Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis.

The aim of this study was to generate practical recommendations to assist rheumatologists and dermatologists in the management of cardiovascular (CV) comorbidities in patients with moderate-to-severe psoriasis (MS-PSO) and psoriatic arthritis (PsA). A two-round Delphi study was conducted. A panel of experts rated their agreement with a set of statements (n = 52) on a nine-point Likert scale (1 = totally disagree; 9 = totally agree). Statements were classified as inappropriate (median 1-3), irrelevant (median 4-6) or appropriate (median 7-9). Consensus was established when at least two-thirds of the panel responded with a score within any one range. A total of 25 experts, 60% rheumatologists and 40% dermatologists, participated in two consultation rounds. There was overall unanimity on the appropriateness of an initial assessment for CV risk factors in all patients with MS-PSO and PsA. Most panelists (88.0%) also supported the evaluation of patients' psychological and physical status. Additionally, most panelists (72.2%) agreed on a novel sequential approach for the management of CV comorbidities. This sequence starts with the assessment of hypertension, diabetes and dyslipidemia along with the identification of depression and anxiety disorders. Once these factors are under control, smoking cessation programs might be initiated. Finally, if patients have not met weight loss goals with lifestyle modifications, they should receive specialized treatment for obesity. This study has drawn up a set of practical recommendations that will facilitate the management of CV comorbidities in patients with MS-PSO and PsA.

Psiquiatría psicosomática del niño y adolescente con enfermedades crónicas digestivas / Psychosomatic psychiatry of the child and adolescent with chronic digestive diseases

Las enfermedades crónicas infantiles influyen negativamente en el desarrollo psicológico. Los niños y adolescentes con enfermedades crónicas digestivas presentan de forma predominante síntomas ansiosos y depresivos. Factores ambientales como el manejo de la sintomatología, la influencia de la respuesta de los pares o de la propia familia pueden determinar el manejo que de la enfermedad tenga el paciente. Estos aspectos son muy relevantes en enfermedades como la Enfermedad de Crohn, la Colitis Ulcerosa, el Dolor Abdominal Recurrente y los Vómitos Psicógenos. Los factores psicológicos que afectan a enfermedades médicas y/o la presencia comórbida de patología mental disminuyen la calidad de vida de estos pacientes afectando también al sistema familiar. La medicina psicosomática aborda estos aspectos de dichas patologías ayudando al paciente y a sus familias. Un abordaje integral por parte digestivo y de salud mental incrementa la salud percibida de los niños y adolescentes con patología digestiva crónica

Chronic childhood diseases negatively influence on the child's psychological development. Children and adolescents with chronic digestive diseases have predominantly anxious and depressive symptoms. Environmental factors such as management of gastrointestinal symptoms, the influence of the response of peers or family itself can determine the handling of the disease. These aspects are very important in diseases like Crohn's disease, ulcerative colitis, recurrent abdominal pain and psychogenic vomiting. Psychological factors affecting medical conditions and / or the presence of comorbid mental illness diminish the quality of life of these patients also the family system is affecting. Psychosomatic medicine addresses these aspects of these diseases helping patients and their families. A comprehensive approach to improving gastrointestinal and psychiatric symptoms increases the perceived health of children and adolescents with chronic digestive diseases

Psiquiatría psicosomática del niño y adolescente con enfermedades crónicas: enfermedades renales / Children and Adolescent Psychomatic Psychiatry: Kidney Diseases

Las enfermedades crónicas infantiles tienen una gran influencia no sólo en lo físico, sino también en el desarrollo psicológico de los niños y adolescentes. Las enfermedades renales son frecuentes en este grupo de edad, presentan fundamentalmente síntomas ansiosos y depresivos, baja autoestima, además de los efectos secundarios de la inmunosupresión. Debido a que son patologías de características crónicas, con gran impacto de los procedimientos diagnósticos y terapéuticos y el alto riesgo de hospitalizaciones para recibir el tratamiento idóneo, conllevan una alteración del funcionamiento (social, familiar, escolar) habitual de los niños y adolescentes. Por lo que es importante, un abordaje multidisciplinar en estos casos, debido a la influencia de los factores psicológicos para minimizar el impacto de la patología, mejorar el curso y la adherencia terapéutica en este tipo de enfermedades de características crónicas

Chronic childhood diseases have a major influence not only physically, but also in the psychological development of children and adolescents. Kidney disease is common in this age group basically have anxious and depressive symptoms , low self-esteem , in addition to the side effects of immunosuppression. Because features are chronic diseases with great impact of diagnostic and therapeutic procedures and the high risk of hospitalization to receive the best treatment, involve an alteration of the normal functioning of children and adolescents (social, family, school). So it is important a multidisciplinary approach in these cases, because the influence of psychological factors to minimize the impact of the disease, improve the course and adherence in such chronic diseases features