóticos
Objective. To measure health related quality of life (HRQL) and social functioning in schizophrenic patients treated with olanzapine under regular clinical practice conditions. Methods. Out-patients diagnosed of schizophrenia and beginning treatment with olanzapine, quetiapine, risperidone or typical oral antipsychotics were included. Information on socio-demographic characteristics was obtained and in each visit (baseline, 3, 6 and 12 months) they were administered the generic HRQL questionnaire Euro- QoL-5D (EQ-5D) and the Social Functioning Scale (SFS). Results. A total of 1,198 patients were followed-up for 12 months. Mean age (SD) was 38.6 (13.3) years and 62.9 % of them were men. In basal conditions the most affected dimensions of EQ-5D were anxiety/depression (76 %), and daily activities (73.6 %). After 12 months treatment the cohort of patients treated with olanzapine showed a better HRQL in the self-care dimension compared to all other treatments (p < 0.05), and in the dimensions of pain/discomfort, anxiety/depression and usual activities compared to the group treated with quetiapine and risperidone (p < 0.05). The Visual Analogue Scale (VAS) of the EQ-5D questionnaire showed a better health state after 12 months in the group treated with olanzapine compared to the groups of quetiapine or risperidone (p < 0.05). The SFS showed a better improvement in the cohort of olanzapine in the three studied dimensions after 12 months: isolation and social relationships in comparison to the risperidone group (p < 0.05), interpersonal communication in comparison to the risperidone and quetiapine group (p < 0.05) and independence performance in comparison to all the other treatments (p < 0,05). Conclusion. Schizophrenic patients treated with olanzapine for one year show a better improvement in HRQL and social functioning than those treated with other antipsychotics
Subject(s)
Adult , Humans , Antipsychotic Agents/therapeutic use , Interpersonal Relations , Outcome Assessment, Health Care/statistics & numerical data , Quality of Life/psychology , Schizophrenia/drug therapy , Schizophrenic Psychology , Social Behavior , Benzodiazepines/therapeutic use , Follow-Up Studies , Risperidone/therapeutic use , Schizophrenia/diagnosis , Severity of Illness IndexABSTRACT
En el presente artículo se realiza un análisis conceptual de ciertos aspectos de la sintomatología afectiva que puede aparecer en el curso de la esquizofrenia, así como una revisión de los artículos publicados hasta la fecha sobre el empleo de la medicación antidepresiva en este tipo de pacientes(con y sin síntomas depresivos). El objetivo es valorar si los resultados de estos trabajos pueden ser considerados concluyentes en cuanto la utilidad del empleo de estos fármacos en la esquizofrenia
Subject(s)
Affective Symptoms , Antidepressive Agents/pharmacology , SchizophreniaABSTRACT
En el presente artículo se realiza un análisis conceptual de ciertos aspectos de la sintomatología afectiva que puede aparecer en el curso de la esquizofrenia, así como una revisión de los artículos publicados hasta la fecha sobre el empleo de la medicación antidepresiva en este tipo de pacientes(con y sin síntomas depresivos). El objetivo es valorar si los resultados de estos trabajos pueden ser considerados concluyentes en cuanto la utilidad del empleo de estos fármacos en la esquizofrenia
