Síntomas residuales y remisión en la depresión: una encuesta de opinión entre psiquiatras españoles / Residual symptoms and remission in depression: an opinion survey among Spanish psychiatrists

Objetivo: La remisión parcial y la persistencia de síntomas residuales en el trastorno depresivo mayor (TDM) son frecuentes en la clínica psiquiátrica. Este estudio pretende determinar la opinión de los psiquiatras españoles acerca de este problema. Material y método: Se elaboró una encuesta de 16 ítems que evalúa el abordaje clínico del TDM, tratando de conocer la opinión de los psiquiatras españoles acerca de los factores que determinan los síntomas residuales. Se encuestó a 1.332 psiquiatras españoles (margen de error del 2,2% para un nivel de confianza del 95%). Resultados: El 58,8% de los encuestados estiman que los tratamientos disponibles no consiguen la remisión completa de la depresión, que alcanzan sólo del 26 al 50%. Señalan como frecuentes síntomas residuales la disminución del placer o el interés (58,4%), el estado de ánimo triste (49,4%), los trastornos del sueño, la astenia y las molestias físicas y/o los dolores crónicos. La persistencia de síntomas se relaciona con factores de riesgo ambiental y/o la personalidad (40,7%). La mayoría (44,7%) cree que entre el 21 y el 40% de los pacientes abandonan el tratamiento antes de obtener una respuesta significativa, y cifra en un 21-40% las tasas de recaída después de 1 año y de evolución a la cronicidad. Conclusiones: Según la mayoría de los psiquiatras españoles, los tratamientos disponibles para la depresión no consiguen, en la mayor parte de los casos, la remisión completa, lo que ocasiona un alto riesgo de recaída después del primer año. El antidepresivo valorado como idóneo debería asegurar una eficacia en una amplia gama de síntomas, con rapidez de acción, buen perfil de seguridad y tolerabilidad y eficacia continua, y debería ser capaz de obtener la remisión

Objective: In clinical psychiatry, partial remission and residual symptoms are frequently found in patients with major depressive disorder (MDD). The aim of this study was to ascertain the opinion of Spanish psychiatrists of this phenomenon. Material and method: A 16-item questionnaire to measure clinical management of MDD was designed to determine Spanish psychiatrists' opinions on the factors leading to the persistence of residual symptoms. A total of 1,332 psychiatrists completed the nationwide survey (2.2% margin of error for a confidence interval of 95%). Results: Of the psychiatrists surveyed, 58.8% believed that available treatments for depression do not achieve full symptom remission and that full remission is obtained in only 26-50% of patients. Frequently cited residual symptoms were loss of interest or pleasure (58.4%), depressed mood (49.4%), sleep disorders, loss of energy, somatic complaints and/or chronic pain. Persistence of symptoms is related to environmental or personality risk factors (40.7%). Most of the psychiatrists (44.7%) believed that between 21% and 40% of patients abandon treatment before achieving a significant response and that between 21% and 40% will relapse after a year and/or progress to chronic depression. Conclusions: According to most Spanish psychiatrists, in the majority of patients, available treatments for depression do not achieve full remission, leading to a high risk of recurrence after the first year. The ideal antidepressant should be effective in a wide variety of symptoms, have rapid onset of action and good safety and tolerability profiles, show long term effectiveness, and achieve full remission

Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study.

Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with "pure" bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients.