Staging of depressive disorders: Relevance of resistance to treatment and residual symptoms.

BACKGROUND: Clinical staging model for depression helps to better define the clinical situation of patients. The objectives of this study are: to correlate the Hetrick's staging model of depression with the severity of depression, associated disability, and resistance to treatment in the established disease stages and to test the modification introduced by our group consisting in the introduction of a substage for recurrence from a previous episode that was stabilized with a complete remission. METHODS: A Cross-sectional study with 133 adult subjects having a current and primary diagnosis of Depressive disorder was developed. Patients were classified according to the model and assessed with: 17-item Hamilton Depression Scale (HAM-D), Clinical Global Impression (CGI); Global Assessment of Function (GAF); Maudsley Staging Method for treatment resistance (MSM) and Sheeham Disability Schedule (SDS). RESULTS: The variable that best contributes to the differentiation between clinical stages, in established Depression, is resistance to treatment evaluated by the MSM. Correlations between MSM and the clinical stages were statistically significant between most pairs of stages. Finally, we showed preliminary data in order to prove that a differential sub-stage for recurrent depression with and without inter-episodic remission in the current heuristic models could be a possible stage for better define depression staging model. CONCLUSIONS: Resistance to treatment should be included in the definition of clinical stages in established depression. Despite the difficulty of establishing a valid model for the staging of depression, it can certainly add great value to diagnosis, therapeutic interventions and clinical research.

Relación entre variables sociodemográficas, psicosociales y clínicas y el estigma personal en pacientes con diagnóstico de esquizofrenia / The relationships between sociodemographic, psychosocial and clinical variables

ANTECEDENTES: Estudios previos sugieren que las personas con esquizofrenia son uno de los grupos más estigmatizados de la sociedad. OBJETIVO: analizar ampliamente el estigma personal en pacientes con esquizofrenia. MÉTODO: Se obtuvieron datos de 89 pacientes. Éstos fueron evaluados con los siguientes instrumentos: características sociodemográficas y clínicas, Escala de Discriminación y Estigma, Cuestionario de Autopercepción del Estigma, Escala de Síndromes positivos y negativos, Escala de depresión de Calgary, Escala de Evaluación de la Actividad Global y Escala Breve de Funcionamiento Social. RESULTADOS: las relaciones entre el estigma personal y las variables sociodemográficas y psicosociales resultaron escasamente significativas. Sin embargo, las variables clínicas correlacionaron significativamente con diferentes facetas del estigma personal. Las correlaciones de las subescalas de estigma personal fueron entre estigma experimentado, estigma anticipado y autoestigma entre sí. El 29,5% de la variación de la subescala "trato injusto" se explicó por la edad de inicio y el nivel de depresión. El 20,1% de la variación de la subescala "autolimitación" se explicó por el nivel de depresión y el género. El 27,3% de la subescala "superación del estigma" se explica por el nivel de depresión y los síntomas psicóticos positivos y negativos. El 35,8% de la variación de la escala de autoestigma se explicó por el nivel de depresión. CONCLUSIONES: Abordar el estigma dentro del tratamiento parece de crucial importancia ya que todas las facetas del estigma están altamente relacionadas con las dimensiones clínicas, especialmente la depresión. Por lo tanto, incluir estrategias para reducir el estigma en los programas de atención puede ayudar a los pacientes con esquizofrenia a una mejor adaptación funcional y proceso evolutivo

BACKGROUND: Studies suggest that people with a diagnosis of schizophrenia are one of the most stigmatized groups in society. AIM: To comprehensively analyze personal stigma in patients diagnosed with schizophrenia. METHOD: Data were obtained from 89 patients. Patients were evaluated with the following scales: a sociodemographic and clinical questionnaire, the Discrimination and Stigma Scale, the Self-perception of Stigma Questionnaire for People with Schizophrenia, the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Global Assessment of Functioning Scale, and the Brief Social Functioning Scale. RESULTS: Relations between personal stigma and socio-demographic and psychosocial variables were poor. However, clinical variables correlated with different facets of personal stigma. Personal stigma subscales ́ correlations were between experienced stigma, anticipated stigma, and self-stigma to each other. 29.5% of the experienced stigma subscale variance was explained by age of onset and level of depression. 20.1% of the anticipated stigma subscale variance was explained by level of depression and gender. 27.3% of the overcoming stigma subscale variance was explained by level of depression and positive and negative psychotic symptoms. 35.8% of the self-stigma scale variance was explained by the level of depression