Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.

Long-term psychopathology changes among the injured and members of the community after a massive terrorist attack.

BACKGROUND AND AIM: To document long-term prevalence trends and changes in post-traumatic stress disorder (PTSD), current major depression (MD), agoraphobia, generalized anxiety disorder (GAD), and panic disorder, in two groups of people with different levels of exposure to a massive terrorist attack. METHODS: Cohort study. Two random samples of people exposed to a terrorist attack, the injured (n=127) and community residents (n=485) were followed and assessed, 2 and 18 months after the event. RESULTS: Among the injured, 2 and 18 months after the attack, the prevalences were respectively, PTSD: 44.1% and 34%, MD: 31.5% and 23.7%, agoraphobia: 23.8% and 20.7%, GAD: 13.4% and 12.4% and panic disorder: 9.4% and 11.3%. The corresponding figures among residents were PTSD: 12.3% and 3.5%, MD: 8.5% and 5.4%, agoraphobia: 10.5% and 8.7%, GAD: 8.6%, and 8.2% and panic disorder 2.1% and 2.7%. CONCLUSIONS: Two months after the event, the prevalence of mental disorders among both injured and residents was higher than expected levels at baseline conditions. Eighteen months after the event, psychopathological conditions did not change significantly among the injured but returned to the expected baseline rates among community residents.

Spanish perspective on enlarging a small specialty: the national research network for liaison psychiatry and psychosomatics.

The Spanish Research Network in Liaison Psychiatry and Psychosomatics (REPEP) comprises 11 centers (nodes), and was one of the successful applicants in a very competitive call for a networking program for the National Institute of Health "Carlos III" project. This article describes its general objectives and strategic plans. Both qualitative and quantitative results support our statement that this "perspective" should help to enlarge what is presently a small specialty. Synergies in the network have been potentiated; an ambitious national study on depressive comorbidity in complex medical patients has been executed; and new research and training programs have been initiated.

[Psychosurgery and the neurosurgical treatment of pain: a systematic review of the experience gained in these kinds of treatment]. / Psicocirugía y tratamiento neuroquirúrgico del dolor: revisión sistemática de la experiencia alcanzada en estos tipos de tratamiento.

INTRODUCTION: Psychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques have been perfected over the last few decades. AIMS: Our aim was to conduct a systematic review of the studies dealing with psychosurgery and NTP reported in the literature, based on the standards of quality used in evidence-based medicine. DEVELOPMENT: Following screening and selection, nine of the 178 papers found (MEDLINE, 1990-2002) were selected for the study: three referring to the treatment of neuropathic pain and six about the treatment of obsessive-compulsive disorder (OCD). The objectives were the therapeutic results in all cases, the study of the anatomical-functional bases in three of them and the description of side effects in five. After adapting the standards of quality used in evidence-based medicine (there are no standards for papers about surgery), one was classified in group B, six in group C and two as C-D. The three papers about the treatment of pain reported a significant improvement in the pain scales in 40-77% of patients. As regards the treatment of OCD, results showed an overall improvement of the scales in 20.4-70% of the patients with an improvement above 50%. The side effects are also described. CONCLUSIONS: Data published support the indication of psychosurgery and NTP for selected patients with neuropathic pain and OCD. The methodological limitations of the papers prevent us from drawing conclusions about the other diseases for which these techniques have been indicated.

Analysis of the -1438 G/A polymorphism of the 5-HT2A serotonin receptor gene in bulimia nervosa patients with or without a history of anorexia nervosa.

A single nucleotide polymorphism (-1438 G/A) located 1438 base pairs upstream of the consensus start site of the 5-HT2A receptor gene has been reported. The hypothesis that this gene polymorphism may be a susceptibility factor in bulimia nervosa was explored in a female population of purgative bulimics. Bulimia nervosa patients who have suffered preceding anorexia nervosa episodes formed the so-called previous anorexia nervosa bulimic patient group. At variance with some previous reports, when the frequency distribution of genotypes and alleles was compared in patients and controls, no differences were detected regardless of whether the bulimia nervosa patients had suffered prior anorexia nervosa episodes.

Psicocirugía y tratamiento neuroquirúrgico del dolor: revisión sistemática de la experiencia alcanzada en estos tipos de tratamiento / Psychosurgey and the neurosurgical treatment of pain: a systematic review of the experience gained in these kinds of treatment

Introducción. La psicocirugía y el tratamiento neuroquirúrgico del dolor (TND) son opciones terapéuticas restringidas a aquellos pacientes resistentes a los tratamientos médicos. Las técnicas quirúrgicas se han perfeccionado durante las décadas pasadas. Objetivo. Revisión sistemática de los estudios sobre psicocirugía y TND presentes en la literatura, con base en los criterios de calidad empleados en la medicina basada en la evidencia. Desarrollo. Tras el cribado y la selección, se eligieron nueve de los 178 artículos encontrados (MEDLINE, 1990-2002): tres referentes al tratamiento del dolor neuropático y seis al tratamiento del trastorno obsesivo-compulsivo (TOC). Los objetivos fueron los resultados terapéuticos en todos los casos, el estudio de las bases anatomofuncionales en tres y la descripción de los efectos secundarios en cinco. Tras adaptar los criterios de calidad de la medicina basada en la evidencia -no existen criterios para los artículos sobre cirugía-, uno de ellos se clasificó en el grupo B, seis en el grupo C y dos como C-D. Los tres artículos sobre el tratamiento del dolor refieren una mejoría significativa en las escalas de dolor en el 40-77 por ciento de los pacientes. En cuanto al tratamiento del TOC, los resultados oscilan entre una mejoría de las escalas global de 20,4-70 por ciento de los pacientes con mejoría superior al 50 por ciento. Se describen los efectos secundarios. Conclusiones. Los datos publicados apoyan la indicación de la psicocirugía y el TND para pacientes seleccionados con dolor neuropático y TOC. Las limitaciones metodológicas de los artículos nos impiden extraer conclusiones sobre el resto de las enfermedades en las que se han indicado estas técnicas (AU)

Introducción. Psychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques have been perfected over the last few decades. Aims. Our aim was to conduct a systematic review of the studies dealing with psychosurgery and NTP reported in the literature, based on the standards of quality used in evidence-based medicine. Development. Following screening and selection, nine of the 178 papers found (MEDLINE, 1990-2002) were selected for the study: three referring to the treatment of neuropathic pain and six about the treatment of obsessive-compulsive disorder (OCD). The objectives were the therapeutic results in all cases, the study of the anatomical-functional bases in three of them and the description of side effects in five. After adapting the standards of quality used in evidence-based medicine (there are no standards for papers about surgery), one was classified in group B, six in group C and two as C-D. The three papers about the treatment of pain reported a significant improvement in the pain scales in 40-77% of patients. As regards the treatment of OCD, results showed an overall improvement of the scales in 20.4-70% of the patients with an improvement above 50%. The side effects are also described. Conclusions. Data published support the indication of psychosurgery and NTP for selected patients with neuropathic pain and OCD. The methodological limitations of the papers prevent us from drawing conclusions about the other diseases for which these techniques have been indicated (AU)

Polymorphisms within the promoter and the intron 2 of the serotonin transporter gene in a population of bulimic patients.

The serotonin transporter (5-HTT) gene is a firm candidate to explain eating disorders. In this association study, two different polymorphisms were analysed: a variable number of tandem repeat (VNTR) polymorphism in intron 2 and a deletion/insertion polymorphism (5-HTTLPR) in the promoter region. The hypothesis that these gene polymorphisms may be a susceptibility factor in bulimia nervosa (BN) was explored in a female population of 102 purgative bulimics. BN patients who have suffered preceding anorexia nervosa (AN) episodes formed the so-called previous AN bulimic patient group. In our sample of normal-eater controls and purging type bulimics, regardless of whether or not the BN patients had suffered prior AN episodes, no differences were found considering the frequencies of genotypes, alleles or haplotypes of both polymorphic regions of the 5-HTT gene.

La imagen corporal en pacientes con deformidades dentofaciales tratados mediante cirugía ortognática / Body image in patients with dentofacial deformities treated by orthognatic surgery

Objetivo: Las posibles repercusiones psicológicas de las deformidades dentofaciales y los efectos que su tratamiento puede ejercer sobre la imagen corporal provocan importantes controversias. En este estudio, que forma parte de una investigación prospectiva más amplia sobre distintos aspectos psicológicos de los pacientes adultos con deformidades dentofaciales graves susceptibles de cirugía ortognática, se evalúa la imagen corporal de una muestra de pacientes antes y en distintos momentos después de su tratamiento quirúrgico. Método: En una muestra de pacientes (N= 58) con diversos tipos deformidades faciales se evaluaron las puntuaciones de imagen corporal mediante las dos subescalas, general y oclusal-facial, del test de Secourd y Jourard modificado en cuatro momentos sucesivos: una semana antes de la cirugía (T0) y un mes (T1), seis meses (T6) y un año (T12) después de la misma. Resultados: A pesar de la gravedad de la deformidad, antes de la cirugía no se observaron diferencias entre los individuos de la muestra y la población general en ninguna de las dos subescalas de imagen corporal. En T6 se observó un aumento significativo respecto la población general en las puntuaciones de ambas subescalas (p< 0,001). En T6 también se observó un incremento significativo respecto a T0 tanto en la escala general (p< 0,05) como en la facialoclusal (p< 0,001). En T12 se mantenían las diferencias significativas en ambas subescalas respecto a la población general, pero en relación a T0 sólo en la subescala facial oclusal (p< 0,001). No se observaron diferencias significativas entre las determinaciones en T6 y T12. Conclusión: En este estudio se confirma el efecto positivo de la cirugía ortognática sobre la imagen corporal a medio plazo, pero es necesario un seguimiento mayor para evaluar la persistencia de estos resultados y sus eventuales cambios (AU)

[Body image in patients with dentofacial deformities treated by maxillofacial surgery]. / La imagen corporal en pacientes con deformidades dentofaciales tratados mediante cirugía ortognática.

OBJECTIVE: Considerable controversies exist about the psychological impact of dentofacial deformities and the effects of treatment on body image. This research, which is a part of a longitudinal prospective study about a number of psychological aspects of adult patients with severe dentofacial deformities treated by orthognatic surgery, assesses the body image of a sample of patients before and after treatment. METHOD: Two subscales, general and facial-oclusal, of the modified Secord and Jourard test were used to evaluate body image of a sample of orthognatic surgery patients (N = 58). The questionnaires were completed at four time points: one week before surgery (T0), and one (T1), six (T6) and twelve months (T12) after surgery. RESULTS: Despite the severity of dentofacial deformity, presurgical mean scores of both subscales of body image test were normal. T6 scores were significantly higher than normative levels in both subscales (p < 0.001). T6 scores were also significantly higher than T0 in both general (p < 0.05) and facial-oclusal subscales (p < 0.001). T12 measurements showed significant differences in both subscales with respect to normative levels but significant differences between T12 and T0 were only found in facial oclusal subscale (p < 0.001). No differences were found between T12 and T6 scores. CONCLUSION: The positive effect of orthognatic surgery on body image is encouraging, but longer follow up is needed to evaluate the persistence of results and the eventual occurrence of any late change.

[Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain]. / El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España.

BACKGROUND: In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD: A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study. RESULTS: Consult request took place 10.6 days (on average) after the patients admission (<>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <>. CONCLUSIONS: The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <> is also emphasized.

[Psychosocial factors in patients with duodenal ulcer]. / Factores psicosociales en la úlcera duodenal.

The authors review the current literature on psychosocial aspects of duodenal ulcer. The initial simple psychosomatic approach, has evolved to a multifactorial schema in which stress and individual vulnerability plays an important role. Psychological features (personality, Type A behaviour, alexithymia, anxiety, depression) and socioenvironmental factors (stress, life events, coping, social support) are analyzed. Newer aspects like the probable stress influence on immunity and infection by Helicobacter pylori are considered.

[Effect of family environment on adaptation to the hemodialysis program in patients with chronic renal insufficiency]. / Influencia del clima familiar en la adaptación al programa de hemodiálisis en pacientes con insuficiencia renal crónica.

In our study we have analyzed the influence of family environment on adjustment of renal patients to the HD as well as on the attitude towards kidney transplantation. The study included 57 patients (34 M, 23 F), mean age 52.3 years, and they had been on dialysis for an average of 34.5 months. We obtained information about adaptation and behavior in the care unit, and attitude and motivation towards renal transplantation. Biochemical variables were used to register disruption of medical compliance or dietetic transgression (K, PRC, BUN, weight gain, etc.). The patient's family climate was assessed through use of the Family Environment Scale (FES, Moos and Moos, 1981). The results showed that patients with aggressiveness and noncompliance during HD sessions tended to have high family conflict in family members. The most positive attitudes towards renal transplantation were found in the patients that came from families with the greatest degree of cohesion and expressiveness. In summary, family social climate is a variable influencing outcome of these patients. Its routine assessment would permit the prediction of adaptation to the therapeutic program as much as better efficacy of HD treatment.

Basal hypersecretion of cortisol in relation to abnormal dexamethasone suppression test response in depression.

The activity of the hypothalamus-hypophysis-adrenal axis was evaluated in a group of patients with primary affective disorder by correlation of basal cortisol hypersecretion and abnormal response to dexamethasone suppression test (DST). The increase in basal cortisol was not found to be responsible for suppression failure. Moreover, this biochemical abnormality was common in the groups of psychiatric patients studied, although the physiopathologic mechanisms involved are different. Further research is necessary to clarify the results.

The dexamethasone suppression test in delusional depression. Further findings.

The results of the overnight 1 mg dexamethasone suppression test (DST) administered to 26 unipolar delusional depressed patients and 47 unipolar non-delusional depressed controls are reported. There were no significant differences between the rates of abnormal responses in the two groups. However, there was a higher percentage of normal responses in the delusional depressive sample with mood incongruency. While 55% of the mood-congruent depressive patients were non-suppressors, only 12% of the depressed patients with mood-incongruent psychotic features had abnormal DST responses.

Dexamethasone suppression test and familial subtypes of unipolar depression.

We have studied the suppression of plasma cortisol after dexamethasone (1 mg) and the peak post-dexamethasone cortisol values in 84 hospitalized patients with a diagnosis of primary unipolar depression. The non-suppressor responses in the three familial subgroups (Winokur) were: 11/22 in familial pure depressive disorder (FPDD), 21/49 in sporadic depressive disease (SDD) and 1/13 in depression spectrum disease (DSD) (FPDD vs. SDD, p less than 0.05; SDD vs. DSD, p less than 0.05). When considering the peak post-dexamethasone cortisol value, or the 8.30-9.00-hour values, the results in the DSD group were lower than in the other two groups (p less than 0.05). These results suggest a different behaviour of DSD as compared with FPDD and SDD.

[Clinical and endocrinological aspects of delusional depression]. / Aspectos clínicos y neuroendocrinológicos de las depresiones delirantes.

A comparative study of 26 delusional depressive patients versus 47 non-delusional depressed controls is presented. In addition to the clinical evaluation, the dexamethasone suppression test was performed. The results show higher severity and increased retardation in the delusional sample. The breakdown of delusions demonstrates that the most common delusions were of reference and guilt. Multiple delusions were found more frequently than one type of delusions. The D.S.T. results show no significant differences between the rates of abnormal responses in both groups. However in the delusional depressive sample with mood-incongruency there was a higher percentage of normal responses.