[Argentine consensus on the diagnosis and therapeutics of treatment resistant schizophrenia]. / Consenso argentino sobre diagnóstico y tratamiento de la esquizofrenia resistente al tratamiento.

Approximately 30% of people with schizophrenia fail to respond to first-line antipsychotic treatment which impacts the burden of the disease. Treatment-resistant schizophrenia (TRS) denotes patients with failure to respond to at least two adequate trials of different antipsychotics. Clozapine is a unique drug approved for treating treatment-resistant schizophrenia, however 1/3 of patients fail to respond to clozapine. Even though different strategies have been proposed for treating clozapine-resistant schizophrenia, the evidence is very limited, unclear, and of poor quality. A formal literature search was conducted and then, panel members were asked to complete 35 questions addressing different aspects of TRS. A modified Delphi method was used to unify expert opinion and achieve consensus. The expert consensus in diagnostic and treatment of TRS is the result of experts from the main national scientific societies under the organization of the Argentine Association of Biological Psychiatric (AAPB). The consensus statement aims to guide on diagnosis and treatment.

[Research Domain Criteria (RDoC). Political framework and content]. / Research Domain Criteria (RDoC). Marco político y contenido.

The Research Domain Criteria (RDoC) is an initiative of the National Institute of Mental Health of the United States of America, which based on research purposes consists of a new way of classifying mental disorders. His raison d'être is based on the conclusion that the knowledge progress of neurosciences does not seem to confirm the validity of the conventional psychiatric diagnoses. Furthermore, researching based on such diagnoses would weaken the progress in Psychiatry. Besides these scientific reasons, the Research Domain Criteria project is born within a political framework, giving raise to economic tensions. The objective of this paper is to discuss the first issue without avoiding the second one.

Research Domain Criteria (RDoC). Marco político y contenido. / [Research Domain Criteria (RDoC). Political framework and content].

The Research Domain Criteria (RDoC) is an initiative of the National Institute of Mental Health of the United States of America, which based on research purposes consists of a new way of classifying mental disorders. His raison dÛtre is based on the conclusion that the knowledge progress of neurosciences does not seem to confirm the validity of the conventional psychiatric diagnoses. Furthermore, researching based on such diagnoses would weaken the progress in Psychiatry. Besides these scientific reasons, the Research Domain Criteria project is born within a political framework, giving raise to economic tensions. The objective of this paper is to discuss the first issue without avoiding the second one.

Research Domain Criteria (RDoC). Marco político y contenido / [Research Domain Criteria (RDoC). Political framework and content].

The Research Domain Criteria (RDoC) is an initiative of the National Institute of Mental Health of the United States of America, which based on research purposes consists of a new way of classifying mental disorders. His raison d’Ûtre is based on the conclusion that the knowledge progress of neurosciences does not seem to confirm the validity of the conventional psychiatric diagnoses. Furthermore, researching based on such diagnoses would weaken the progress in Psychiatry. Besides these scientific reasons, the Research Domain Criteria project is born within a political framework, giving raise to economic tensions. The objective of this paper is to discuss the first issue without avoiding the second one.

[Mental health as seen from a psychiatric standpoint]. / La Salud mental vista desde la perspectiva de la psiquiatría.

This paper proposes a psychiatric perspective on mental health given by many years of experience and confrontation with many clinical forms in which the lost of mental health is expressed. This lost brings by effects on those who suffer it as well as on their relatives. The mental health law of Argentina 26657 is analyzed from this particular standpoint. It is recognized that its spirit is part of an ecumenical movement which stimulates inclusion and full citizenship for all the people, even for minorities such as mentally ill patients. It is also proposed that some of the ideological origins are traceable back to critical trends within psychiatry and that a lack of academic and professional consult at the moment of its redaction has generated an unnecessary dispute despite important agreements on the spirit of the law.

Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders.

OBJECTIVE: To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients. METHOD: Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI. RESULTS: Specificity of MDQ was 0.97 and BSDS was 0.81. MDQ sensitivity was 0.70 for bipolar type I (BD-I), 0.52 for bipolar II (BD-II) and 0.31 for bipolar not otherwise specified (BDNOS). BSDS sensitivities were 0.75, 0.70 and 0.51 respectively. LIMITATIONS: This study was performed in specialized outpatient settings and thus its results are not necessarily representative for other clinical settings. There was not a systematic evaluation of comorbid psychiatric disease or test-retest reliability. CONCLUSION: The local versions of the MDQ and the BSDS showed a sensitivity and specificity comparable to previous research. Our results indicate that in this sample, MDQ was more specific for BD and BSDS was more sensitive to detect BD-II and NOS. Since BD-I is more readily recognized than bipolar spectrum disorders, enhanced sensitivity of BSDS for soft bipolarity may be an advantage.

[Revision of systematic treatment enhancement program for bipolar disorder (STEP-BD)]. / Revisión del Programa para la Mejoría Sistemática del Tratamiento del Trastorno Bipolar (STEP-BD).

The STEP-BD is a public initiative, created to generate data, obtained in pragmatic or real life research environments, from the bipolar disorder. The primary objectives are: to investigate the effectiveness of therapeutic interventions in bipolar disorder, the impact on the disease course of these interventions in the 'real life' and to raise the knowledge about the disease. This program included in six years, n = 4361 patients. This program is not a study in phases but an infrastructure for more than 40 published studies and 30 conference presentations. These studies aim to capture the heterogeneity of the disease in their different clinical presentations, treatments, comorbidities, functionality and quality of life. Patients entering the program have a common assessment. The program consists of two main pathways: the standard treatment and randomized treatment of acute bipolar depression, bipolar depression and refractory relapse prevention. In addition several studies completed the program in an attempt to give coherence to the different clinical presentations of this disease, different treatments and interventions for similar clinical phenomena.

Revisión del Programa para la Mejoría Sistemática del Tratamiento del Trastorno Bipolar (STEP-BD) / Revision of systematic treatment enhancement program for bipolar disorder (STEP-BD)

El programa STEP-BD es una iniciativa pública que surge de la necesidad de tener datos sobre el trastorno bipolar obtenidos en entornos de investigación pragmáticos o de la vida real. Los objetivos primarios son: investigar la efectividad de las intervenciones terapéuticas en el trastorno bipolar, el impacto en el curso de la enfermedad de estas intervenciones en entornos pragmáticos o de la vida real y aumentar el conocimiento sobre la enfermedad. Incluyó, en seis años, a 4361 pacientes. Este programa no es un estudio en fases, es una infraestructura compuesta por más de 40 estudios publicados y 30 presentaciones en congresos. Estos estudios tienen por objetivo captar la heterogeneidad de la enfermedad en sus presentaciones clínicas, tratamiento, comorbilidades, funcionalidad y calidad de vida. Los pacientes que ingresan al programa tuvieron una evaluación común. El programa consta de dos ramas principales: tratamiento estándar y tratamientos randomizados de depresión bipolar aguda, depresión bipolar refractaria y prevención de recaídas. Además, diversos estudios completan el programa en un intento de darle coherencia a las diferentes presentaciones clínicas de esta enfermedad, a los diferentes tratamientos y las diferentes intervenciones para fenómenos clínicos similares.(AU)

The STEP-BD is a public initiative, created to generate data, obtained in pragmatic or real life research environments, from the bipolar disorder. The primary objectives are: to investigate the effectiveness of therapeutic interventions in bipolar disorder, the impact on the disease course of these interventions in the "real life" and to raise the knowledge about the disease. This program included in six years, n = 4361 patients. This program is not a study in phases but an infrastructure for more than 40 published studies and 30 conference presentations. These studies aim to capture the heterogeneity of the disease in their different clinical presentations, treatments, comorbidities, functionality and quality of life. Patients entering the program have a common assessment. The program consists of two main pathways: the standard treatment and randomized treatment of acute bipolar depression, bipolar depression and refractory relapse prevention. In addition several studies completed the program in an attempt to give coherence to the different clinical presentations of this disease, different treatments and interventions for similar clinical phenomena.(AU)

Revisión del Programa para la Mejoría Sistemática del Tratamiento del Trastorno Bipolar (STEP-BD) / Revision of systematic treatment enhancement program for bipolar disorder (STEP-BD)

El programa STEP-BD es una iniciativa pública que surge de la necesidad de tener datos sobre el trastorno bipolar obtenidos en entornos de investigación pragmáticos o de la vida real. Los objetivos primarios son: investigar la efectividad de las intervenciones terapéuticas en el trastorno bipolar, el impacto en el curso de la enfermedad de estas intervenciones en entornos pragmáticos o de la vida real y aumentar el conocimiento sobre la enfermedad. Incluyó, en seis años, a 4361 pacientes. Este programa no es un estudio en fases, es una infraestructura compuesta por más de 40 estudios publicados y 30 presentaciones en congresos. Estos estudios tienen por objetivo captar la heterogeneidad de la enfermedad en sus presentaciones clínicas, tratamiento, comorbilidades, funcionalidad y calidad de vida. Los pacientes que ingresan al programa tuvieron una evaluación común. El programa consta de dos ramas principales: tratamiento estándar y tratamientos randomizados de depresión bipolar aguda, depresión bipolar refractaria y prevención de recaídas. Además, diversos estudios completan el programa en un intento de darle coherencia a las diferentes presentaciones clínicas de esta enfermedad, a los diferentes tratamientos y las diferentes intervenciones para fenómenos clínicos similares.

The STEP-BD is a public initiative, created to generate data, obtained in pragmatic or real life research environments, from the bipolar disorder. The primary objectives are: to investigate the effectiveness of therapeutic interventions in bipolar disorder, the impact on the disease course of these interventions in the "real life" and to raise the knowledge about the disease. This program included in six years, n = 4361 patients. This program is not a study in phases but an infrastructure for more than 40 published studies and 30 conference presentations. These studies aim to capture the heterogeneity of the disease in their different clinical presentations, treatments, comorbidities, functionality and quality of life. Patients entering the program have a common assessment. The program consists of two main pathways: the standard treatment and randomized treatment of acute bipolar depression, bipolar depression and refractory relapse prevention. In addition several studies completed the program in an attempt to give coherence to the different clinical presentations of this disease, different treatments and interventions for similar clinical phenomena.

[Permanent psychiatric effects in former addicts to marijuana or stimulants]. / Efectos psiquiátricos permanentes en ex abusadores de marihuana o de estimulantes.

It's an evidence based data that the abuse of drugs produces toxic psychiatric effects, in the acute and sub acute phases of the intoxication and also in the recent abstinence. It is more conflicting the data about if they can produce or unmask vulnerabilities to long term psychiatric disorders; or to affect its course and phenomenology; or to influence the response to the therapeutic resources used to treat them, beyond the period of abstinence. The objective is to update the knowledge available on the ability of the marijuana and the stimulants to produce long term psychiatric disorders, or to unmask vulnerabilities to them. We have done an electronic bibliographical research in MEDLINE using the following key words: psychiatric disorders, amphetamine, stimulants, marijuana, cannabis, long term effects, psychosis, cognitive and cognitive deficits. The marijuana might induce permanent psychosis in subjects with vulnerability to schizophrenia or to psychosis. The cognitive effects are acute and subacute, related with the presence of delta-9-tetrahydrocannabinol in the central nervous system. The stimulants can produce a schizophrenia-like psychosis, and they can produce long term cognitive deficits. The stimulants also might produce subsyndromic mood disorders.

Efectos psiquiátricos permanentes en ex abusadores de marihuana o de estimulantes / Permanent psychiatric effects in former addicts to marijuana or stimulants

Es un dato de la evidencia que las drogas de abuso producen efectos psiquiátricos tóxicos agudos, subagudos y en la abstinencia. Es una cuestión más controvertida si ellas pueden producir o desenmascarar cuadros psiquiátricos de largo plazo o incidir en su curso o fenomenología; o influir sobre la respuesta a los recursos terapéuticos empleados para tratarlos, más allá del período de abstinencia. Este trabajo actualizará los conocimientos disponibles sobre este último punto en lo que hace a la marihuana y los estimulantes. Búsqueda bibliográfica electrónica en MEDLINE usando las siguientes palabras claves: anfetamina, estimulantes, marihuana, cannabis, efectos psiquiátricos, psicosis, trastornos del ánimo y efectos cognitivos. La marihuana produce psicosis permanentes en sujetos con vulnerabilidad a la esquizofrenia o a la psicosis. Los efectos cognitivos son agudos y subagudos, vinculados con la presencia de delta-9-tetrahydrocannabinol en el sistema nervioso central. Los estimulantes pueden producir psicosis de curso similar a la esquizofrenia y producir trastornos cognitivos a largo plazo. Hay algunos datos que indican que producen también trastornos del ánimo subsindrómicos.

It's an evidence based data that the abuse of drugs produce toxic psychiatric effects, in the acute and sub acute phases of the intoxication and also in the recent abstinence. It is more conflicting the data about if they can produce or unmask vulnerabilities to long term psychiatric disorders; or to affect its course and phenomenology; or to influence the response to the therapeutic resources used to treat them, beyond the period of abstinence. The objective is to update the knowledge available on the ability of the marijuana and the stimulants to produce long term psychiatric disorders, or to unmask vulnerabilities to them. We have done an electronic bibliographical research in MEDLINE using the following key words: psychiatric disorders, amphetamine, stimulants, marijuana, cannabis, long term effects, psychosis, cognitive and cognitive deficits. The marijuana might induce permanent psychosis in subjects with vulnerability to schizophrenia or to psychosis. The cognitive effects are acute and subacute, related with the presence of delta-9-tetrahydrocannabinol in the central nervous system. The stimulants can produce a schizophrenia-like psychosis, and they can produce long term cognitive deficits. The stimulants also might produce subsyndromic mood disorders.

Bipolar disorders and affective temperaments: a national family study testing the "endophenotype" and "subaffective" theses using the TEMPS-A Buenos Aires.

BACKGROUND: The purpose of this study is to examine the prevalence of affective temperaments between clinically unaffected relatives of bipolar patients and secondarily to investigate the impact of these "subaffective" forms on their quality of life (QoL). METHODS: The study was performed in seven sites across Argentina. We administered the scales TEMPS-A and Quality of Life Index to a sample of 114 non-ill first degree relatives of bipolar disorder patients ("cases") and 115 comparison subjects without family history of affective illness ("controls"). We used The Mood Disorder Questionnaire to rule out clinical bipolarity. RESULTS: Mean scores on all TEMPS-A subscales were significantly higher in cases, except for hyperthymia. The prevalence of affective temperaments, according to Argentinean cut-off points, was also higher, with statistical significance for cyclothymic and anxious temperaments. Regarding QoL, we found no significant differences between both groups, except for interpersonal functioning, which was better in controls. A detailed subanalysis showed significant effects of QoL domains for all temperaments, except for the hyperthymic. LIMITATIONS: We used self-report measures. A larger sample size would have provided us greater statistical power for certain analyses. CONCLUSIONS: Our findings support the concept of a spectrum of subthreshold affective traits or temperaments - especially for the cyclothymic and anxious - in bipolar pedigrees. We further demonstrated that, except for the hyperthymic, quality of life was affected by these temperaments in "clinically well" relatives. Overall, our data are compatible with the "endophenotype" and "subaffective" theses for affective temperaments.

[Argentine consensus on the treatment of bipolar disorders]. / Consenso argentino sobre el tratamiento de los Trastornos Bipolares.

The consensus guidelines of argentine experts in the treatment of bipolar disorders are the result of three days of work of the 10 main local experts under the organization of the Argentine Association of Biological Psychiatry (AAPB). It was adopted a mixed criterion for its preparation: all the recent data of the evidence medicine based published until now were discussed and were balanced with the knowledge acquired from clinical experience of the local experts on the bipolar field. It presents general recommendations and suggested therapeutic sequences for the phase of maintenance, the manic/hypomanic or mixed episode and the depressive episode. These have been divided according to the classification in type I and II; with or without rapid cycling. Since the group of experts identified the delay and miss-diagnoses like the most important barrier for a suitable treatment enclosed a series of recommendations for differential diagnosis of bipolar disorders.

[Pharmacological treatment of Bipolar Disorder]. / El tratamiento farmacológico de la depresión bipolar.

Due to recent long term follow up studies, the patients with Bipolar Disorder are in the Bipolar Depression phase most of the time. Is in the Depressive phase where most of the suicide attempts and the consumed suicides occur. The Bipolar Depression is the reason why the patients with Bipolar Disorder have an important functional deterioration. The treatments of the Bipolar Depression don't fulfill the expectations of the clinicians. There is a consensus about the use of mood stabilizers, and is controversial the use of antidepressants in the acute and in the maintenance phase due to the potential damage that they might produce in both phases. New drugs and new combinations are in study to improve the therapeutic results.

El tratamiento farmacológico de la depresión bipolar / [Pharmacological treatment of Bipolar Disorder]

Due to recent long term follow up studies, the patients with Bipolar Disorder are in the Bipolar Depression phase most of the time. Is in the Depressive phase where most of the suicide attempts and the consumed suicides occur. The Bipolar Depression is the reason why the patients with Bipolar Disorder have an important functional deterioration. The treatments of the Bipolar Depression don’t fulfill the expectations of the clinicians. There is a consensus about the use of mood stabilizers, and is controversial the use of antidepressants in the acute and in the maintenance phase due to the potential damage that they might produce in both phases. New drugs and new combinations are in study to improve the therapeutic results.

El tratamiento farmacológico de la depresión bipolar. / [Pharmacological treatment of Bipolar Disorder]

Due to recent long term follow up studies, the patients with Bipolar Disorder are in the Bipolar Depression phase most of the time. Is in the Depressive phase where most of the suicide attempts and the consumed suicides occur. The Bipolar Depression is the reason why the patients with Bipolar Disorder have an important functional deterioration. The treatments of the Bipolar Depression dont fulfill the expectations of the clinicians. There is a consensus about the use of mood stabilizers, and is controversial the use of antidepressants in the acute and in the maintenance phase due to the potential damage that they might produce in both phases. New drugs and new combinations are in study to improve the therapeutic results.

[Psychic change in schizophrenic patients produced group therapy]. / Cambio psíquico en pacientes esquizofrénicos en tratamiento grupal.

The objective of this paper is to analyze the effectiveness of group therapy to produce psychic change in patients with schizophrenia and other related psychosis. The experience took place in a Public Psychiatric Hospital. It involved 96 patients with this condition who entered different groups from 1998 up to the present. During the year 2000, 66 of them were asked to answer a questionnaire especially designed to investigate the changes that they thought they had gone through during this treatment. On one hand, the results show the high valorization of the group appliance, while on the other hand the most valued operational categories were the facilitation of interpersonal links, the valorization of listening and being listened, the recognition of improvement and the recognition of one's own characteristics in the other person. On account of these discoveries, the mechanisms of these group appliances to produce such changes are postulated. In conclusion, group treatment for schizophrenic patients and related psychosis turns out to be useful for producing psychic changes different from those achieved with psychopharmacological agents.

[Pharmacologic treatment of the psychotic symptoms in schizophrenia]. / Tratamiento farmacológico de los síntomas psicóticos en la esquizofrenia.

Psychotic symptoms, among others, are present in Schizophrenia. The most severe developments during the moments of exacerbation, are meliorated after this period, although they do not absolutely disappear in the majority of the cases. Anti psychotic drugs are key in the treatment. As far as it is known, the efficacy of these drugs is due to the dopaminergic blockade. Nevertheless, the rythm, and the universal validity of this treatment actually have an heterogeneous character. At this moment, various medication algorithms are available, which are usefull in the orientation of the medical prescription. The comparative analysis and the practical conclusions are necessary for a correct management of them.

Tratamiento farmacológico de los síntomas psicóticos en la esquizofrenia / [Pharmacologic treatment of the psychotic symptoms in schizophrenia]

Psychotic symptoms, among others, are present in Schizophrenia. The most severe developments during the moments of exacerbation, are meliorated after this period, although they do not absolutely disappear in the majority of the cases. Anti psychotic drugs are key in the treatment. As far as it is known, the efficacy of these drugs is due to the dopaminergic blockade. Nevertheless, the rythm, and the universal validity of this treatment actually have an heterogeneous character. At this moment, various medication algorithms are available, which are usefull in the orientation of the medical prescription. The comparative analysis and the practical conclusions are necessary for a correct management of them.

Cambio psíquico en pacientes esquizofrénicos en tratamiento grupal / [Psychic change in schizophrenic patients produced group therapy]

The objective of this paper is to analyze the effectiveness of group therapy to produce psychic change in patients with schizophrenia and other related psychosis. The experience took place in a Public Psychiatric Hospital. It involved 96 patients with this condition who entered different groups from 1998 up to the present. During the year 2000, 66 of them were asked to answer a questionnaire especially designed to investigate the changes that they thought they had gone through during this treatment. On one hand, the results show the high valorization of the group appliance, while on the other hand the most valued operational categories were the facilitation of interpersonal links, the valorization of listening and being listened, the recognition of improvement and the recognition of one’s own characteristics in the other person. On account of these discoveries, the mechanisms of these group appliances to produce such changes are postulated. In conclusion, group treatment for schizophrenic patients and related psychosis turns out to be useful for producing psychic changes different from those achieved with psychopharmacological agents.