Factors associated with the intensity of anxiety and depression symptoms in health workers of two centres of reference for COVID 19 patient care in Antioquia, Colombia - A latent class analysis.

OBJECTIVE: To classify the staff of two reference institutions for COVID-19 care in Antioquia according to the intensity of anxiety and depression symptoms, and to determine the factors associated with these classes. METHODS: Cross-sectional study in which the GAD-7, PHQ-9, fear of COVID-19, and the Copenhagen Burnout scale were used. Latent class analysis was performed to identify the classes, and the factors associated with these were determined using multinomial logistic regression. RESULTS: 486 people participated. The three-class model had the best fit: class I with low scores on the scales; class II with mild degrees of anxiety and depression, and intermediate levels of fear of COVID-19 and perceived stress; and class III with moderate and severe degrees of anxiety, depression, and perceived stress. The factors associated with belonging to class III were age (OR = 0.94; 95%CI, 0.91-0.96), change of residence to avoid exposing relatives (OR = 4.01; 95%CI, 1.99-8.09), and a history of depressive disorder (OR = 3.10; 95%CI, 1.27-7.56), and anxiety (OR = 5.5; 95%CI, 2.36-12.90). Factors associated with class II were age (OR = 0.97; 95%CI, 0.95-0.99), history of depressive disorder (OR = 3.41; 95%CI, 1.60-7.25), living with someone at risk of death from COVID-19 (OR = 1.86; 95%CI, 1.19-2.91), family member being healthcare staff (OR = 1.58; 95%CI, 1.01-2.47), and change of residence to avoid exposing relatives (OR = 1.99; 95%CI, 1.11-3.59). CONCLUSIONS: Three classes of participants were obtained, two of them with anxiety and depression symptoms. Younger age and a history of mental disorder were factors associated with the two classes of symptomatic patients; other factors may be causes or consequences of the symptoms.

Epidemiology and factors associated with acute stress disorder in burned patients: a case-control study.

INTRODUCTION: A burn injury is a very painful experience, with subsequent emotional problems, which have been gaining relevance to the extent that survival from burns has improved. Among the alterations of the mental sphere in this population is Acute Stress Disorder (ASD) that has been described in up to one-third of patients with major burns. METHODOLOGY: A nested case-control study was carried out in a cohort of hospitalized patients in a burn referral unit, in patients over 16 years of age. A total of 135 patients, 41 cases, and 94 controls were included. All of them underwent a psychiatric interview, a standardized form was filled out on sociodemographic and clinical information, and the PID-5-BF scale was applied to evaluate associated personality elements. The diagnosis of acute stress was made with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. RESULTS: The incidence of acute stress was 23.4%. When the clinical and sociodemographic characteristics of both the cases and the controls were compared, the risk factors were subsidized insurance, flame burn, burn in a special area, third-degree burn, high pain, stay in the Intensive Care Unit (ICU), peritraumatic amnesia and life threat. Patients also had a higher percentage of burned body surface, higher average pulse, longer hospital length of stay, higher average in the negative affect variable and in the psychoticism variable of the PID-5-BF scale. But for the multivariate analysis using logistic regression, the model that best explains the presence of acute stress only includes the variables life threat (Odds Ratio adjusted (ORa): 117.0; Confidence Interval (CI): 10.9-1258.5), severe pain (ORa: 9.9; CI: 1.8-52.8), electrical burn (ORa: 20.8; CI: 17.2-250), burn in a special area (ORa: 8.9; CI: 1, 0-76.8), third-degree burn (ORa: 10.4; CI: 0.7-166.7). CONCLUSION: Acute stress disorder is frequent in the hospitalised burn population, and is more frequent than in other types of trauma. Associated factors with the presentation of Acute Stress Disorder are the feeling of life threat at the time of the burn, having pain classified as strong (Visual Analog Scale (VAS) 5-10), electrical burn, and burns in special areas.

Trastornos del sueño en pacientes en hemodiálisis Prevalencia y características clínicas y epidemiológicas / Sleep Disorders in Hemodialysis Patients. Prevalence and Clinical and Epidemiological Features

Introducción: Dormir mal es una de las quejas más frecuentes de los pacientes en hemodiálisis. Este problema afecta negativamente la calidad de vida y la salud de quienes los padecen. Objetivo: Determinar la prevalencia de los trastornos del sueño y los factores clínicos y epidemiológicos relacionados, en pacientes adultos con enfermedad renal crónica que se encuentran en hemodiálisis. Método: Se realizó un estudio descriptivo prospectivo de corte transversal. Se evaluaron los pacientes mayores de 18 años con enfermedad renal crónica que requieren diálisis y asisten a las unidades de hemodiálisis de los hospitales universitarios de San Ignacio, en Bogotá, y San Vicente, en Medellín. Se diseñó un cuestionario para recopilar información sociodemográfica y clínica. Se emplearon escalas para medir la calidad del sueño, la excesiva somnolencia diurna y el riesgo de apnea del sueño y de síndrome de piernas inquietas. Resultados: Se evaluaron 139 pacientes, entre 20 y 84 años de edad, el 54% (75) fueron de sexo masculino; 94,2% merecen atención médica por su problema de sueño. Conclusión: Los trastornos del sueño son una condición clínica de alta prevalencia en los pacientes con enfermedad renal crónica en hemodiálisis. En todo paciente que se encuentre en hemodiálisis se debe buscar de forma rutinaria problemas de sueño.

Introduction: Poor sleep is one of the most common complaints of patients on hemodialysis. This in turn affects the quality of life and health of those who suffer from it. Objective: To determine the prevalence of sleep disorders and related clinical and epidemiological features in adult patients with chronic kidney disease who are on hemodialysis. Method: We conducted a prospective cross-sectional study. The patients assessed were over 18 years old, had chronic kidney disease requiring dialysis, and attended the hemodialysis units of the University Hospital San Ignacio in Bogotá and the San Vicente Foundation in Medellin. We designed a questionnaire to collect socio-demographic and clinical information. Scales were used to measure sleep quality, daytime sleepiness, risk of sleep apnea, and restless legs syndrome. Results: 139 patients were assessed between the ages of 20 and 84 years old, 54% (75) were male. 94.2% of the patients were deserving of medical attention due to sleep problem. Conclusion: Sleep disorders are a highly prevalent clinical condition in hemodialysis patients with chronic kidney disease. Sleep problems should be routinely assessed in all dialysis patients.

Delírium: evaluación de tres guías clínicas con el instrumento AGREE / Assessment of three clinical practice guidelines for the management of delirium using the AGREE instrument

Introducción: El delírium es el síndrome neuropsiquiátrico más prevalente en el hospital general. Su presencia se asocia con un incremento en la morbilidad, mortalidad, sufrimiento y costos de atención hospitalaria. Para un mejor manejo se han desarrollado guías de práctica clínica (GPC), hechas a partir de recomendaciones clínicas desarrolladas de forma sistemática, cuyo fin es ayudar a los equipos médicos a tomar las decisiones adecuadas en circunstancias clínicas específicas. Objetivo: Analizar tres guías de práctica clínica para delírium con el instrumento AGREE y determinar cuál de ellas tiene mejor calidad metodológica. Método: Se evaluaron tres guías clínicas para el manejo de delírium con el instrumento AGREE. Esas tres GPC las evaluaron cuatro psiquiatras de enlace colombianos, quienes aplicaron el instrumento AGREE. Resultados: Luego de la evaluación se encontró que las guías australianas para manejo de delírium alcanzan una alta calificación con el instrumento AGREE, lo que las convierte en “muy recomendadas” para el manejo de delírium. Conclusiones: Sorprende la escasa evidencia científica en torno a un tema clínico tan importante como el delírium; por ello es prioritario desarrollar investigaciones en esta importante área de la psiquiatría de enlace...

Introduction: Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is associated with increased morbidity, mortality, suffering, and costs of hospital care. Clinical practice guidelines have been developed for the management of delirium with the purpose of assisting medical teams in making the right decisions in specific clinical circumstances. Objective: To analyze three clinical guidelines for delirium using the AGREE Instrument to determine which one has better methodological quality. Method: We assessed three clinical guidelines for the management of delirium. The three chosen guidelines were evaluated by four Colombian liaison psychiatrists who applied the AGREE instrument. Results: After the evaluation we found that the Australian guidelines for the management of delirium reached a high rating with the AGREE Instrument rendering them “highly recommended”. Conclusions: The lack of scientific evidence dealing with this important clinical issue is surprising. The development of research in this important area of liaison psychiatry should be a priority...

Delírium: incidencia y características clínicas y epidemiológicas en un hospital universitario / Delirium: incidence and clinical and epidemiological characteristics in a teaching hospital

Introducción: El delírium es un trastorno neuropsiquiátrico frecuente en el hospital. Es un estado de conciencia anormal que altera la cognición, en especial la orientación y la atención. Se considera una complicación del cuidado hospitalario susceptible de prevención. Objetivos: Determinar la incidencia y el perfil clínico y epidemiológico del delírium en un hospital universitario en Medellín, Colombia. Método: Se realizó un estudio descriptivo prospectivo de corte transversal. Se evaluaron pacientes mayores de 18 años de edad para determinar la presencia de delírium y las variables sociodemográficas y clínicas relacionadas. Resultados: Se evaluaron 421 pacientes, de los cuales 29 cumplieron con los criterios diagnósticos de delírium según la CAM y los criterios diagnósticos del DSM-IV-TR. La proporción de incidencia de delírium fue 6,9%. El 62,1% de los pacientes con delírium eran hombres y la edad promedio fue de 64 años. Los subtipos motores fueron mixto, hiperactivos, hipoactivos, y el 6,9% no tuvo alteración motora. En el 86,2% de los pacientes el delírium fue debido a múltiples etiologías. El promedio de días de hospitalización fue de 37. El delírium fue identificado por los médicos tratantes en el 75,9% de los pacientes. Hubo mejoría en el 59%, y 13,8% de los identificados fallecieron durante la hospitalización. Conclusiones: El delírium es una condición clínica frecuente en el hospital general que se asocia con mayor estancia hospitalaria y mortalidad elevada...

Introduction: Delirium is a frequent and serious acute neuropsychiatric syndrome with core features of inattention and global cognitive dysfunction. Delirium can be considered a hospital care complication which might be prevented. Objectives: To determine the incidence and epidemiological profile of delirium in a teaching hospital in Medellin, Colombia. Method: A transversal section descriptive prospective study was carried out. Patients over 18 years of age were assessed to determine the presence of delirium and related clinical and sociodemographic features. Results: 421 patients were studied of whom 29 met the diagnostic criteria for delirium according to CAM, and the diagnostic criteria of DSM-IV-TR. The delirium incidence proportion was 6.9%. 62.1% of patients with delirium were male and the average age was 64 years. Motor subtypes were mixed, hyperactive, hypoactive, and 6.9% had no motor disturbance. In 86.2% of the patients delirium was due to multiple etiologies. The average days of hospitalization were 37 days. Delirium was identified by treating pysicians in 75.9% of the patients. Of these, 59% improved and 13.8% died during hospitalization. Conclusion: Delirium is a frequent clinical condition in the general hospital associated with an extended stay at the hospital and high mortality...

Encefalitis límbica en mujer de 41 años con masa mediastinal y cambios de comportamiento / Limbic encephalitis in a 41 year-old female with a mediastinal mass and behavior changes

Introducción: La encefalitis límbica paraneoplásica es un síndrome poco frecuente que produce síntomas neuropsiquiátricos y, en algunos casos, demencia rápidamente progresiva. Objetivo: Discutir el curso clínico de una paciente con encefalitis límbica paraneoplásica asociado con timoma. Método: Reporte de caso de una mujer de 41 años de edad. Resultados: La mujer presentó pérdida de peso, tos y diarrea crónica, de ocho meses de evolución, por un síndrome de Good; además, cambios comportamentales con pérdida progresiva de la memoria por encefalitis límbica paraneoplásica. A pesar del tratamiento quirúrgico, esteroides y gamaglobulina, la paciente sufrió deterioro clínico progresivo y falleció. Conclusiones: La encefalitis límbica paraneoplásica puede causar alteraciones neuropsiquiátricas y demencia rápidamente progresiva. Es importante para los psiquiatras de enlace conocer las características clínicas de la encefalitis límbica paraneoplásica, lo cual permitirá lograr un diagnóstico precoz y tratamiento oportuno...

Introduction: Paraneoplastic limbic encephalitis is a rare syndrome that causes neuropsychiatric symptoms and in some cases rapidly progressive dementia. Objective: To discuss the clinical course of a patient with paraneoplastic limbic encephalitis associated with thymoma. Method: Case report. Results: We report a 41 year-old female who had weight loss, chronic cough and diarrhea for eight months associated with Good´s syndrome and behavioral changes and progressive loss of memory from paraneoplastic limbic encephalitis. Despite surgical treatment, steroids and gammaglobulin, the patient presented progressive clinical deterioration and died. Conclusions: Paraneoplastic limbic encephalitis may cause neuropsychiatric disturbances and rapidly progressive dementia. It is important for liaison psychiatrists to know the clinical features of paraneoplastic limbic encephalitis thus ensuring early diagnosis and appropriate treatment...

Validación de la versión para Colombia de la Escala de Evaluación de Introspección Expandida (SAI-E) en sujetos con trastornos afectivos y psicóticos / Validation of the Colombian Version of Scale for Assessment of Insigth Expanded Version (SAI-E) in Subjects with Mood and Pychotic Disorders

Introducción: Aunque la introspección es un concepto fundamental en psiquiatría, no tiene una definición precisa. Para estudiar y entender mejor este fenómeno se ha usado ampliamente la Escala para Evaluación de Introspección-Expandida (SAI-E), porque es de fácil aplicación y ha demostrado buenas propiedades psicométricas. Objetivo: Validar la SAI-E para su uso en pacientes con trastornos psiquiátricos de Colombia. Método: La SAI-E fue traducida y retrotraducida por expertos en inglés y español, y dichas traducciones fueron revisadas por psiquiatras con experiencia en psicopatología y psicosis. Luego, la escala fue aplicada a 146 pacientes hospitalizados con diagnósticos de esquizofrenia, trastorno esquizoafectivo, trastorno afectivo bipolar y episodio depresivo mayor. Resultados: Se obtuvo una versión clara y clínicamente útil, fácil de aplicar por parte de profesionales de la salud mental. Esta versión mostró una adecuada consistencia interna, reproducibilidad prueba-reprueba e interevaluador, y sensibilidad al cambio. En el análisis factorial exploratorio se encontraron tres dominios (conciencia de enfermedad, conciencia de los síntomas y aceptación del tratamiento farmacológico), similares a los propuestos por los autores originales de la SAI-E. Conclusión: La versión para Colombia de la SAI-E tiene buenas propiedades psicométricas. Su uso en investigación puede contribuir a un mejor entendimiento transcultural de las alteraciones de la introspección entre pacientes psiquiátricos...

Introduction: Although insight is a crucial concept in psychiatry, its precise definition remains elusive. The Scale for the Assessment of Insight Expanded Version (SAI-E) is a scale that has been widely used and has demonstrated good psychometric properties and it is easy to apply. Objective: To validate the SAI-E for its use among patients with psychiatric disorders from Colombia. Methods: the SAI-E was translated and backtranslated by experts in English and Spanish languages and the translations was reviewed by psychiatrists with expertise in psychopathology and psychoses. Then, the scale was applied to 146 inpatients with the following diagnoses: schizophrenia, schizoaffective disorder, bipolar disorder and major depressive episode. Results: A clear, concise and clinically useful version was obtained. It was easy to apply by mental health professionals after a brief training period. It showed good internal consistency, test-retestand inter-rater reproducibility validity, and responsiveness. The existence of three principal domains of insight (illness awareness, symptom awareness, and pharmacological treatment acceptance) was found in the exploratory factor analysis and it is in agreement with the components of insight proposed by the original authors of the SAI-E. Conclusion: The Colombian version of the SAI-E scale has good psychometric properties. Its use for research in Colombian populations can contribute to a better cross-cultural understanding of insight disturbances among psychiatric patients...

Neuropsiquiatría en Colombia: ¿por qué?, ¿para qué? / Neuropsychiatry in Colombia. Why? What for?

Introducción: existen dos maneras de defi nir la neuropsiquiatría: la visión estadounidense, que entiende esta práctica como neurología de la conducta, y la europea, que la propone como una subespecialidad psiquiátrica relacionada con el enfoque diagnóstico y el tratamiento de los pacientes con enfermedades neurológicas establecidas que tienen manifestaciones psicopatológicas en su conducta. Objetivo: plantear esta práctica clínica como un neuroenlace, que pone al profesional de la salud mental en la necesidad de un trabajo interdisciplinario que se adapte a las particularidades del individuo afectado. Conclusión: aunque existe un cuerpo teórico neuropsiquiátrico importante, en Colombia aún son necesarias reformas curriculares profundas en los posgrados de Psiquiatría, para poder responder a las necesidades de formación de nuevos profesionales en este campo de trabajo, por eso en este artículo se plantean algunos precedentes necesarios para la discusión.

Introduction: There are two broad ways of defi ning neuropsychiatry: the North American view understands this discipline as behavioral neurology and European view argues that it constitutes a subspeciality within psychiatry dealing with diagnosis and treatment of patients with established neurological diseases that have disturbances in their behavior. Objectives: To understand the clinical practice of neuropsychiatry as a sort of neuro-liasion creates the need of an interdisciplinary work for the neuropsychiatrist adapted to the different needs of the affected individual. From this perspective treatment and rehabilitation teams in neuropsychiatry accept the relationships existing between structural brain damage, behavior and environment and relational contexts. Additionally, psychiatric interview and case formulation are helped by techniques coming from neuropsychology and neuroimaging. Conclusion: Although there are several groups interested in neuropsychiatry in Colombia, important curricular changes are needed in order to make possible the creation of training programs in this area. In this paper some key aspects for discussing this matter are enounced.