Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD).

Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS: The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

Effect of Low-Dose Statins in Addition to Standard Therapy on Brain Perfusion and Neurocognitive Performance in Patients with Major Depressive Disorder.

INTRODUCTION: Major depressive disorder (MDD) is a prevalent condition which has a well-known association with ischemic cardiomyopathy, probably explained by an inflammatory mediator mechanism. Statins, besides reducing cholesterol production, have pleiotropic effects including anti-inflammatory activity. The goal was to evaluate the effect of statins as an addition to standard therapy on mood status, brain perfusion, and neurocognitive performance in MDD. METHODS: We studied 20 MDD patients with brain single-photon emission tomography and Cambridge Neuropsychological Test Automated Battery (CANTAB), half randomized to 10 mg of Rosuvastatin or placebo, in addition to selective serotonin reuptake inhibitors (SSRIs) therapy and being reevaluated 3 months later. The images were compared using Statistical Parametric Mapping; clinical scores (Hamilton Depression Score with 17 items and Beck's Depression Inventory) as well as neurocognitive parameters were applied as covariances (CoV) to estimate regional cerebral blood flow (rCBF) changes with both therapies. RESULTS: Clinical scores decreased in both groups (p = 0.0001); Beck's presented a larger decrease with statins. We observed significantly rCBF changes expressed as significant larger clusters of voxels (p < 0.05) in the pre/subgenual anterior cingulate plus orbitofrontal cortex and a small area in the posterior cingulate gyrus in the statins group, whereas it was not observed with placebo, when using clinical scores as CoV. A similar pattern of rCBF changes was present with emotions recognition, attentional, paired associates learning, spatial planning, and working memory tasks. CONCLUSION: Short-term use of low-dose statins in MDD patients under SSRIs results in important rCBF changes in key mood associated areas to improvement in neurocognitive performance. These findings, even though demonstrated in a small sample, could open a new therapeutic tool in the comprehensive management of this disorder.

Regional Brain Perfusion Is Associated with Endothelial Dysfunction Markers in Major Depressive Disorder.

BACKGROUND: Major depressive disorder (MDD) is an important independent risk factor for cardiovascular disease. Cumulative data suggest that depressive patients exhibit derangement in regional cerebral blood flow (rCBF), although underlying mechanisms remain mostly unknown. Endothelial dysfunction (ED), defined as different forms of abnormal endothelial activity, plays a key role in the pathogenesis of vascular disease. ED is associated with several clinical conditions characterized by high cardiovascular risk. Diverse ED markers have been found in mood disorders. PURPOSE: To evaluate the association between rCBF and peripheral ED markers in MDD patients, at baseline and after selective serotonin receptor inhibitors (SSRIs) therapy. PATIENTS AND METHODS: Twenty-seven untreated unipolar MDD patients in their first episode were evaluated with the Hamilton Depression Rating Scale (HAM-D) and brain perfusion SPECT at baseline and after 2 months of SSRIs. Statistical Parametric Mapping (SPM) was employed to evaluate rCBF; circulating endothelial cells (CECs), plasma soluble intercellular adhesion molecule (sICAM), and high-sensitivity C-reactive protein (hsCRP) were used as independent covariates. RESULTS: Baseline CECs and sICAM were increased in MDD patients compared with matching controls (p = 0.0001) and hsCRP (p = 0.03). HAM-D scores (21 items) and CECs diminished after SSRI therapy in MDD patients (p < 0.0001). There was a significant rCBF decrease, mainly in deep central structures. HAM-D change was associated with rCBF decrease at the left amygdala, right striatum levels, and Brodmann area 25. CEC change was associated with rCBF at deep brain level and sICAM with large rCBF areas at the left caudate and tectum; hsCRP was associated, to a lesser extent, with the left dorsal striatum and mesencephalic tectum. CONCLUSION: ED markers in patients with MDD are associated with significant changes in rCBF which are features of depression. These findings suggest that systemic damage/activation of the endothelium may contribute to the abnormal rCBF observed in MDD patients.

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis.

BACKGROUND: Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a twofold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. METHODS: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. RESULTS: Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD -0.584 [95% CI -1.126 to -0.042], p = 0.03. Also, a significant decrease in depressive symptomatology (SMD -0.894 [95% CI -1.388 to -0.399], p < 0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p < 0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI -1.164 to 1.632, p = 0.74) or affective switch were found. CONCLUSION: Adding TSD to medications to bipolar depression treatment resulted in an augmentation in acute response. We also found that medications have a positive impact in acute response when added to TSD. Furthermore, this higher response rate was maintained after 3 months while keeping Lithium therapy.

Trastornos del ánimo, nutrición y craving / Mood disorders, nutrition and craving

Resumen Objetivos: La relación entre diversas variaciones de la ingesta alimentaria y los trastornos del ánimo es un fenómeno bien conocido para diversos clínicos. No obstante estos fenómenos han sido escasamente estudiados a la fecha. Los métodos de evaluación del atracón o "craving" son diversos, lo que ha generado hallazgos heterogéneos y superficiales. El objetivo de esta revisión es un análisis de la fenomenología del craving y las diversas relaciones entre nutrición y trastornos del ánimo, específicamente con el trastorno bipolar (TBP). Método: Se realizó una revisión narrativa a través de una búsqueda no sistemática de la literatura a través de la base de datos MEDLINE, utilizando términos MeSH. Resultados: Los resultados en esta área a la fecha son escasos y diversos. Se evaluó la evidencia a la fecha en torno a la relación bidireccional entre TBP y nutrición, y con trastornos de la conducta alimentaria (TCA), específicamente el trastorno por atracones (TA). Por otro lado se revisó la literatura en cuanto a la comprensión del concepto de craving (antojo o deseo intenso) por carbohidratos, su neurobiología y sus relaciones con los trastornos del ánimo, específicamente con el TBP. Conclusiones: A pesar de que los desórdenes analizados aquí presentan relaciones conocidas de larga data por los clínicos dedicados a trastornos del ánimo, la literatura de investigación ha sido bastante limitada acerca de tales relaciones. Considerando las importantes implicancias que pueden llegar a tener en el diagnóstico, evolución y terapéutica de los pacientes, parece necesario un esfuerzo por continuar avanzando en la comprensión de los mecanismos más íntimos de estos trastornos, sus aspectos clínicos y sus diversas relaciones.

Objectives: The relationship between food intake alterations and mood disorders is a well-known phenomenon for various clinicians. However, these phenomena have been scarcely studied to date. The methods of evaluation of craving are diverse, generating heterogeneous and superficial findings. A more refined analysis of the phenomenology of craving and the various relationships between nutrition and mood disorders, specifically Bipolar Disorder (BPD), are the objetives of the present review. Method: A narrative review was carried out through a non-systematic search of the literature through the MEDLINE database, using MeSH terms. Results: The results in this area to date are scarce and diverse. We evaluated the evidence to date about the bidirectional relationship between BPD and nutrition, and Eating Disorders (ED), specifically, Binge Eating Disorder (BEA). On the other hand, the literature was revised in terms of understanding the concept of craving for carbohydrates, its neurobiology, and its relationships with mood disorders, specifically BPD. Conclusions: Despite being concepts and relationships long-known by clinicians dedicated to mood disorders, literature and research was quite limited in relation to this. Independent academic efforts remain pending to continue developing in the understanding of the intimate mechanisms of these disorders, their clinical phenomena and diverse relationships, considering the important implications that they may have on the diagnosis, evolution and therapies of patients.

Estrategia de tratamiento acortado y estrictamente supervisado en pacientes con tuberculosis pulmonar confirmada / Strategy of strictly monitored and shortened treatment in patients with confirmed pulmonary tuberculosis

Se realizó una investigación descriptiva y transversal para caracterizar a los pacientes con tuberculosis pulmonar, cuyos esputos fueran positivos para bacilos-ácido-alcohol-resistente, en una población abierta del municipio de Santiago de Cuba, desde el 2003 hasta el 2007, los cuales se acogieron a la estrategia de tratamiento acortado estrictamente supervisado. En la casuística predominaron el sexo masculino, los adultos jóvenes, así como los factores de riesgo: hábito tabáquico, alcoholismo y antecedente de contactos con personas afectadas por dicha enfermedad. La atención primaria de salud no cumplió el indicador operacional del diagnóstico de estos pacientes ni el seguimiento baciloscópico mensual. Se recomienda elaborar una estrategia de intervención que contemple un proyecto capacitante, encaminado a elevar la competencia profesional del personal sanitario en relación con la asistencia integral incluida en el Programa Nacional de Control de la Tuberculosis(AU)

A cross-sectional and descriptive study was conducted to characterize patients with pulmonary tuberculosis whose sputa were positive for acid-alcohol resistant bacilli, in a general population of Santiago de Cuba municipality, from 2003 to 2007, who opted for the strategy of strictly monitored and shortened treatment. Male sex, young adults as well as risk factors: smoking habit, alcoholism and history of contacts with people affected by this disease prevailed in the case material. Primary health care neither meet the operational indicator of the diagnosis of these patients nor the monthly bacilloscopy. It is recommended to develop an intervention strategy that includes a project aimed at improving the professional competence of health personnel with regard to comprehensive care included in the National Program of Tuberculosis. Control(AU)

Estrategia de tratamiento acortado y estrictamente supervisado en pacientes con tuberculosis pulmonar confirmada / Strategy of strictly monitored and shortened treatment in patients with confirmed pulmonary tuberculosis

Se realizó una investigación descriptiva y transversal para caracterizar a los pacientes con tuberculosis pulmonar, cuyos esputos fueran positivos para bacilos-ácido-alcohol-resistente, en una población abierta del municipio de Santiago de Cuba, desde el 2003 hasta el 2007, los cuales se acogieron a la estrategia de tratamiento acortado estrictamente supervisado. En la casuística predominaron el sexo masculino, los adultos jóvenes, así como los factores de riesgo: hábito tabáquico, alcoholismo y antecedente de contactos con personas afectadas por dicha enfermedad. La atención primaria de salud no cumplió el indicador operacional del diagnóstico de estos pacientes ni el seguimiento baciloscópico mensual. Se recomienda elaborar una estrategia de intervención que contemple un proyecto capacitante, encaminado a elevar la competencia profesional del personal sanitario en relación con la asistencia integral incluida en el Programa Nacional de Control de la Tuberculosis

A cross-sectional and descriptive study was conducted to characterize patients with pulmonary tuberculosis whose sputa were positive for acid-alcohol resistant bacilli, in a general population of Santiago de Cuba municipality, from 2003 to 2007, who opted for the strategy of strictly monitored and shortened treatment. Male sex, young adults as well as risk factors: smoking habit, alcoholism and history of contacts with people affected by this disease prevailed in the case material. Primary health care neither meet the operational indicator of the diagnosis of these patients nor the monthly bacilloscopy. It is recommended to develop an intervention strategy that includes a project aimed at improving the professional competence of health personnel with regard to comprehensive care included in the National Program of Tuberculosis. Control

Current challenges and future perspectives of the role of governments in the psychiatric/mental health systems of Latin America.

The practices and systems of mental health in Latin America and the Caribbean are heterogeneous and are connected to dissociation between national macro systems and the complex quotidian that occurs in the daily attention of mental pathologies. The health care experiences in mental health are diverse and go back to the 1960s; these took a boost with the Caracas Declaration of 1990. The Health Care Reform has had several stages, lately focused in the strength that derives from a growing psychiatric epidemiology "base". In addition, it notes that the majority of countries have a National Plan of Mental Health, but they do not seem purposely deployed in local developmental plans or in other sectors. It is proposed the existence of a willing to discuss psychiatry, critical and bold; trans and intrasectoral face to the national and communal developments. Governments need to prioritize strategies in mental health as an integral part of another national project with regard for quality of life and productivity of citizens. The communication poses challenges for the next 15 years, with what is complete the first quarter of this century, proposing a series of measures even basic, but valid for this part of the continent.

Apuntes sobre la configuración actual del ethos médico / Sketches about nowaday's medical ethos / Apontamentos sobre a confuguracão atual do ethos médico

El perfil que en términos éticos ha ido adquiriendo el rol del médico en la sociedad actual no ha sido considerado suficientemente como objeto de análisis ni entre el mismo cuerpo médico ni por otras instancias de reflexión, aun cuando los efectos de este insensible pero significativo cambio se dejan ver en múltiples aspectos del ejercicio de la profesión médica. Por de pronto, en la "legalización" de la actividad médica, en el cambio de la relación médico-paciente a otra del tipo médico-cliente, en la presión que ejerce la medicina administrada sobre la temporalidad del acto médico, etc., situaciones en las cuales se pueden notar de manera palmaria manifestaciones de lo señalado. Este artículo pretende presentar ciertas bases para una reflexión sobre el tema, desde la perspectiva del "estar en el mundo" que eventualmente correspondería al rol del médico.

In ethical terms the profile that the doctor's rôle has acquired in todayÆs society has not been sufficiently considered as an analysis' object neither among the medical corps nor in other reflection instances, even though the effects of this insensible but significant change can be noticed in multiple aspects of the medical professional practice. To begin with, in the "legalization" of the medical activity, in the path from a doctor-patient relationship to another one of the type doctor-client, in the pressure that the administrated medicine puts on the temporality of the medical act, etc., situations through which you can clearly see manifestations of what has just been pointed out. This paper pretends to set certain basis that would lead to consider the subject from the "to be in the world" perspective that, eventually, corresponds to the doctor's role.

O perfil ético que vem adquirindo o papel do médico na sociedade atual não tem sido considerado suficientemente objeto de análise, sequer pelo próprio corpo médico, além de outras instâncias de reflexão, ainda quando os efeitos desta insensível, porém significativa mudança, tornam-se visíveis nos múltiplos aspectos do exercício da profissão médica. Uma, de imediato, na "legalização" da atividade médica, na mudança da relação médico-paciente; a outra, do tipo médico-cliente, na pressão que exerce a medicina administrada sobre a temporalidade do ato médico etc., situações nas quais se pode notar, de modo palmar, manifestações do que foi assinalado. Este artigo pretende apresentar certas bases para uma reflexão sobre o tema, a partir da perspectiva do "estar no mundo" que eventualmente corresponde ao papel do médico

Rorschach y bipolaridad: sistema comprehensivo como descriptor de deficit cognitivos / Rorschach and bipolarity: a comprehensive system and describer of cognitive deficit

Nowadays, there is an increasing interest in the study of cognitive disturbances which are involving to the bipolar patients. In this article we propose the use of the Rorschach`s test like a valid instrument to clarify that kind of deficiency. It is used like codifying method in the John E. Exner`s Comprehensive System.

En la actualidad existe un interés creciente por el estudio de los déficit cognitivos que afectan a los pacientes bipolares. En este artículo se propone la utilización del test de Rorschach como herramienta válida en la clarificación de tales déficit. Se utiliza como método de codificación el Sistema Comprehensivo de John E. Exner.

Psicoeducación en el trastorno bipolar: rol del tutor / Psychoeducation in bipolar disorder: tutor role

The present report pretends to evaluate the impact of the application of a psychoeducation model in bipolar patients where the presence of a tutor in incorporated. The protocol consists in the abbreviated version of the bipolar syndrome program of the Clinic Hospital, Barcelona which considers eight sessions with a weekly frequency. Aleatorily, two groups where formed from the University Psychiatric Clinic of the University of Chile. In one group (group 1) the traditional program is applied in the other group (group II ) the tutor in incorporated to the sessions, and who participates during the whole process. Both groups were un by type I bipolar patients. Both the patients from group I and group II maintain eutimic scores at the end of the eight sessions. The application of the Moorfhead-Ardelt test in group I shows an average of + 0.479 which suggests that the group of subjects manifested a better impression of their actual state after the end of the session, while the subjects in group II (with tutor) showed an average of + 0.666 which signals a better appreciation of their state at the end of the sessions compared to group I. In regard to OQ-45.2, the group I showed favorable results, with six subjects from twelve with significant statistical scores ( p<0.05). en group II, four from nine subjects presented significant statistical scores for positive change at the end of the sessions, which in average is slightly superior to the group I scours. There were no significant statistical negative scores observed in either group. In the five month monitoring, the group with a tutor shoed a better evolution, seven out of nine patients were eutimic, while in the group without a tutor just five out twelve maintained in these clinical conditions, which signal a better functioning of the group which incorporated a tutor to the psychoeducational sessions.

El presente informe intenta conocer el impacto de la aplicación de un modelo psicoeducativo en pacientes bipolares donde se incorpora la presencia de un tutor. El protocolo consiste en la versión abreviada del programa de trastornos bipolares del Hospital Clinic, Barcelona que considera 8 sesiones con una frecuencia semanal. Aleatoriamente, se conforman dos grupos de sujetos bipolares atendidos en la Clínica Psiquiátrica Universitaria de la Universidad de Chile. En un grupo (grupo I) se aplica el programa tradicional mencionado, mientras que en el otro grupo (grupo II) se incorpora la presencia de un tutor a las sesiones, el que participa durante todas las jornadas. Los dos grupos estuvieron conformados por bipolares tipo I. Tanto los pacientes del grupo I como del grupo II mantienen al término de las 8 sesiones puntajes de eutimia. La aplicación de la prueba de Moorehead-Ardelt en el grupo I muestra un índice promedio de + 0.479, lo que señala que el conjunto de sujetos manifestó una mejor impresión de su estado actual luego del término de las sesiones, mientras el grupo II (con tutor) mostró un índice promedio de + 0.666, lo que señala un a mejor apreciación de su estado al término de las sesiones con respecto al grupo I. En cuanto al OQ-45-2, el grupo I mostró resultados favorables, con 6 sujetos de 12 con índices estadísticamente significativos (p< 0,05). En el grupo II, 4 de 9 sujetos presentan índices significativos estadísticos de cambio positivo al término de las sesiones, lo que en promedio supera levemente a los apreciados en el grupo I. No se observaron resultados negativos estadísticamente significativos en ningún sujeto tanto del grupo I como del II. En el seguimiento a cinco meses, el grupo contutor mostró una mejor evolución, pues 7 de 9 pacientes mostraron eutimia, mientras que el grupo sin tutor sólo 5 de 12 se mantenían en estas condiciones del grupo en que se incorporó al tutor a las sesiones psicoeducativas.

Cuestionario de estado disfórico (CED): evaluación de la versión piloto / Dysphoric status questionnaire: evaluation of the pilot version

In the field of the affective disorders, clinical experience and diverse factorial analysis studies raise the existence of a dysphoric syndrome as a different affective state, distinguible from depressive and maniac states. This syndrome could be more frequent in bipolar patients and be at the base of some of the denominated mixed forms. This discussion has been delineating a psychopathology for dysphoric states that is necessary to operationalize for research purposes. The present study has sought to create of a dysphoric syndrome screening tool for patients with affective disorders, and to explore its psychometric properties in an ambulatory mixed clinical sample of unipolar and bipolar patients. The instrument has encouraging psychometric properties. We found that some items separately, and the questionnaire as a whole, had good discriminating capacity to distinguish between unipolar and bipolar patients.

En el campo de los trastornos afectivos, la experiencia clínica y diversos estudios de análisis factorial plantean la existencia de un síndrome disfórico como un estado afectivo diferente y distinguible de los estados depresivos y maníacos. Este síndrome podría ser más frecuente en pacientes bipolares y estar a la base de algunas de las denominadas formas mixtas. Esta discusión, ha ido delineando una psicopatología del estado disfórico que es necesario operacionalizar para propósitos de investigación. El presente estudio ha buscado crear de un instrumento de screening para el síndrome disfórico en pacientes con trastornos afectivos, y explorar sus propiedades psicométricas en una muestra clínica mixta de pacientes psiquiátricos ambulatorios monopolares y bipolares. El instrumento posee propiedades psicométricas alentadoras. Encontramos que algunos ítems por separado, y el cuestionario en su conjunto, poseían buena capacidad discriminante para distinguir entre pacientes unipolares y bipolares.

Privación total de luz en estados mixtos / Total light deprivation in mixed episodes

Los pacientes bipolares presentarían una acentuada vulnerabilidad a los cambios en los ritmos biológicos, a las alteraciones del ciclo vigilia-sueño así como mayor sensibilidad a los efectos de la luz y oscuridad. Existen trabajos preliminares donde se reporta que la oscuridad total se ha usado exitosamente en el tratamiento de manía aguda y ciclación rápida. A tres mujeres diagnosticadas como bipolares tipo I, que cursan recientes estados mixtos, que mantienen el tratamiento farmacológico sin modificaciones, se les agrega oscuridad total durante 14 horas los primeros siete días y 10 horas desde ese momento y durante cuatro meses. Al cabo de tres semanas se alcanza respuesta objetivada con escalas de manía de Young y de depresión de Hamilton y desaparición del perfil mixto en carta diaria de ánimo. Tratamientos cronobiológicos como la oscuridad total pueden ser de utilidad en el tratamiento de estados mixtos, asociándolos a tratamiento en uso.

Bipolar patients tend to be more vulnerable to biological paces changes, as to wakefulness sleep cycle disturbances, and they are more sensitive to the effects of light and darkness. There are preliminary data reports on investigations with total darkness treatment, showing that it is a successful weapon for mood stabilization of manic and rapid-cycling bipolar patients. Three women diagnosed as type I bipolar disorder, whose recent episode was a mixed state, where exposed to total darkness for 14 hours during the first week and 10 hours for the rest of the investigation(4 months), without taking away or changing pharmacotherapy. After three weeks, a response was reached (evaluated with YMRS and the Hamilton Depression rating scale). By the same time, the mixed mood symptoms disappeared on daily mood charts. Chronobiological treatments such as total darkness may be a useful tool in the treatment of mixed states.

Trastonos del ánimo en pacientes HIV + y SIDA / Mood disorders on HIV patients and AIDS

Los trastornos del ánimo se presentan como una expresión frecuente del efecto de la infección por el HIV en el Sistema Nervioso Central, en especial la depresión mayor. Las características de la población HIV+/SIDA, su tratamiento antiviral y la importante comorbilidad, hacen que sea especialmente difícil realizar un manejo farmacológico adecuado sin incurrir en costo de efectos adversos e interacciones medicamentosas. Pese a lo anterior se justifica el tratamiento farmacológico de los trastornos anímicos por beneficios reportados en calidad de vida, adherencia a terapia antirretroviral, disminución en consultas y hospitalizaciones en servicios de urgencia, y en el costo económico asociado. En la línea del manejo terapéutico de los Trastornos depresivos aparecen como primera alternativa los ISRS por su efectividad y bajo perfil de efectos adversos. Los antidepresivos noveles podrían significar una alternativa atractiva en el momento en que se disponga de más información relativa a su seguridad y eficacia en este grupo de pacientes. En cuanto al manejo de las manías, el Litio constituye el estabilizador de elección por su rol protector en el deterioro neurocognitivo, estimulación de la función hematopoyética y en la ganancia de peso, aún cuando su tolerancia es menor que en la población general. El Valproato es cuestionado por un efecto promovedor de la replicación viral in vitro y por su interacción con AZT. La Carbamazepina no debiera preferirse al representar riesgo importante por efectos adversos dérmato y hematológicos, además de su importante interacción con medicamentos antirretrovirales. Por último, falta investigación para definir con más claridad la neurofisiopatología de los Trastornos anímicos por HIV y ensayos con poblaciones mayores buscando los esquemas que representen la mejor alternativa en bajo costo de efectos adversos e interacciones farmacocinéticas y un alto beneficio por efectividad en respuestas.

The mood disorders show up as a frequent expression of the effect in the Central Nervous Sistem`s HIV inffection, specially as Major Depression. The HIV/AIDS population´s characteristics, the antiviral treatment and the frequent comorbidity make specially difficult to achieve a proper therapy without provoking lateral effects or pharmacological interactions. Despite this, it is justified to offer a pharmacological treatment in mood disorders, because it would report a benefit in life quality and therapy compliance, less rates in urgency attentions, incomes in general hospital sand involved economic resources. In the therapeutic management of the depressive disorders ,the SISR are the election because of its effectiviness and low perfil in lateral effects. Novels antidepressants drugs may be a good alternative when were available more information supporting its security and efficacy in this group of patients. In relation of the management in Mania, Lithium is still the first choice as a mood stabilizator, due its neurocognitive protection function, weigthgain and its hematopoyetic effect, even tough it is less tolered in this group than in general population. Valproic acid is not widely accepted because its probably stimulating action in viral replication and for its interaction with Zidovudine. Carbamazepine would not be elected because it is more likely to induce hematologic and dermatologic side effects, and its multiple interaction with other drugs commonly used in AIDS/HIV patients. In last place, there is need to obtain more information from new researchs for find the fisiophathology in mood disorders in HIV population and follow up works with larger groups to lead for the best pharmacologic choice in clinical response and lower adverse effects.

[Trends in benzodiazepine use in primary care patients]. / Tendencia del uso de benzodiazepinas en una muestra de consultantes en atención primaria.

BACKGROUND: Benzodiazepine use is associated to a risk of abuse of dependency. In Chile benzodiazepine abuse is a public health issue. In an attempt to overcome this problem, several restrictions in their prescription were implemented by the health authority. Despite these measures, inadequate use of benzodiazepines in primary care continues to be frequent. AIM: To study the frequency of benzodiazepine use among primary care patients. MATERIAL AND METHODS: Cross sectional survey done during two days, with seven physicians working in public primary care clinics. They applied a structured questionnaire about psychotropic medication use. RESULTS: One hundred eighty eight subjects aged 46.8 +/- 17.5 years, 66% women, were interviewed. Thirty two percent were consuming a psychotropic drug and 82% of these corresponded to benzodiazepines. General practitioners and psychiatrists prescribed the drug to 75% and 13% of subjects, respectively. A higher frequency of benzodiazepine use was observed in women and in urban areas. CONCLUSIONS: Benzodiazepine use continues to be highly prevalent in primary care patients, in spite of the nationwide implementation of controlled prescriptions.

Periodicidades en la evaluacíon longitudinal del estado afectivo / Periodicities in the longitudinal evaluation of affective status

Se dellatan los ritmos circadianos e infradianos de estado afectivo (EA) en 12 sujetos (10 con trastornos afectivos y 2 sin trastorno mental). Se utilizó la escala visual segmentada ESTA-III, con la cual se obtienen puntajes para dos dimensiones: Animo e Impulso. Los sujetos hicieron una auto-evaluación del EA cada 8 horas por alrededor de un mes. Se comunica el procedimiento estadístico y se discuten las implicaciones teóricas de los hallazgos

Periodicidades en la evaluacíon longitudinal del estado afectivo / Periodicities in the longitudinal evaluation of affective status

Se dellatan los ritmos circadianos e infradianos de estado afectivo (EA) en 12 sujetos (10 con trastornos afectivos y 2 sin trastorno mental). Se utilizó la escala visual segmentada ESTA-III, con la cual se obtienen puntajes para dos dimensiones: Animo e Impulso. Los sujetos hicieron una auto-evaluación del EA cada 8 horas por alrededor de un mes. Se comunica el procedimiento estadístico y se discuten las implicaciones teóricas de los hallazgos (AU)

La CIE-10 y los trastornos del humor / The ICD-10 and the mood disorders

Se evalúan 30 pacientes afectivos por une quipo de Salud Mental siguiendo criterios diagnósticos CIE-10 y DSM-III-R. Se comparan los resultados. Se analizan aspectos significativos de la CIE-10 y diferencias entre ambas clasificaciones en esta área