Concordancia entre observadores de videos de pacientes con sospecha diagnóstica de autismo y psicosis infantiles / Inter-rater Reliability in Videos of Patients with a Suspected Diagnostic of Autism and Child Psychosis

RESUMEN Introducción: Dados la complejidad del abordaje y el tratamiento del autismo y las psicosis infantiles y el impacto que tienen en la vida del niño y su familia, es fundamental ser cautos a la hora de hacer un diagnóstico que tiene implicaciones pronosticas. Se utiliza la perspectiva psicodinámica para acceder a la posibilidad de incluir en el diagnóstico aspectos tanto patológicos como sanos y promover el potencial evolutivo de cada paciente. Objetivo: Determinar la concordancia entre evaluadores y evaluar cuantitativa y cualitativa mente las variables que influyen en el diagnóstico de pacientes con sospecha de autismo y psicosis infantiles desde la perspectiva psicodinámica. Métodos: Se realizó un estudio de concordancia entre observadores basado en la evaluación diagnóstica de videos de pacientes con sospecha de autismo o psicosis infantiles que asisten a junta diagnóstica (sesión de observación) en el Instituto de Ortopedia Infantil Roosevelt. Resultados: Se obtuvieron valores de kappa que oscilaron en general entre 0,24 y 0,50, con una fuerza de concordancia que varió de leve a moderada y K = 0,24 para la organización de personalidad. Esta manera de diagnosticar toma en consideración los aspectos tanto patológicos como saludables que constituyen la organización de personalidad. Al final se discuten las limitaciones y los puntos que tener en cuenta en los estudios posteriores. Conclusiones: Se recomienda que evalúe al niño con perturbaciones mayores un equipo interdisciplinario, y no un solo observador, pues este espacio favorece la discusión, que es crucial a la hora de establecer un diagnóstico y evita lecturas parciales del funcionamiento psíquico del paciente que consulta.

ABSTRACT Introduction: Diagnosing and treating autism and child psychoses is very difficult; these pathologies impact not only the child's life but also the family as a whole. Therefore caution is required when giving a diagnosis with prognostic implications. We use the psychodynamic perspective in order to take into consideration both pathological and healthy diagnostic aspects, and to promote evolutionary potential of each patient. Objective: To determine the inter-rater reliability and to test quantitatively and qualitati vely the variables involved in the diagnoses of patients with suspected autism and child psychoses, based upon psychodynamic concepts. Methods: An inter-rater reliability study was carried on, based upon the diagnostic evaluation of videos of patients with suspected autism or child psychoses who attended the diagnostic meeting (observation session) at the Instituto de Ortopedia Infantil Roosevelt. Results: Kappa values were obtained, ranging from .24 to .50, with a reliability force varying from slight to moderate, and K=.24 for personality organization. This type of diagnosis takes into account both the pathological and healthy aspects which make up personality orga nization. Finally, limitations and aspects that should be considered in further studies were discussed. Conclusions: The results reinforce the need to evaluate a child with major disorders in an interdisciplinary team, and but a single observer, in order to allow discussion, and debate, and therefore, avoid partial readings of the patient's psychological functioning.

Inter-rater Reliability in Videos of Patients With a Suspected Diagnostic of Autism and Child Psychosis. / Concordancia entre observadores de videos de pacientes con sospecha diagnóstica de autismo y psicosis infantiles.

INTRODUCTION: Diagnosing and treating autism and child psychoses is very difficult; these pathologies impact not only the child's life but also the family as a whole. Therefore caution is required when giving a diagnosis with prognostic implications. We use the psychodynamic perspective in order to take into consideration both pathological and healthy diagnostic aspects, and to promote evolutionary potential of each patient. OBJECTIVE: To determine the inter-rater reliability and to test quantitatively and qualitatively the variables involved in the diagnoses of patients with suspected autism and child psychoses, based upon psychodynamic concepts. METHODS: An inter-rater reliability study was carried on, based upon the diagnostic evaluation of videos of patients with suspected autism or child psychoses who attended the diagnostic meeting (observation session) at the Instituto de Ortopedia Infantil Roosevelt. RESULTS: Kappa values were obtained, ranging from .24 to .50, with a reliability force varying from slight to moderate, and κ=.24 for personality organization. This type of diagnosis takes into account both the pathological and healthy aspects which make up personality organization. Finally, limitations and aspects that should be considered in further studies were discussed. CONCLUSIONS: The results reinforce the need to evaluate a child with major disorders in an interdisciplinary team, and but a single observer, in order to allow discussion, and debate, and therefore, avoid partial readings of the patient' s psychological functioning.

[The knowledge acquired during and adherence to a postgraduate course concerned with mental health aimed at school counselors]. / Conocimiento adquirido y adherencia en un diplomado sobre la salud mental para docentes orientadores.

OBJECTIVE: To evaluate the academic performance in, and adherence to, a postgraduate course focused on promotion, prevention, identification, and early intervention with regard to the different mental problems and pathologies affecting children and adolescents. MATERIALS AND METHODS: This was a before-and-after intervention study involving a postgraduate course. The population of school counselors from the Colombian regions of Boyacá and Cundinamarca were invited to participate in a postgraduate course that addressed mental health. Their knowledge was evaluated before and after having received it. RESULTS: The school counselors performed well on the academic test, with 48.5 % of the population obtaining a score of 4.0/5.0 before the intervention. After the course, 61.2 % achieved the same score. It was thus considered that the course functioned as a tool for improving knowledge about promotion, prevention, recognition, and early intervention with regard to mental health in educational institutions. There was a 90.6 % adherence to the 120-hour-long postgraduate course. CONCLUSION: The postgraduate course seemed to have a positive impact in terms of the knowledge acquired about mental health, and there was good adherence to the course.

Otras posibles aplicaciones clínicas de fármacos con efecto 5HT2A y 3 en psiquiatría de enlace: reporte de casos / Other Possible Clinical Applications of Drugs with 5HT2A effect in Liaison Psychiatry: Cases Report

Introducción: En psiquiatría de enlace se logra obtener una visión integral del tratamiento y de las necesidades de cada paciente prestando especial atención a las interacciones medicamentosas y a las contraindicaciones. Algunos casos particulares motivaron la descripción, reporte y revisión bibliográfica acerca de otras posibles aplicaciones de fármacos antagonistas de los recetores 5HT2A y 3, particularmente mirtazapina y olanzapina, en síndrome de hiperalgesia, tinitus y leucoencefalopatía multifocal progresiva por virus JC. Método: reporte de casos. Resultados y Conclusiones: Se describen los casos de tres pacientes en los cuales fue necesario usar mirtazapina y olanzapina no solo para el control de los síntomas psiquiátricos (afectivos, comportamentales y trastorno del sueño), sino también como coadyuvantes en las patologías de base de cada paciente. El uso de cualquier medicamento en psiquiatría de enlace debe tener en cuenta el contexto del paciente, la comorbilidad, las contraindicaciones y las interacciones farmacológicas para garantizar un desenlace positivo, además de promover el trabajo multidisciplinario entre especialistas.

Introduction: In liaison psychiatry it is possible to get an integral view of patient's treatment and needs, paying special attention to pharmacological interactions and contraindications. Some particular cases motivated the description, report and review about other possible applications of 5HT2A and 5HT3 antagonist, particularly Mirtazapine and Olanzapine, in hyperalgesia syndrome, tinnitus and Progressive Multifocal Leukoencephalopathy by JC virus. Method: Cases report. Results: We describe 3 cases of patients in which Mirtazapine and Olanzapine were necessary not only to control psychiatric symptoms (affective / behavioral symptoms and insomnia) but to act as adjuvant therapy in axis III diseases. The use of any drug in psychiatry must take in to account the context of the patient, the presence of comorbidity, contraindications and pharmacological interactions so as to grant a positive outcome also promoting the multidisciplinary work between specialists.

La hipnosis como intervención para la cesación del consumo de tabaco / Hypnosis as intervention for smoking cessation

Introducción: El tabaquismo es una de las mayores causas de mortalidad en el mundo. Casi el 50% de los fumadores intentan dejarlo cada año, pero sólo un 7% tiene éxito. Las técnicas desarrolladas para la cesación del tabaco son múltiples e incluyen desde la consejería y terapias aversivas hasta manejos psicoterapéuticos estructurados y ayudas farmacológicas. Objetivo: Revisar la literatura disponible acerca de la hipnosis como técnica para dejar de fumar. Método: Búsqueda en Medline y Chocrane de la literatura médica publicada entre 1971 y 2010 sobre el tema con la siguiente estrategia de búsqueda: (hypnosis [Mesh] AND smoking cessation [Mesh]) OR (hypnosis [Mesh] AND tobacco use cessation [Mesh]). Resultados: Se encontraron 56 artículos, de los cuales, al criterio de la autora, se seleccionaron 51. Adicionalmente, se consultó MPOWER: el plan de medidas para hacer retroceder la epidemia del tabaquismo de la Organización Mundial de la Salud del 2008 y el Estudio Nacional de Salud Mental (Colombia, 2003). Conclusiones: La calidad de los estudios disponible es limitada; la mejor estrategia de tratamiento debe incluir una intervención multidimensional en la que se emplee la suplencia de nicotina, técnicas comportamentales e hipnóticas y estrategias para mantener la abstinencia a largo plazo...

Introduction: Smoking is a major cause of mortality worldwide, nearly 50% of smokers try to quit each year but only 7% are successful. Multiple techniques have been developed for smoking cessation. Counseling, aversive therapy, structured psychotherapeutic approaches and pharmacological aids are some of them. Objetive: To review the available literature about the hypnosis as a technique to stop smoking. Methods: Review in Medline and Chocrane of medical literature published between 1971 and 2010 on with the following search strategy: (Hypnosis [Mesh] AND Smoking Cessation [Mesh]) OR (Hypnosis [Mesh] AND Tobacco Use Cessation [Mesh]). Results: 51 studies were selected for the purpose of this review. Additionally, MPOWER: The plan of action to Roll Back the tobacco epidemic to the World Health Organization, 2008 and the National Mental Health Study (Colombia, 2003) were consulted. Conclusions: The quality of the available evidence is limited; however, a multidimensional intervention that employs nicotine replacement, behavioral and hypnotic techniques and strategies to maintain long-term abstinence must be pursued...