Síntomas conductuales y emocionales de adolescentes que consultan a un programa especializado de trastornos de la conducta alimentaria / Behavioural and Emotional Symptoms of Adolescents Consulting a Specialised Eating Disorders Programme

RESUMEN Introducción: Los trastornos de la conducta alimentaria (TCA) son afecciones complejas de origen multifactorial que tienen como principal característica la preocupación excesiva por el peso y la forma del cuerpo, que causa gran malestar y afectación física llevando a una disminución de la calidad de vida y alteraciones de la funcionalidad del paciente y su entorno social. El objetivo de este estudio es describir los síntomas de orden emocional y conductual de los adolescentes que consultan en la ciudad de Bogotá a un programa especializado en TCA. Métodos: Estudio observacional y descriptivo de corte transversal, para el que se reclutó a pacientes de 11-19 arios con diagnóstico de TCA. Resultados: Se incluyeron 40 pacientes con diagnóstico de TCA, el 92% mujeres. El promedio de edad de los pacientes fue 16,6 ± 1,9 años. El 57% de los pacientes viven en hogar biparental y el 30%, en hogar monoparental. El 72% de la población tenía un rendimiento académico excelente. El 50% de los pacientes estaban moderadamente enfermos. El 60% estaba en tratamiento farmacológico con ISRS. El 65% de los pacientes cumplían criterios clínicos de trastorno de ansiedad; el 30%, de trastorno depresivo; el 22,5%, de problemas de agresividad, y el 17,5%, de conducta delictiva. El 72,5% de la muestra muestra criterios clínicos de síntomas internalizantes y el 42,5%, de síntomas externalizantes, y la mayoría de ellos son pacientes con diagnóstico de bulimia nerviosa. Conclusiones: Los pacientes con bulimia nerviosa obtuvieron en los diferentes síntomas de orden emocional y conductual puntuaciones superiores que con los demás trastornos alimentarios. Esta entidad ofrece mayor psicopatología, la cual se debe examinar rigurosamente al momento de la atención clínica, buscando disminuir el impacto funcional que estos síntomas generan en el individuo.

ABSTRACT Introduction: Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. Methods: Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. Results: Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6 ± 1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. Conclusions: Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.

Behavioural and emotional symptoms of adolescents consulting a specialised eating disorders programme.

INTRODUCTION: Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS: Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS: Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS: Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.

Behavioural and Emotional Symptoms of Adolescents Consulting a Specialised Eating Disorders Programme. / Síntomas conductuales y emocionales de adolescentes que consultan a un programa especializado de trastornos de la conducta alimentaria.

INTRODUCTION: Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS: Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS: Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS: Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.

Teorías contemporáneas del desarrollo ético y su aplicación a la psiquiatría / Contemporary Theories of Ethical Development and their Application to the Field of Psychiatry

Introducción: Este artículo presenta una revisión que expone los modelos explicativos e interpretativos de los procesos mentales que conllevan los juicios morales en el ámbito de la bioética. Métodos: Una investigación de carácter documental de las recientes teorías del desarrollo ético, organizada y sistematizada en las categorías que relacionan los diferentes modelos interpretativos de desarrollo ético. Resultados: Se encontraron en la bioética, las psicologías sociales y evolucionistas y la neurótica, nuevas teorías explicativas del desarrollo ético, en las cuales se enfatiza el componente emocional y situacional del individuo y su fundamentación neurofisiológica. Conclusiones: En la literatura analizada se consideraron los referentes teóricos que fundamentan el proceso de desarrollo moral; además, se postula la necesidad de trabajar en un modelo narrativo desde la bioética, centrado en particularidades del individuo o la comunidad...

Introduction: This article presents a review of interpretive models that explain mental processes involved in moral judgments in the field of bioethics. Method: We conducted a documentary research of recent theories of ethical development, organizing and systematizing them into categories that relate different interpretive models of ethical development. Results: We found in bioethics, social and evolutionary psychology, and neuroethics, new explanatory theories of ethical development that emphasize the emotional and situational component of the individual together with its neurophysiological basis. Conclusions: The analyzed literature examines the theoretical framework that provides the foundation for the moral development process...

Costs of medication nonadherence in patients with diabetes mellitus: a systematic review and critical analysis of the literature.

OBJECTIVES: Information on the health care costs associated with nonadherence to treatments for diabetes is both limited and inconsistent. We reviewed and critically appraised the literature to identify the main methodological issues that might explain differences among reports in the relationship of nonadherence and costs in patients with diabetes. METHODS: Two investigators reviewed Medline, EMBASE, Cochrane library and CINAHL and studies with information on costs by level of adherence in patients with diabetes published between January 1, 1997 and September 30th 2007 were included. RESULTS: A total of 209 studies were identified and ten fulfilled the inclusion criteria. All included studies analyzed claims data and 70% were based on non-Medicaid and non-Medicare databases. Low medication possession ratios were associated with higher costs. Important differences were found in the ICD-9/ICD-9 CM codes used to identify patients and their diagnoses, data sources, analytic window period, definitions of adherence measures, skewness in cost data and associated statistical issues, adjustment of costs for inflation, adjustment for confounders, clinical outcomes and costs. CONCLUSIONS: Important variation among cost estimates was evident, even within studies of the same population. Readers should be cautious when comparing estimated coefficients from various studies because methodological issues might explain differences in the results of costs of nonadherence in diabetes. This is particularly important when estimates are used as inputs to pharmacoeconomic models.

Analysis of US Food and Drug Administration Warning Letters: False Promotional Claims Relating to Prescription and Over-the-Counter Medications.

BACKGROUND: Recent studies have suggested that there has been an increase in the number of 'warning letters' issued by the US Food and Drug Administration (FDA) despite the publication of the FDA advertising guidelines. However, limited information is available on the description of warning letters. The objective of this study was to analyse the frequency and content of FDA warning letters in relation to promotional claims and discuss the influence of regulatory and industry constraints on promotion. METHODS: All warning letters published by the FDA between 5 May 1995 and 11 June 2007 were reviewed. Warning letters related to promotional issues were included and analysed. Information related to the identification number, date of the warning letter, FDA division that issued the letter, drug name, manufacturer, specific warning problem, type of promotional material and requested action was extracted. Two independent investigators reviewed and classified each PDF file, any differences were discussed until a consensus was reached. RESULTS: Between May 1995 and June 2007 a total of 8692 warning letters were issued, of which 25% were related to drugs. Of these, 206 warning letters focused on drug promotion and were included in this study: 23% were issued in 2005, 15% in 2004 and 14% in 1998. In total, 47% of the warning letters were issued because of false or misleading unapproved doses and uses, 27% failed to disclose risks, 15% cited misleading promotion, 8% related to misleading labelling and 3% promoted false effectiveness claims. DISCUSSION: There is an important variation in the number of warning letters issued in the last decade, probably because of the increasing number of drugs approved by the FDA, drug withdrawal scandals, and the publication of the FDA and the Pharmaceutical Research and Manufacturers of America (PhRMA) guidelines. CONCLUSION: We found that benefit-related claims, such as unapproved uses or doses of drugs, and failure to disclose risks, are the main causes of FDA issued warning letters for promotional claims related to medications.

Características epidemiológicas asociadas a psicopatología en niños y adolescentes / epidemiological characteristics associated with psychopathology in children and adolescents

Este es un estudio descriptivo donde se analizaron variables epidemiológicas como son edad, sexo, nivel de escolaridad, composición familiar, diagnósticos psicosociales, enfermedades o limitaciones físicas, y se correlacionaron con los diagnósticos psiquiátricos recibidos por 482 niños que asistieron a consulta de psiquiatría infantil y a quienes se les practicó evaluación mediante entrevista semiestructurada. Los resultados coinciden en su mayoría con las tendencias mostradas en estudios internacionales, excepto en lo relacionado a los cuadros psicopatológicos asociados al tamaño de la familia y el orden de los hijos en el hogar. Los hallazgos confirman la importancia de los factores psicosociales en los trastornos psiquiátricos del niño y del adolescente...

This is a descriptive study where epidemiological variables such as age, sex, schooling level, family structure, psychosocial diagnosis, physical illness or limitations were correlated with a psychiatric diagnosis in 482 children who attended a child psychiatric service where they were evaluated with a semistructured interview. Results are simílar to those tendencies shown in the literature except in the cases of psychiatric disorders associated with the family size and ordinal positíon of the child. These results confirm the importance of psychosocial factors in psychiatric disorders in childhood and adolescence...