Characterisation of three polymorphisms of the tryptophan hydroxylase 2 gene in a sample of Colombian population with major depressive disorder / Caracterización de tres polimorfismos del gen de la triptófano hidroxilasa 2 en una muestra de población colombiana con trastorno depresivo mayor

ABSTRACT Objective: Identify whether rs11179000, rs136494 and rs4570625 polymorphisms of the tryptophan hydroxylase 2 gene, are associated with a major depressive disorder in a sample of the Colombian population. Methods: Case-control study was conducted in which a comparison was made between subjects diagnosed with major depressive disorder at some point in adulthood or active symptoms at the time of evaluation, and subjects with no psychiatric disease. Subjects were studied in the Department of Psychiatry, Faculty of Medicine and the Institute of Genetics at the National University of Colombia. Polymorphisms were genotyped using Taqman probes in real time PCR. As well as studying the association between major depressive disorder and these single nucleotide polymorphisms (SNPs), the association with other factors previously associated with depression were also analysed. Results: No statistically significant association between genotypic and allelic frequencies of each polymorphism and major depressive disorder was found. Association between sex and complication during pregnancy/childbirth and major depressive disorder was observed. Association between sex and complication during pregnancy/childbirth and major depres sive disorder was observed. Conclusions: There was no association between any polymorphism and major depressive disorder.

RESUMEN Objetivo: Identificar si los polimorfismos rs11179000, rs136494 y rs4570625 del gen de la triptófano hidroxilasa 2 están asociados a trastorno depresivo mayor en una muestra de población colombiana. Métodos: Estudio de casos y controles en el que se comparó a sujetos con trastorno depresivo mayor diagnosticado en algún momento de la vida adulta o con síntomas activos en el momento de la valoración y sujetos sin enfermedad psiquiátrica. Se estudió a los sujetos en el Departamento de Psiquiatría de la Facultad de Medicina y en el Instituto de Genética de la Universidad Nacional de Colombia. Se genotipificaron los polimorfismos usando reacción en cadena de la polimerasa en tiempo real y sondas Taqman. Además de buscar asociación entre trastorno depresivo mayor y estos polimorfismos de un solo nucleótido, se exploró asociación con otros factores relacionados previamente con depresión. Resultados: No se encontró asociación estadísticamente significativa entre las frecuencias genotípicas o alélicas de cada polimorfismo y el trastorno depresivo mayor. Se observó asociación entre sexo y complicaciones durante el embarazo/parto y trastorno depresivo mayor. Conclusiones: No se halló asociación entre polimorfismo alguno y el trastorno depresivo mayor.

[Characterisation of three polymorphisms of the tryptophan hydroxylase 2 gene in a sample of Colombian population with major depressive disorder]. / Caracterización de tres polimorfismos del gen de la triptófano hidroxilasa 2 en una muestra de población colombiana con trastorno depresivo mayor.

OBJECTIVE: Identify whether rs11179000, rs136494 and rs4570625 polymorphisms of the tryptophan hydroxylase 2 gene, are associated with a major depressive disorder in a sample of the Colombian population. METHODS: Case-control study was conducted in which a comparison was made between subjects diagnosed with major depressive disorder at some point in adulthood or active symptoms at the time of evaluation, and subjects with no psychiatric disease. Subjects were studied in the Department of Psychiatry, Faculty of Medicine and the Institute of Genetics at the National University of Colombia. Polymorphisms were genotyped using Taqman probes in real time PCR. As well as studying the association between major depressive disorder and these (single nucleotide polymorphisms (SNPs), the association with other factors previously associated with depression were also analysed. RESULTS: No statistically significant association between genotypic and allelic frequencies of each polymorphism and major depressive disorder was found. Association between sex and complication during pregnancy / childbirth and major depressive disorder was observed. Association between sex and complication during pregnancy / childbirth and major depressive disorder was observed. CONCLUSIONS: There was no association between any polymorphism and major depressive disorder.

The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) - Spanish version: A validity and feasibility study

Background and Objectives: The study aims to assess the feasibility and the level of agreement between the Spanish version GMHAT/PC diagnosis and psychiatrists’ ICD-10 based clinical diagnosis. Methods: Participants in the study ranged from those who were in remission to others who had different mental illnesses. They were recruited from inpatient and outpatient mental health settings. All consecutive patients were interviewed using Spanish version of GMHAT/PC and they were assessed independently by psychiatrists to in order to get their ICD-10 based diagnosis. Results: Two hundred ninety-nine patients participated in the study. The mean duration of interview was 12.5 minutes. There is an acceptable to good level of agreement between the GP’s (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58 95% C.I (0.46, 0.72). There is good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with mental illness and 27 out of 35 of those without. Conclusions: The finding of the study suggest that GMHAT/PC Spanish version used by GPs detected mental disorders accurately and it was feasible to use GMHAT/PC (Spanish version) in Latin America settings (AU)

No disponible

[Metabolic Control, Evaluation and Follow-up Interventions in Patients With Schizophrenia]. / Evaluación y seguimiento metabólico del paciente con diagnóstico de esquizofrenia.

OBJECTIVES: To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. METHODS: A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS: The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. CONCLUSION: Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations.

Evaluación y seguimiento metabólico del paciente con diagnóstico de esquizofrenia / Metabolic Control, Evaluation and Follow-up Interventions in Patients With Schizophrenia

Objetivos: Determinar los exámenes paraclínicos relacionados con riesgo metabólico, que se les deben practicar a los pacientes adultos con diagnóstico de esquizofrenia. Ayudar al clínico en la toma de decisiones sobre las estrategias de evaluación diagnóstica complementarias basadas en el adulto con diagnóstico de esquizofrenia. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se adoptó y actualizó la evidencia de la guía NICE 82, que contestaba la pregunta acá planteada. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: El riesgo de mortalidad general en esquizofrenia es mayor que en la población general excluyendo el suicidio. Los resultados relacionados con la mortalidad asociada a antipsicóticos muestran resultados contradictorios. Los desenlaces metabólicos mostraron una mayor incidencia y asociación con la esquizofrenia y el tratamiento con antipsicóticos (APS). El diagnóstico de dislipidemia en los hombres con esquizofrenia parece ser menor que en la población general. Sin embargo, los cambios en el peso, en los niveles de glicemia, colesterol HDL y triglicéridos están influidos por el uso de antipsicóticos y en general hay un mayor riesgo de desarrollar diabetes mellitus en las personas adultas con esquizofrenia. Conclusión: Con base en la evidencia encontrada se justificó la formulación de un plan de evaluación de variables fisiológicas y paraclínicas, tanto antes como durante el manejo con AP del adulto con diagnóstico de esquizofrenia. Se consideró que la calidad general de la evidencia es baja teniendo en cuenta que la mayoría de los reportes provienen de estudios de observaciones que tienen riesgo de sesgo y algunos diseños tienen limitaciones metodológicas.

Objectives: To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. Methods: A clinical practice guideline was elaborated under the parameters of the Met hodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. Results: The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. Conclusion: Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations.

El proceso de Recertificación es una realidad / The recertification on the way

En Colombia hay 58 Facultades de Medicina, aproximadamente 83400 médicos, casi 150 especialidades médicas reconocidas, en contraste con 40 en Europa. En Psiquiatría hay 17 programas de formación, y más o menos 1300 psiquiatras. Cada vez hay una mayor cantidad de médicos con calidad de formación y experticias muy variables, y un modelo de salud que no favorece los procesos de actualización de los profesionales, siendo la medicina una de las áreas de mayores avances, que requiere por tanto procesos de actualización permanentes para poder brindar la mejor atención a los pacientes. Hay diferentes maneras de garantizar de alguna manera este propósito. Una de ellas es a través de los procesos de recertificación o "Manteinance of Certification".

In Colombia there are 58 Faculties of Medicine, approximately 83,400 doctors, almost 150 recognized medical specialties, in contrast to 40 in Europe. In Psychiatry there are 17 training programs, and more or less 1,300 psychiatrists. There is an increasing number of doctors with highly variable quality of training and expertise, and a health model that does not favor the updating processes of professionals, medicine being one of the areas of greatest progress, which therefore requires processes of permanent updates to provide the best care to patients. There are different ways to guarantee this purpose in some way. One of them is through the recertification processes or "Manteinance of Certification".

Revisión crítica sobre los instrumentos para la evaluación psiquiátrica en atención primaria / Critical revision of Mental health Assessment Tools in Primary Care

Antecedentes. Actualmente existen múltiples escalas y guías de entrevista en atención primaria en salud mental. Sin embargo, estas tienen limitaciones en la práctica clínica diaria. Muchas fueron creadas para realizar investigación, otras requieren gran entrenamiento de quien las aplica y en su gran mayoría cubren un rango limitado de síntomas, por ejemplo ansiedad y depresión. Escalas de gran uso clínico para síntomas ansiosos y depresivos permiten evaluar la presencia o ausencia de síntomas más que dar un diagnóstico específico y deja por fuera un espectro amplio de trastornos psiquiátricos como la demencia y la psicosis. Por estas razones, se han propuesto múltiples alternativas que permitan superar los problemas mencionados. Objetivo. Revisar de forma crítica los instrumentos utilizados para la evaluación psiquiátrica en atención primaria. Materiales y métodos. Revisión de la literatura. Resultados. Dentro de las herramientas desarrolladas y más utilizadas se encuentran la Primary Care Evaluation of Mental Disorders (PRIME-MD) y el Patient Health Questionnaire (PHQ). Otra estrategia es la Herramienta Mundial de Evaluación en Salud Mental (GMHAT). Esta herramienta permite hacer tamizajes amplios y diagnósticos de problemas mentales por personas con poco entrenamiento en psiquiatría y en poco tiempo. Conclusiones. Se recomiendan los instrumentos breves que realizan una valoración global del estado mental sobre aquellos que son específicos para un solo trastorno.

Background. There are many instruments to use in primary care in Mental Health. However, the overall limitations found are that some instruments were developed specifically for research purposes and scales cover a limited range of symptoms and mental disorders like anxiety and depression. Scales used in clinical settings for anxiety and depressive symptoms usually assess the presence or absence of symptoms rather than give a specific diagnosis and leaves out a broad spectrum of psychiatric disorders such as dementia and psychosis. For this reasons, multiple alternatives to overcome these problems have been proposed worldwide. Objective. To review in a critical way the instruments used in primary care. Materials and methods. Literatury review. Results. Among the tools developed and used are the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Patient Health Questionnaire (PHQ). Another instrument is the Global Mental Health Assessment Tool (GMHAT). This tool allows broad screening and diagnosis of mental health problems for people with little training in psychiatry and in a short time. Conclusion. Short Instruments that perform an overall assessment of the mental state are preferred over those that are specific to a single disorder.

Evaluación del riesgo de suicidio en la guía de práctica clínica para diagnóstico y manejo de la depresión en Colombia / Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia

Introducción: El suicidio es la complicación más grave de la depresión, ocasiona altos costos en salud y millones de muertes anuales alrededor del mundo; dadas sus implicaciones, es importante conocer los factores que aumentan su riesgo de ocurrencia y los instrumentos más útiles para abordarlos. Objetivos: Determinar los signos y síntomas que indican un mayor riesgo de suicidio y los factores que aumentan el riesgo en pacientes con diagnóstico de depresión. Establecer los instrumentos que tienen las mejores propiedades para identificar el riesgo suicida en personas con depresión. Método: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de la Protección Social para recolectar evidencia y graduar las recomendaciones de las guías NICE 90 y CANMAT para las preguntas que estas guías contestaban y se desarrollaron de novo para las preguntas no encontradas. Resultados: Se presentan las fundamentaciones y recomendaciones del capítulo de la guía de práctica clínica de episodio depresivo y trastorno no depresivo recurrente correspondientes a la evaluación del riesgo de suicidio. Se incluye el grado de recomendación correspondiente.

Introduction: Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. Objectives: To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. Method: Clinical practice guidelines were developed, following those of the method methodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. Results: Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included.

Factores asociados a rehospitalización temprana en psiquiatría / Factors associated with early psychiatric rehospitalization

Introducción. La rehospitalización temprana es la que se presenta dentro de los tres primeros meses después de un egreso hospitalario. Objetivo. Determinar los factores de riesgo para rehospitalización temprana, evaluando dos posibilidades: que hubiera ocurrido en los primeros tres meses o en el primer mes después del egreso, . Materiales y métodos. Se hizo un estudio de cohorte prospectiva que incluyó 214 pacientes que asistieron a un hospital psiquiátrico en Bogotá. El seguimiento se efectuó durante un año después del egreso. Se analizaron 311 eventos de hospitalización. Se utilizaron modelos de ecuaciones de estimación generalizada (Generalized Estimating Equation, GEE) para datos longitudinales para manejar el caso de medidas repetidas en el análisis estadístico. Resultados. El 49,5 % de los eventos hospitalarios evaluados cumplió el criterio de rehospitalización temprana dentro de los tres meses siguientes y el 31 %, dentro del mes siguiente al egreso. En el modelo de tres meses se encontró asociación significativa con las variables estado civil separadodivorciado (tienen mayor riesgo que los casados), diagnóstico relacionado con uso de sustancias, diagnóstico secundario a condición médica (tienen menor riesgo que los pacientes con enfermedad maníaco-depresiva) y salida por remisión. En el modelo de un mes se encontraron como factores protectores el sexo masculino y la unión libre. Conclusión. En esta muestra de pacientes, la rehospitalización temprana es un fenómeno frecuente. Los factores que mostraron una relación más fuerte tienen que ver con el soporte social, las enfermedades médicas concomitantes, el uso de sustancias psicoactivas y la decisión de remisión a otro centro.

Introduction: Early psychiatric rehospitalization is defined as the readmission within the first three months after discharge. Objective: To determine risk factors for early rehospitalization through the evaluation of two scenarios: readmission within three months and within one month post-discharge. Materials and methods: A prospective cohort study was conducted including 214 patients attending a psychiatric hospital in Bogotá. The follow-up included one year post discharge. A total of 311 hospitalization events were analyzed. GEE models for longitudinal data were used to deal with repeated measures in the statistical analysis. Results: Using the three-month criteria, early rehospitalization was found in 49.5% of 311 hospitalization events, while the one-month criteria was found in 31% of them. The three-month model showed that marital status (divorced-separated), diagnosis of substances use disorder, diagnosis related to medical condition and discharge produced by remission are factors associated with the outcome. The onemonth model showed that male gender and domestic partnership act as protective factors. Conclusion: In this sample, early rehospitalization is a frequent phenomenon. Factors strongly associated are related to psychosocial support, medical comorbidity, psychoactive substances use disorders and remission to a different hospital.

[Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia]. / Evaluación del riesgo de suicidio en la guía de práctica clínica para diagnóstico y manejo de la depresión en Colombia.

INTRODUCTION: Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. OBJECTIVES: To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. METHOD: Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. RESULTS: Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included.

[Factors associated with early psychiatric rehospitalization]. / Factores asociados a rehospitalización temprana en psiquiatría.

INTRODUCTION: Early psychiatric rehospitalization is defined as the readmission within the first three months after discharge. OBJECTIVE: To determine risk factors for early rehospitalization through the evaluation of two scenarios: readmission within three months and within one month post-discharge. MATERIALS AND METHODS: A prospective cohort study was conducted including 214 patients attending a psychiatric hospital in Bogotá. The follow-up included one year post discharge. A total of 311 hospitalization events were analyzed. GEE models for longitudinal data were used to deal with repeated measures in the statistical analysis. RESULTS: Using the three-month criteria, early rehospitalization was found in 49.5% of 311 hospitalization events, while the one-month criteria was found in 31% of them. The three-month model showed that marital status (divorced-separated), diagnosis of substances use disorder, diagnosis related to medical condition and discharge produced by remission are factors associated with the outcome. The one-month model showed that male gender and domestic partnership act as protective factors. CONCLUSION: In this sample, early rehospitalization is a frequent phenomenon. Factors strongly associated are related to psychosocial support, medical comorbidity, psychoactive substances use disorders and remission to a different hospital.

[Age of onset symptoms and gender in schizophrenic spectrum disorders]. / Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico.

INTRODUCTION: Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. OBJECTIVE: The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. MATERIALS AND METHODS: A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. RESULTS: A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. CONCLUSION: The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte I: Factores de riesgo, tamización, diagnóstico y evaluación de riesgo de suicidio en pacientes con diagnóstico de depresión / Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive DisorderPart I: Risk Factors, Screening, Suicide Risk Diagnosis and Assessment in Patients with a Depression Diagnosis

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte I: Factores de riesgo, tamización, diagnóstico y evaluación de riesgo de suicidio en pacientes con diagnóstico de depresión...

Integral care guide for early detection and diagnosis of depressive episodes and recurrent depressive disorder in adults. integral attention of adults with a diagnosis of depressive episodes and recurrent depressive disorderpart i: risk factors, screening, suicide risk diagnosis and assessment in patients with a depression diagnosis...

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte II: Aspectos generales del tratamiento, manejo de la fase aguda, continuación y mantenimiento del paciente con diagnóstico de depresión / Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive DisorderPart II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis. Integral Care

Introducción: El presente artículo busca presentar las recomendaciones basadas en la evidencia que surgieron como respuesta a una serie de preguntas clínicas respecto al episodio depresivo y al trastorno depresivo recurrente, haciendo hincapié en los aspectos generales de tratamiento, el tratamiento en la fase aguda y el manejo de la fase de continuación/mantenimiento, con el fin de brindar parámetros de atención en salud basados en la mejor y más actualizada evidencia disponible para lograr los estándares mínimos de calidad en el abordaje de adultos con dichos diagnósticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de la Protección Social. Se adaptaron las recomendaciones de las guías NICE90 y CANMAT para las preguntas que estas guías contestaban y se desarrollaron de novo para las preguntas no encontradas. Resultados: Se presentan las recomendaciones 5-22 correspondientes al manejo de la depresión...

Introduction: This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. Methodology: A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Results: Recommendations 5-22 corresponding to management of depression are presented...

Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente Parte III: Tratamiento de la depresión resistente y la depresión con psicosis, tratamiento con terapia ocupacional y hospital día / Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder Part III: Treatment of Resistant Depression and Psychotic Depression, Occupational Therapy and Day Hospital Treatment

Introducción: El objetivo del presente artículo es presentar las recomendaciones basadas en la evidencia que surgieron como respuesta a una serie de preguntas clínicas con respecto al episodio depresivo y al trastorno depresivo recurrente, haciendo hincapié en los aspectos generales del tratamiento de la depresión resistente y la depresión con psicosis, el tratamiento con terapia ocupacional y el hospital día, con el fin de brindar parámetros de atención en salud basados en la mejor y más actualizada evidencia disponible para lograr los estándares mínimos de calidad en el abordaje de adultos con dichos diagnósticos. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de la Protección Social. Se adaptaron las recomendaciones de las guías NICE90 y CANMAT para las preguntas que estas guías contestaban y se desarrollaron de novo para las preguntas no encontradas. Resultados: Se presentan las recomendaciones 23-25 correspondientes al manejo de la depresión...

Introduction: This article presents recommendations based on the evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder. Emphasis was given to general treatment issues of resistant depression and psychotic depression, occupational therapy and day hospital treatment so as to grant diagnosed adult patients the health care parameters based on the best and more updated evidence available and achieve minimum quality standards. Methodology:A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while denovo questions were developed. Results: Recommendations 23-25 corresponding to the management of depression are presented...

Edad de inicio como marcador de subtipos de enfermedad maniacodepresiva / Age at onset as a marker of subtypes of manic-depressive illness

Introducción: En los trastornos bipolares, la edad de inicio se ha sugerido como una variable que puede asociarse con diferentes subtipos clínicos. Objetivo: Identificar patrones en la distribución de la edad de inicio de la enfermedad bipolar y determinar si la edad de inicio se asocia con características clínicas específicas. Métodos: Se usó análisis de distribuciones normales mezcladas para identificar subtipos de trastorno bipolar de acuerdo con la edad de inicio. Se aplicó la escala EMUN para evaluar las características clínicas y se estimaron componentes principales para evaluar la relación entre subtipos, según edad de inicio y síntomas en la fase aguda de la enfermedad, utilizando análisis multivariables. Resultados: De acuerdo con la edad de inicio, se encontraron tres distribuciones: inicio temprano: 17,7 años (S. D. 2,4); inicio intermedio: 23,9 años (S. D. 5,6); inicio tardío: 42,8 años (S. D. 12,1). El grupo de inicio tardío es asocial, con síntomas depresivos, trastornos del pensamiento y el lenguaje, y comportamientos socialmente peligrosos. Conclusión: En pacientes con enfermedad bipolar, la edad de inicio es asocial, con tres grupos que tienen características clínicas específicas…

Introduction: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. Objective: To identify patterns in the distribu-tions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. Methods: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. Results: According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. Conclusions: In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics…

Edad de inicio de los síntomas y sexo en pacientes con trastorno del espectro esquizofrénico / Age of onset symptoms and gender in schizophrenic spectrum disorders

Introducción. Existe controversia sobre la posibilidad de que la edad de inicio de la esquizofrenia y de algunas características clínicas del trastorno, sean diferentes entre hombres y mujeres. Objetivo. Evaluar la relación entre sexo, edad de inicio y síntomas negativos en pacientes con trastornos del espectro esquizofrénico. Materiales y métodos. Se evaluaron 225 pacientes para medir la edad de inicio de los síntomas y el puntaje en la escala SANS (Scale for the Assessment of Negative Symptoms). Se usaron estimadores de densidad kernel para evaluar las características de la edad de inicio. Se estimaron los parámetros de distribuciones mezcladas usando algoritmos de máxima verosimilitud. La relación síntomas negativos-edad de inicio se evaluó usando regresión múltiple. Resultados. Hubo diferencia significativa en la edad de inicio según el sexo (24,5 años en hombres Vs. 27,5 años en mujeres). Se encontró asociación entre sexo y comienzo temprano de síntomas, siendo este último más frecuente en hombres. Los estimadores de densidad para la edad de inicio sugieren un modelo mezclado con tres componentes, con los siguientes parámetros: m1=21,55, sd1=5,25; m2=29,54, sd2=7,22; y m3=40,01, sd3=3,98. Al tener en cuenta el sexo, se aíslan dos estructuras bimodales: la de hombres tiene la menor media de edad de inicio (18,02 años) mientras que la de media más alta corresponde a las mujeres (41,03 años). Los coeficientes de regresión sugieren incremento en los síntomas negativos a medida que aumenta el tiempo con enfermedad. Conclusión. Nuestros resultados apoyan la hipótesis de que existe relación entre la edad de inicio de los síntomas, el sexo y las características clínicas, en pacientes con trastornos del espectro esquizofrénico, lo que demuestra que los hombres tienen un inicio más temprano y un curso de la enfermedad con mayor deterioro.

Introduction. Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. Objective. The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. Materials and methods. A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. Results. A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. Conclusion. The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Análisis de la estructura del síndrome psicótico agudo / Analysis of the structure of acute psychotic disorder

Introducción: La psicosis es una entidad clínicamente heterogénea. Estudios previos han encontrado una estructura multifactorial de dicho síndrome. El objetivo del presente estudio fue evaluar posibles categorías diagnósticas en pacientes con sintomatología psicótica aguda, a partir de las características de los síntomas en una evaluación transversal. Métodos: Se ensambló un instrumento a partir de las escalas SANS, SAPS, BPRS, EMUN y de depresión de Zung. Con base en criterios de redundancia y de tipo estadístico, un instrumento inicial de 101 ítems fue reducido a 57. El instrumento fue aplicado a 232 pacientes con sintomatología psicótica aguda no orgánica que asistieron a la Clínica de la Paz de Bogotá, y al Hospital San Juan de Dios, de Chía, entre abril del 2008 y diciembre del 2009. Se aplicaron técnicas estadísticas de análisis multivariado. Resultados: Casi 80% de los pacientes tuvo diagnóstico de esquizofrenia. El síndrome psicótico agudo se encontró conformado por los siguientes seis dominios: deficitario, agresivo-paranoide, desorganizado, depresivo, delirios extraños, alucinaciones. El análisis de conglomerados reveló ocho subtipos que, a partir de la estructura factorial, pueden denominarse así: 1) delirios extraños-alucinaciones; 2) deterioro y síntomas de desorganización; 3) deterioro; 4) deterioro con paranoia, ansiedad y agresividad; 5) delirios extraños; 6) paranoia, ansiedad, agresividad; 7) síntomas depresivos y delirios extraños; 8) paranoia, ansiedad, agresividad con síntomas depresivos. Conclusión: Los subtipos permiten una caracterización más exhaustiva que la que permiten los sistemas de clasificación vigentes. Es necesario validar estas agrupaciones en estudios longitudinales…

Introduction: Schizophrenia is a clinically heterogeneous disorder. A multifactorial structure of this syndrome has been described in previous reports. The aim of this study was to evaluate what are the possible diagnostic categories in patients having acute psychotic symptoms, studying their clinical characteristics in a cross-sectional study. Methods: An instrument for measuring psychotic symptoms was created using previous scales (SANS, SAPS, BPRS, EMUN, Zung depression scale). Using as criteria statistical indexes and redundance of items, the initial instrument having 101 items has been reduced to 57 items. 232 patients with acute psychotic symptoms, in most cases schizophrenia, attending Clínica Nuestra Señora de la Paz in Bogotá and Hospital San Juan de Dios in Chía have been evaluated from April, 2008 to December, 2009. Multivariate statistical methods have been used for analyzing data. Results: A six-factor structure has been found (Deficit, paranoid-aggressive, disorganized, depressive, bizarre delusions, hallucinations). Cluster analysis showed eight subtypes that can be described as: 1) bizarre delusions-hallucinations; 2) deterioration and disorganized behavior; 3) deterioration; 4) deterioration and paranoid-aggressive behavior; 5) bizarre delusions; 6) paranoiaanxiety- aggressiveness; 7) depressive symptoms and bizarre delusions; 8) paranoia and aggressiveness with depressive symptoms; Conclusion: These subtypes allow a more exhaustive characterization that those included in standard classification schemes and should be validated in longitudinal studies…

[Age at Onset as a Marker of Subtypes of Manic-Depressive Illness]. / Edad de inicio como marcador de subtipos de enfermedad maniacodepresiva.

INTRODUCTION: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. OBJECTIVE: To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. METHODS: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. RESULTS: According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. CONCLUSIONS: In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.