Diagnostic accuracy of the Spanish version of the 4AT scale (4AT-ES) for delirium screening in older inpatients

Background and objectivesThe 4AT scale is a sensitive tool for screening delirium, which can be applied rapidly in clinical settings without any specific training. It has not been translated, adapted, and validated to assess Spanish older adults. The aims of the study are: to translate and adapt to Spanish culture the 4AT scale, to present evidence of the diagnostic accuracy of this version (4AT-ES) when applied in non-specialized hospital wards, and to assess the loss of diagnostic accuracy in presence of risk factors.MethodsA prospective sample was independently assessed on the 4AT-ES and the reference standard. One hundred and twenty-one inpatients (70+ years) for whom a psychiatric assessment was requested were included. Out of them, 50 were diagnosed with delirium. Nurses without specific training applied the 4AT-ES, and experienced psychiatrists cast the reference standard diagnosis (DSM-V criteria).ResultsPatients with delirium were older and had more risk factors (more previous delirium episodes, a higher likelihood of prior dementia/cognitive impairment) than controls. The 4AT-ES had excellent validity, sensitivity (96%) , and specificity (83.1%). The area under the curve was 0.918; in the subsample with any of those risk factors, its value did not decrease.ConclusionThe 4AT-ES version of the 4AT scale was developed. When applied by non-specifically trained, nursing staff it showed excellent validity, sensitivity, and specificity, even in a subsample with previous risk factors. All indices were comparable to the original version. We recommend its use for efficient delirium screening in hospitalized older patients with suspected delirium. (AU)

[Pulmonary thromboembolism in primary care]. / Tromboembolismo pulmonar en atención primaria.

The Primary Care physician must know the risk factors and to suspect the presence of a pulmonary thromboembolism (PTE) when there is a compatible clinical picture. We present two cases of a massive PTE in young healthy women in whom the taking of ethinylestradiol combined with cyproterone acetate was the only existing risk factor. We believe that the recommendations of the Spanish Medicines Agency should be followed and prescribe those contraceptives that have less than 30ug of ethinylestradiol and a second generation gestagen.

Tromboembolismo pulmonar en atención primaria / Pulmonary thromboembolism in primary care

El médico de atención primaria debe conocer los factores de riesgo y sospechar la presencia de una tromboembolismo pulmonar (TEP) ante un cuadro clínico compatible. Presentamos 2 casos de TEP masivos en mujeres jóvenes sanas en las que la toma de etilnilestradiol asociado a acetato de ciproterona era el único factor de riesgo existente. Creemos necesario atender a las recomendaciones de la Agencia Española del Medicamento y prescribir aquellos anticonceptivos que aporten menos de 30 μg de etinilestradiol y un gestágeno de segunda generación (AU)

The Primary Care physician must know the risk factors and to suspect the presence of a pulmonary thromboembolism (PTE) when there is a compatible clinical picture. We present two cases of a massive PTE in young healthy women in whom the taking of ethinylestradiol combined with cyproterone acetate was the only existing risk factor. We believe that the recommendations of the Spanish Medicines Agency should be followed and prescribe those contraceptives that have less than 30ug of ethinylestradiol and a second generation gestagen (AU)

[A prospective study of patient with schizophreniform disorder: a nosological dilemma?]. / Un estudio prospectivo de pacientes con trastorno esquizofreniforme: dilema nosológico?

We study retrospectively 42 inpatients of the psychiatry department of the Ramón y Cajal Hospital, through a period between 1st January of 1988 and the 31st December 1993. All of them were diagnosed at discharge of schizophreniform disorder according to DSM-III R diagnostic criteria and it was in all of them the index episode of the psychosis. Sociodemographic, clinical, evolutive, and therapeutical variables are analyzed. We made a new assessment of the patients in the sample during April 1994 through a direct interview. The mean follow-up period was 4.18 years. The main results were: A predominance of male/female proportion (2/1), nearly half of the sample had emotional or psychosocial stressors previous to the episode. Previous schizoid personality traits were found in 57.1%. 11.9% had first degree relatives antecedents of schizophrenia and 19% of non-bipolar affective disorders. At follow-up 40.4% needed to be hospitalized again. It is noteworthy that 80.9% were rediagnosed during follow-up as schizophrenia.

[Detoxification treatment with naltrexone in opiate dependence]. / Tratamiento de deshabituación con naltrexona en la dependencia de opiáceos.

Outcome of a maintenance treatment with naltrexone (350 mg/week) are examined in a sample of 50 patients with opiate dependence disorder. Treatment was followed in an outpatient facility, in a setting similar to patient's own environment. The average attendance rate was of 6.4 months. Six months after the onset of the treatment, 46% of the patients still remained drug-free. Results of treatment was correlated with changes in life style of the addicts. A follow-up study found that, overall, the naltrexone treatment caused an increase in alcohol consumption whereas there was a noticeable decrease in cocaine use. Factors related to successful results were a good work adjustment, no use of other drugs and lack of psychopathology.