Uso de criterios y guías clínicas en la creación de una unidad de trastornos del ánimo / Use of criteria and clinical guidelines in the creation of a mood disorders unit

Los trastornos del ánimo (uni o bipolares) constituyen un significativo problema de salud pública, tanto por su alta prevalencia como por el elevado índice de discapacidad que generan. El presente artículo aborda el problema de la resistencia a tratamiento como también las estrategias y guías clínicas para el manejo de los cuadros de mayor complejidad. Se analizan los aportes de la terapia farmacológica, de la psicoterapia y de las terapias somáticas no farmacológicas, intentando un enfoque integrativo. El equipo multidisciplinario de la Unidad de Trastornos del Ánimo del Departamento de Psiquiatría de Clínica Las Condes busca aplicar un modelo integrativo con una mirada amplia, con el objetivo de encontrar el mejor manejo para cada paciente, orientado no solo a la remisión sintomática sino también a la recuperación funcional (autonomía, calidad de vínculos, etc.), para incidir de este modo en la calidad de vida global de los pacientes.

Affective disorders (uni­ or bipolar) represent a significant public health issue, due both to its high prevalence as well as the high index of disability that they generate. This article addresses the problem of treatment resistance, as well the use of clinical guidelines and strategies for the treatment of more complex cases. We analyze the contributions of pharmacological treatments, psychotherapy and non-pharmacological somatic therapies, from an integrative point of view. The multidisciplinary team of Mood Disorders Unit at Clínica Las Condes Psychiatry Department seeks to apply a broad-view integrative model with the aim of finding the better management strategy for each patient. Our objectives are both symptomatic remission and functional recovery (autonomy, quality of affective bonds, etc.), in order to make a difference on the patients' overall quality of life.

Impairments of prepulse inhibition of the startle response in abstinent alcoholic male patients.

AIMS: Prepulse inhibition (PPI) of the startle reflex, which refers to the ability of innocuous sensory events to reduce the startle reflex, has been described as an operational measure of sensorimotor gating that is reduced in several neuropsychiatric disorders, such as schizophrenia, but experience is lacking in addictions and alcoholism. The aim of this study was to examine the existence of impairments in the startle response and PPI in abstinent alcoholic men. METHODS: Testing for PPI was conducted on 60 abstinent alcoholic men aged 18-65 years (mean 46.37) who met DSM-IV criteria for alcohol dependence and had been abstinent for more than a month at the time of testing. The comparison group were compared with 37 sex- age- and education-matched controls without alcohol dependence. RESULTS: Magnitudes of the startle reflex were lower in patients than in controls. The differences were statistically significant (P < 0.05) in trials with prepulses presented 30 and 120 ms before the onset of the startle stimulus. There was also a statistically significant (P < 0.05) reduced percentage of PPI when the prepulse was presented 30 ms before the startle stimulus. CONCLUSIONS: These data suggest that sensory information processing mechanisms could be damaged in abstinent alcoholic patients. The fact that these findings are common to other psychiatric disorders could indicate the existence of a common vulnerability marker and explain the high degree of comorbidity between alcoholism and other mental illnesses.