Social blushing: a neuropsychiatric disorder? / El sonrojo social: ¿un trastorno neuropsiquiátrico?

Until recently, social blushing was rarely discussed in the medical literature. It was usually considered only a normal and occasional physiological reaction associated with emotions such as embarrassment brought on by social situations. This has changed in recent years with attention increasingly being paid to blushing, either in the context of social anxiety disorder or in its own right. Some argue that blushing has adaptive value, so it may not make sense to treat people for blushing, a view we do not agree with since the blushing experience is not the same for everyone and those who seek medical help do so because their blushing impairs their quality of life. Furthermore, the fact that a symptom is adaptive does not place it beyond the scope of medical treatment. Quite the contrary: physicians treat many symptoms that cause discomfort, e.g. pain and vomiting, which may be regarded as adaptive, yet few doubt the value of treating such problems. The same is true for blushing. Recognizing its potential adaptive value does not mean that it should not be treated. The distress of those who blush easily and seek help justifies attempts to find ways to help them. This article underlines the need to distinguish between normal social blushing and pathological social blushing and, at the same time, reviews current available treatments for individuals who seek help for this condition.

Hasta hace poco tiempo, rara vez se debatía sobre el sonrojo social en la literatura médica. Se le consideraba solo una reacción fisiológica normal y ocasional, provocada por situaciones sociales. Esto ha cambiado en años recientes pues se le presta cada vez mayor atención, ya sea en el contexto del trastorno de ansiedad social o por derecho propio. Algunos argumentan que sonrojarse tiene valor adaptativo y que por lo tanto no tiene sentido tratar a las personas que se sonrojan, visión que no compartimos porque la experiencia de ruborizarse no es igual en todos los individuos y porque los que consultan lo hacen debido a que las sucesivas experiencias de rubor van minando su calidad de vida. Más aún, el que un síntoma sea adaptativo no lo pone fuera del ámbito de la medicina. Al contrario: hay numerosos síntomas que tratamos los médicos, desagradables para el individuo -el dolor y los vómitos son buenos ejemplos-, los cuales pueden considerarse adaptativos y sin embargo pocos podrían en duda la legitimidad de tratarlos. Lo mismo es válido para el sonrojo. Reconocer su potencial valor adaptativo no hace ilegítimo su tratamiento. El sufrimiento de aquellos que se sonrojan fácilmente y buscan ayuda por ello, justifica los intentos de encontrar modos de ayudarlos. Este texto subraya la necesidad de distinguir entre el sonrojo social normal y el sonrojo social patológico y, a la vez, revisa los tratamientos actualmente disponibles para las personas que consultan por esta condición.

First validation of a Spanish-translated version of the Edinburgh postnatal depression scale (EPDS) for use in pregnant women. A Chilean study.

The objective of the study was to evaluate the psychometric properties of the Edinburg Postnatal Depression Scale (EPDS) to detect depression during pregnancy in Chile. The EPDS was applied to a sample of 111 pregnant women, who were attending an antenatal appointment in primary care centers. The Beck Depression Inventory (BDI-I) was used to assess the convergent validity, and the Depressive Episode module of the MINI was used to identify cases. The factor analysis showed that there was a good fit, with a factor model that explains 57.6 % of the total variance. There was a high degree of internal consistency (Cronbach's α = 0.914) and good convergent validity with the BDI-I (rho = 0.850, p < 0.001). The EPDS was capable of differentiating cases of depression from non-cases. The best cutoff point was between 12 and 13, corresponding to an overall accuracy of 87.4 %. The questionnaire has good psychometric properties and can be useful for detecting cases of depression during pregnancy.

Evaluating the efficacy of endoscopic thoracic sympathectomy for generalized social anxiety disorder with blushing complaints: a comparison with sertraline and no treatment-santiago de chile 2003-2009.

OBJECTIVE: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. METHOD: Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1-64) after endoscopic thoracic sympathectomy or initiation of sertraline. RESULTS: At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being "severe" or "extreme." At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of blushing. At endpoint, Brief Social Phobia Scale total scores exhibited a greater decline with either treatment than with no treatment. Nonetheless, in comparison to no treatment, only the results obtained with endoscopic thoracic sympathectomy achieved statistical significance (p=0.003). Compensatory sweating occurred in 99 percent of patients who underwent endoscopic thoracic sympathectomy. High degrees of satisfaction with treatment were reported by 89 percent of patients undergoing endoscopic thoracic sympathectomy and by 59 percent of patients taking medication. CONCLUSION: Endoscopic thoracic sympathectomy was associated to a greater reduction of blushing and Brief Social Phobia Scale scores, and higher degrees of satisfaction with treatment, in comparison to sertraline and no treatment.

[Characterization of depressed mothers in the postpartum]. / Caracterización de madres deprimidas en el posparto.

BACKGROUND: Postpartum depression (PPD) is a mood disorder that occurs during a specific period of womens lifetime: puerperium. The prevalence of PPD ranges from 8% to 30%, and a three-fold increase is seen in emerging as compared to developed countries. AIM: To characterize women consulting in primary care facilities for PPD. MATERIAL AND METHODS: Social and demographic features, obstetrical history, clinical symptoms and puerperal care of 440 postpartum women that sought help in primary care and were diagnosed as depressed, are described. RESULTS: These women had no paid employment (82.7%), had unplanned pregnancies (62.5%) and lacked adequate social support (59.4%). From the clinical viewpoint, most of these puerperal women had a family history of depression (64.2%) and 31% had suffered from previous depressive episodes. The clinical symptoms of these patients consisted of depressed mood (93.2%), anhedonia (87.9%) and fatigue (87%). CONCLUSIONS: Women depressed postpartum form a group that requires more clinical attention due to its great biological vulnerability, active depressive symptoms, and enormous psychosocial risk. The mother and child program, which benefits them, needs to be combined with a mental health component that can offer them a treatment adapted to their psychosocial context.

Caracterización de madres deprimidas en el posparto / Characterization of depressed mothers in the postpartum

Background: Postpartum depression (PPD) is a mood disorder that occurs during a specific period of women’s lifetime: puerperium. The prevalence of PPD ranges from 8 percent to 30 percent, and a three-fold increase is seen in emerging as compared to developed countries. Aim: To characterize women consulting in primary care facilities for PPD. Material and Methods: Social and demographic features, obstetrical history, clinical symptoms and puerperal care of 440 postpartum women that sought help in primary care and were diagnosed as depressed, are described. Results: These women had no paid employment (82.7 percent), had unplanned pregnancies (62.5 percent) and lacked adequate social support (59.4 percent). From the clinical viewpoint, most of these puerperal women had a family history of depression (64.2 percent) and 31 percent had suffered from previous depressive episodes. The clinical symptoms of these patients consisted of depressed mood (93.2 percent), anhedonia (87.9 percent) and fatigue (87 percent). Conclusions: Women depressed postpartum form a group that requires more clinical attention due to its great biological vulnerability, active depressive symptoms, and enormous psychosocial risk. The mother and child program, which benefits them, needs to be combined with a mental health component that can offer them a treatment adapted to their psychosocial context.

Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial.

BACKGROUND: The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. METHODS: 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830. FINDINGS: 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8.5 [95% CI 7.2-9.7] vs 12.8 [11.3-14.1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10.9 [9.6-12.2] vs 12.5 [11.1-13.8]). The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 (95% CI -6.3 to -2.7; p<0.0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49-69%] to 38/106 [36%; 27-46%]; usual care from 18/108 [17%; 10-25%] to 11/102 [11%; 6-19%]). INTERPRETATION: Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

Creativity as a healing support in life: the art of Carmen Aldunate

Carmen Aldunate es una artista plástica chilena que se ha dedicado durante más de cuarenta años a la pintura, el dibujo y el grabado. A pesar de haber carecido de una educación regular y de titulación universitaria, su vida artística ha sido fructífera, logrando reconocimiento nacional e internacional. En 2004 se convirtió en la primera mujer artista visual nombrada miembro de la Academia Chilena de Bellas Artes. Este estudio examina las principales características de la psicopatobiografía de Aldunate y muestra la influencia de los antecedentes familiares, la historia vital y el trastorno del humor en su trabajo artístico. El modo como Aldunate crea arte, con pureza y refinamiento de estilo, está llamativamente en paralelo con el modo como se aproxima a la vida: teniendo que luchar siempre con estados afectivos extremos que la amenazan, se ve forzada al control de sí misma, a un trabajo artístico obsesivo y a la búsqueda de la belleza. Mientras que para Aldunate la expresión creativa es un fin en sí misma, que configura su modo de vida, también llega a ser un medio para preservar o restaurar su salud(AU9

Carmen Aldunate is a Chilean visual artist devoted for more than forty years to painting, drawing and engraving. Despite having neither an ordinary education nor a university degree, she has had a fruitful artistic life, receiving national and international recognition. In 2004 she became the first woman visual artist to be made a member of the Chilean Academy of Fine Arts, This study examines the main features of Aldunate´s psycho-patho-biography, showing the influence of there family background, life history and mood disorder on her artistic work. The manner Aldunate creates art, using refinement and purity of style, remarkably parallels the way she approaches life: having to fight permanently with extreme mood states that threaten her, she resort to self control, obsessive artistic work and search for beauty. While for Aldunate creative expression is an end in itself, determining her way of living, it also becomes a medium to preserve or restore her health(AU)

Culturally-sensitive complaints of depressions and anxieties in women.

BACKGROUND: Current classifications of Mental Disorders are centered on Westernized concepts and constructs. "Cross-cultural sensitivity" emphasizes culturally-appropriate translations of symptoms and questions, assuming that concepts and constructs are applicable. METHODS: Groups and individual psychiatrists from various cultures from Asia, Latin America, North Africa and Eastern Europe prepared descriptions of main symptoms and complaints of treatment-seeking women in their cultures, which are interpreted by clinicians as a manifestation of a clinically-relevant dysphoric disorder. They also transliterated the expressions of DSM IV criteria of main dysphoric disorders in their cultures. RESULTS: In many non-western cultures the symptoms and constructs that are interpreted and treated as dysphoric disorders are mostly somatic and are different from the Western-centered DSM or ICD systems. In many cases the DSM and ICD criteria of depression and anxieties are not even acknowledged by patients. LIMITATIONS: The descriptive approach reported here is a preliminary step which involved local but Westernized clinicians-investigators following a biomedical thinking. It should be followed by a more systematic-comprehensive surveys in each culture. CONCLUSIONS: Westernized concepts and constructs of mental order and disorders are not necessarily universally applicable. Culturally-sensitive phenomena, treatments and treatment responses may be diversified. Attempts at their cross-cultural harmonization should take into consideration complex interactional multi-dimensional processes.

Opciones terapéuticas en depresión posparto / Therapeutics alternatives in postpartum depression

La depresión posparto es una enfermedad del ánimo que constituye una complicación médica frecuente en el puerperio. Su diagnóstico y adecuado manejo son importantes debido a que tienen consecuencias a corto y largo plazo, tanto en la madre como en el/la hijo/a. El objetivo de este artículo es describir las opciones terapéuticas disponibles en la actualidad. Específicamente, se ha demostrado la eficacia de intervenciones psicoterapéuticas interpersonales, cognitivo-conductuales y consejería no directiva en el tratamiento de esta patología. Pese a que la eficacia de la farmacoterapia en la enfermedad depresiva está ampliamente demostrada, son escasos los ensayos clínicos controlados llevados a cabo en DPP. Se han estudiado los efectos de los fármacos antidepresivos siguiendo las indicaciones generales para el tratamiento de la depresión, se recomienda el uso de fármacos antidepresivos para los casos más severos. Con el conocimiento disponible se podría con cautela utilizar sertralina o nortriptilina, sin necesidad de suspender la lactancia materna. Se hacen necesarias investigaciones bien diseñadas para evaluar diferentes componentes del tratamiento además de combinaciones y programas de tratamiento que sean costo efectivos.

El conflicto de intereses en medicina: una preocupación de la Sociedad de Neurología, Psiquiatría y Neurocirugía (SONEPSYN) / Conflicts of Interest: A Concern of the Society of Neurology, Psychiatry and Neurosurgery (SONEPSYN)

La literatura médica está prestando creciente atención al conflicto de intereses, de modo principal aunque no exclusivo, desde la perspectiva de las relaciones entre los médicos y la industria farmacéutica. Cuando hay intereses en competencia muchas veces la posibilidad de la distorsión del juicio médico no es visible a primera vista. Deben considerarse el posible sesgo inconsciente y no intencionado de autoservicio, como los efectos de que el juicio profesional parezca influenciado, independiente de si lo está o no. El advenimiento de la Medicina basada en la Evidencia y de la Salud Administrada plantea tensiones entre el enfoque poblacional de la medicina y las obligaciones de los médicos hacia sus pacientes individuales. Al igual que en otros países, es necesario que las sociedades científicas nacionales impulsen el estudio, conocimiento y difusión de aquellos factores que pueden contribuir a sesgar el juicio médico, como asimismo instituir pautas éticas locales que guíen a los profesionales.

Síndrome neuroléptico maligno: revisión / Neuroleptic malignant syndrome: review

El síndrome neuroléptico maligno, descrito en 1968 ha cobrado importancia dado el amplio uso de los neurolépticos en la ctualidad. Su reconocimiento precoz y manejo adecuado contribuyen a disminuir las complicaciones potencialmente letales del cuadro. En este trabajo realizamos una revisión de la literatura de los últimos años poniendo especial énfasis en aquellos aspectos relacionados con definición del cuadro clínico, complicaciones, factores predisponentes y de riesgo, tratamiento y manejo posterior. Con respecto al tratamiento y manejo posterior no se encuentran estudios prospectivos bien diseñados que avalen una conducta determinada, de manera que nos limitamos a sugerir aquellas maniobras de mayor consenso. Finalmente, se plantea la posibilidad de considerar al Síndrome Neuroléptico Maligno como parte del espectro común de reacciones del sistema nervioso frente a noxas diversas. Se hace evidente la necesidad de mayor investigación en este campo

Expresión plástica de psicóticos: informe de una experiencia / Plastic expression of psychotic patients report of an experience

Los autores dan a conocer el resultado y reflexiones de una experiencia -en que participaron alumnos universitarios de arte y pacientes psiquiátricos- que tuvo como objetivo enriquecer la experiencia humana y artística de los estudiantes. Se tuvo en consideración un enfoque antropológico de la práctica psiquiátrica que valora las diversas dimensiones y expresiones del hombre. Dan a conocer antecedentes, señalan material y método empleados y muestran las características de forma y de contenido que encontraron en pacientes esquizofrénicos, los cuales constituyeron la gran mayoría. Ilustran su trabajo con algunos ejemplos. Presentan opiniones formuladas por los universitarios sobre esta experiencia, los temores que la precedieron, las conexiones entre la manera de percibir la realidad en el artista y en el psicótico y la necesidad de ayudar a los enfermos. Se destaca finalmente el valor terapéutico del arte y la amplitud de la visión del artista, manifestando que el estudio de la personalidad sana o enferma, no compete sólo a la ciencia o al arte, sino a ambos

Formación de postgrado en psiquiatría: evaluación de una experiencia / Postgraduate training in psychiatry: evaluation of an experience (a survey)

Se investiga el grado de satisfacción experimentado por becarios de un departamento de psiquiatría en relación al cumplimiento de los objetivos de la educación de postgrado en la especialidad. Con este fin, se diseño un cuestionario de 50 preguntas que fue contestado por los becarios adscritos al programa de formación en noviembre de 1985. Con posterioridad al análisis de los resultados obtenidos con la primera aplicación del instrumento, se introdujeron modificaciones al programa formativo, medidas cuyo impacto se analiza luego de un período de 10 meses al aplicarse de nuevo el mismo instrumento. Aunque se encontraron deficiencias importantes en algunas áreas como la psicoterapia y el área de la psiquiatría comunitaria, en general se aprecian progresos considerables, incluso en estas áreas, luego de 10 meses. Se estiman atribuibles, en parte, a las modificaciones efectuadas al programa de formación. Se concluye en la importancia de diseñar e implementar sistemas de evaluación del desempeño docente de los departamentos, como un modo de mejorar la formación de postgrado en la especialidad

Etiología de la esquizofrenia: genes o ambiente? / Etiology of schizophrenia: genes or enviroment?

Se revisan los aspectos principales de las teorías genéticas y ambiental sobre etiología de la esquizofrenia y la evidencia a favor de cada una de ellas. Aunque hay fuerte evidencia a favor de un factor genético, los estudios muestran que los factores biográficos y ambientales también son importantes para el desarrollo de la enfermedad. Se señala que sólo el modelo internacional es capaz de conciliar los resultados de las distintas investigaciones en la actualidad