[Integrated management of patients with schizophrenia: beyond psychotropic drugs]. / Manejo integral del paciente con esquizofrenia: más allá de los psicofármacos.

INTRODUCTION: Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. THEME DEVELOPMENT: It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. DISCUSSION: It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. CONCLUSIONS: The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential.

Manejo integral del paciente con esquizofrenia: más allá de los psicofármacos / Integrated management of patients with schizophrenia: beyond psychotropic drugs

Introducción: La esquizofrenia es una enfermedad compleja con graves repercusiones funcionales, por lo que amerita un tratamiento que vaya más allá de los fármacos. Desarrollo del tema: Se requiere un enfoque que, considerando el proceso de diátesis estrés, incluya la rehabilitación, estrategias psicoterapéuticas para los síntomas cognitivos, negativos y psicóticos persistentes, psicoeducación del paciente y las comunidades, estrategias para la adaptación en comunidad como introducción a la fuerza laboral y el modelo comunitario como cambio del paradigma manicomial. Discusión: Es necesario que se establezcan iniciativas privadas y públicas para la atención integral de la esquizofrenia en el país, abogando por el bienestar de quienes la padecen. Conclusiones: El manejo integral del paciente con esquizofrenia requiere una mirada global de este y su enfermedad y es imperativo su desarrollo.

Introduction: Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. Theme development: It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. Discussion: It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. Conclusions: The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential.

[Sensitivity and specificity between the Composite International Diagnostic Interview Version 3.0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012]. / Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3.0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012.

INTRODUCTION: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. OBJECTIVE: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. METHODOLOGY: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. RESULTS: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. CONCLUSIONS: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

[Intervention of Schizophrenia From the Community Model]. / Intervención de la esquizofrenia desde el modelo comunitario.

INTRODUCTION: Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. METHODOLOGY: Case report. RESULTS: This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. DISCUSSION: The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. CONCLUSIONS: A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.

Intervención de la esquizofrenia desde el modelo comunitario / Intervention of Schizophrenia From the Community Model

Introducción: La esquizofrenia es una enfermedad compleja cuyo manejo farmacológico es una medida terapéutica insuficiente para garantizar la adaptación a la comunidad y el restablecimiento de la calidad de vida del paciente, por lo que es necesario un manejo multidimensional, propuesto por las intervenciones comunitarias. Metodología: reporte de caso. Resultados: Se trata de un caso clínico que ilustra la respuesta a un tratamiento multidisciplinario basado en el modelo comunitario de atención a la salud mental en Envigado, Colombia. Discusión: El manejo de la esquizofrenia exige intervenciones multimodales que incluyan la detección en comunidad, la psicoeducación de los individuos, sus familias y la sociedad, y el abordaje de distintas áreas de funcionamiento que permitan la adaptación del sujeto a su ambiente social. Conclusiones: Es necesaria una intervención integradora que el modelo comunitario puede proporcionar implementando políticas que permitan su aplicación.

Introduction: Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. Methodology: Case report. Results: This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. Discussion: The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. Conclusions: A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.

Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3. 0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012 / Sensitivity and specificity between the Composite International Diagnostic Interview Version 3. 0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012

Introducción: El abordaje de los problemas de salud mental de la población colombiana hace necesario disponer de instrumentos diagnósticos válidos, fáciles de aplicar y comparables (local e internacionalmente). Objetivo: Comparar la sensibilidad y la especificidad diagnóstica entre el CIDI 3.0 y el SCID-! para el trastorno depresivo mayor, el trastorno afectivo bipolar I y II y el trastorno por dependencia de sustancias. Metodología: Estudio transversal que comparó en 100 sujetos las prevalencias de vida de tres trastornos mentales por medio del CIDI 3.0 y el SCID-I. La investigación fue aprobada por el Comité de Ética Institucional. Se midieron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo (con sus respectivos intervalos de confianza del 95%) de las dos entrevistas diagnósticas. Para el análisis de la información se utilizó el software SPSS® versión 21.0. Resultados: La mediana de edad fue 43,5 [intervalo intercuartílico, 30] anos. La sensibilidad (Se) y la especificidad (Es) más altas se observaron en el diagnóstico de trastorno por dependencia de drogas -Se, 80% (IC95%, 34,94%-100%); Es, 98,46% (IC95%, 94,7%-100%)-. Conclusiones: El SCID-I y el CIDI 3.0 mostraron diferentes niveles de sensibilidad y especificidad para los tres trastornos estudiados así: altas para el trastorno por dependencia de sustancias, moderadas para el trastorno afectivo bipolar I y II y bajas para el trastorno depresivo mayor.

Introduction: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. Objective: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. Methodology: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. Results: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. Conclusions: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.