[Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital]. / Implementación de un sistema protocolizado de pesquisa temprana de patología psiquiátrica en un hospital general. Protocolo de Vigilancia Neuropsiquiátrica (VNP): avanzando hacia un modelo de psiquiatría de enlace proactivo.

BACKGROUND: The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital. AIM: To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice. MATERIAL AND METHODS: Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team. RESULTS: A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals. CONCLUSIONS: The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

Implementación de un sistema protocolizado de pesquisa temprana de patología psiquiátrica en un hospital general. Protocolo de Vigilancia Neuropsiquiátrica (VNP): avanzando hacia un modelo de psiquiatría de enlace proactivo / Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital

BACKGROUND: The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital. AIM: To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice. MATERIAL AND METHODS: Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team. RESULTS: A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals. CONCLUSIONS: The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

Psychometric Properties of the Fibromyalgia Survey Questionnaire in Chilean Women With Fibromyalgia.

OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Chilean version of the Fibromyalgia Survey Questionnaire (FSQ). METHODS: Women with fibromyalgia (FM; n = 214), women with rheumatoid arthritis (RA; n = 97), and women without chronic pain (being followed by Gynecology, G; n = 117) from the Red de Salud UC CHRISTUS (Santiago, Chile) participated. Women with FM completed the FSQ, Fibromyalgia Impact Questionnaire (Revised Version), Numerical Pain Rating Scale, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Patient Health Questionnaire 15, and Short-Form Health Survey. Two weeks later, they completed the FSQ again by phone (n = 120). RESULTS: The FSQ total scale showed excellent to good internal consistency at T1 (α = 0.91, ω = 0.91) and T2 (α = 0.78, ω = 0.78), and good test-retest reliability (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.72-0.85). It showed medium to large correlations with the other measures. Discriminant analysis between the FM group and the control group (RA and G) revealed that the FSQ total scale reached a classification accuracy of 81.3%. Receiver operating characteristic curve (adjusted area under the curve, 0.88; 95% CI, 0.85-0.92) showed that the best FSQ cutoff was 17, resulting in sensitivity of 89% (95% CI, 0.84-0.93) and specificity of 75% (95% CI, 0.69-0.80). Considering the FM diagnosis performed by a rheumatologist as the criterion standard, sensitivity and specificity of the modified 2010 American College of Rheumatology preliminary criteria for FM were 92.8% (95% CI, 0.88-0.96) and 63.4% (95% CI, 0.57-0.70), respectively. CONCLUSIONS: The Chilean version of the FSQ presents good psychometric properties and is a useful tool in clinical settings to assist in FM diagnosis and symptom assessment. A cutoff score of 17 or higher seems to be the most appropriate for Chilean population.

The efficacy of adding group behavioral activation to usual care in patients with fibromyalgia and major depression: design and protocol for a randomized clinical trial.

BACKGROUND: Fibromyalgia and major depression frequently co-occur. Patients with both conditions have a worse prognosis and higher disability, and their treatment options are scarce. Behavioral activation (BA) may be an especially useful intervention for these patients, as it targets mechanisms of action that seem to be common to both disorders. Nevertheless, its efficacy has not been examined in people with both conditions. We describe the design and rationale of a randomized clinical trial aimed to evaluate the efficacy of adding BA (applied in groups) to usual care in order to reduce the severity of depressive symptoms (primary outcome) among Chilean women with fibromyalgia and major depression (N = 90). Pain intensity, fibromyalgia impact, pain catastrophizing and hypervigilance, physical health symptoms, environmental reward, and BA will be evaluated as secondary outcomes. METHODS: Women will be randomized to an experimental arm (n = 45) which will receive usual care (UC) for fibromyalgia with comorbid depression plus BA; and a comparison arm, which will receive only UC for fibromyalgia with comorbid depression (n = 45). Outcome assessment will take place at four time points: (1) at baseline, (2) when the experimental arm is under treatment (between sessions 6 and 7), (3) immediately after the experimental arm complete the treatment, and (4) at a 3-month follow-up. The following instruments will be used: Chilean version of the Patient Health Questionnaire-9 (PHQ-9), Composed Pain Intensity Index, Fibromyalgia Impact Questionnaire Revised (FIQ-R), Pain Catastrophizing Scale (PCS), Pain Vigilance and Awareness Questionnaire (PVAQ), Patient Health Questionnaire (PHQ-15), Reward Probability Index (RPI), and the Activation subscale of the Behavioral Activation for Depression Scale (BADS). DISCUSSION: We expect that, after treatment, the group receiving BA should experience greater reductions in the primary and secondary outcomes than the group receiving only UC. These reductions should be both statistically and clinically significant and will be maintained at follow-up. This study will contribute to facilitate the integrated treatment of fibromyalgia and depression. TRIAL REGISTRATION: ClinicalTrials.gov under the name "Testing Interventions for Patients with Fibromyalgia and Depression," Identifier: NCT03207828 . Registered on 5 July 2017 (last update posted 21 September 2017).

Coste hospitalario asociado al delirium en pacientes mayores / Hospital costs associated with delirium in older medical patients

Introducción. El delirium es una complicación frecuente y potencialmente prevenible del adulto mayor hospitalizado, asociado a mayor morbilidad y mortalidad. El objetivo de este estudio fue evaluar los costes asociados a delirium en pacientes mayores en un hospital universitario. Materiales y métodos. Estudio prospectivo de cohortes de pacientes de 65 años o más, ingresados en la Unidad de Agudos no Quirúrgicos. Un equipo de psicogeriatras investigaron delirium usando el Confusion Assessment Method (CAM-S) cada 48h. Se consignaron datos demográficos, duración de la estancia hospitalaria, tipo de unidad, costes de farmacia y coste total de la hospitalización. Se realizó análisis bivariado y multivariado de los costes en relación a diagnóstico de delirium y posibles variables confundentes. Resultados. Cuatrocientos cincuenta y cuatro pacientes fueron analizados, 160 (35,2%) de la cohorte con delirium y 294 (64,8%) de la cohorte sin delirium. La cohorte delirium tuvo mayor estancia hospitalaria y mortalidad del 7,0% comparado con el 1,7% del grupo control. La mediana de gasto total durante la estancia hospitalaria fue un 38,7% mayor en la cohorte con delirium versus la cohorte sin delirium (p<0,001). En el análisis ajustado por variables confundentes, el coste total es significativamente mayor en pacientes con delirium (p=0,01). Conclusiones. Este estudio confirma que la presencia de delirium se asocia a costes significativamente mayores. Considerando que la prevención del delirium es posible, conocer los costes asociados a éste puede contribuir a justificar la implementación de programas de prevención y mejorar la calidad de atención de personas mayores(AU)

Introduction Delirium is a common and serious complication in older patients, associated with increased, potentially preventable, morbidity and mortality. The aim of this study was to evaluate the associated costs of delirium during hospitalization in a university affiliated hospital in Chile. Materials and methods. Prospective cohort study of consecutive patients 65 years and older, admitted to a medical ward. A psychogeriatric team assessed patients during the first and every 48h until discharge using the Confusion Assessment Method (CAM-S), length of hospital stay, pharmacy and total hospitalization costs were analyzed. Statistical analysis was performed using bivariate and multivariate analysis according to delirium diagnosis. Results. Data from 454 patients was analyzed, 160 of them in a delirium cohort (35.2%) and 294 in a non-delirium cohort (64.8%). The delirium cohort had a longer hospital stay (DATA) and higher mortality (7.0% versus 1.7%). The median of total costs of delirium during hospital stay was 38.7% higher than the non-delirium cohort (P<.001). Total costs were significantly higher in the delirium cohort after adjustment of covariables (P=.01). Conclusions. This study confirms that delirium is associated with significantly greater costs. Considering that effective delirium prevention is possible, the knowledge of associated costs can help health care providers to justify prevention strategies and finally give better care for older patients(AU)

[Hospital costs associated with delirium in older medical patients]. / Coste hospitalario asociado al delirium en pacientes mayores.

INTRODUCTION: Delirium is a common and serious complication in older patients, associated with increased, potentially preventable, morbidity and mortality. The aim of this study was to evaluate the associated costs of delirium during hospitalization in a university affiliated hospital in Chile. MATERIALS AND METHODS: Prospective cohort study of consecutive patients 65 years and older, admitted to a medical ward. A psychogeriatric team assessed patients during the first and every 48h until discharge using the Confusion Assessment Method (CAM-S), length of hospital stay, pharmacy and total hospitalization costs were analyzed. Statistical analysis was performed using bivariate and multivariate analysis according to delirium diagnosis. RESULTS: Data from 454 patients was analyzed, 160 of them in a delirium cohort (35.2%) and 294 in a non-delirium cohort (64.8%). The delirium cohort had a longer hospital stay (DATA) and higher mortality (7.0% versus 1.7%). The median of total costs of delirium during hospital stay was 38.7% higher than the non-delirium cohort (P<.001). Total costs were significantly higher in the delirium cohort after adjustment of covariables (P=.01). CONCLUSIONS: This study confirms that delirium is associated with significantly greater costs. Considering that effective delirium prevention is possible, the knowledge of associated costs can help health care providers to justify prevention strategies and finally give better care for older patients.

[Anesthesia awareness]. / Awareness, consecuencias de una experiencia estresante.

Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, on the operating table, when a patient has not had enough general anesthetic or analgesic to prevent consciousness or waking up during surgery. According to international studies its global incidence ranges from 0.1 to 0.2%. Its impact on people can be as severe as other traumatic experiences such as natural disasters, violent fights or sexual abuse. The prevalence of symptoms compatible with post traumatic stress disorder can be as high as 50%, after experiencing the awareness phenomenon. This paper reviews the main issues of the awareness phenomenon.

El problema del insomnio / Insomnia as a problem

El insomnio es una patología muy frecuente en la clínica general que conlleva notables repercusiones en la vida diaria de los pacientes. Para actualizar los conocimientos sobre su diagnóstico y tratamiento hemos revisado los textos más representativos sobre el sueño y sus trastornos. Conclusiones: Ante la sospecha de un trastorno relacionado con el sueño, la adecuada realización de la historia clínica es el dato que más información aporta de cara al diagnóstico. Posteriormente se programarán las pruebas complementarias o su derivación a una Unidad de Sueño. El tratamiento se realizará en base al diagnóstico, procurando iniciar primero medidas no farmacológicas (AU)