[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.

[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.

Clinical Outcomes After 1 Year of Augmented Insulin Pump Therapy in Patients with Diabetes in a Specialized Diabetes Center in Medellín, Colombia.

BACKGROUND: Type 1 diabetes can be difficult to control. Augmented pump therapy (CSII-rtCGM) has become an important tool for controlling blood glucose and decreasing hypoglycemia. METHODS: Describe the results 1 year after starting CSII-rtCGM in patients with diabetes in Medellín, Colombia. This is an observational, retrospective study. Patients with type 1 and type 2 diabetes started on CSII-rtCGM between January 2008 and June 2015 were included. Qualitative variables were analyzed as absolute or relative frequencies. Quantitative variables were obtained through central tendency and dispersion according to the normal distribution of the analyzed variable using Kolmogorov-Smirnov. SPSS 19 from IBM was used. RESULTS: Two hundred forty-seven patients were identified, of those 183 were included. The starting HbA1C was 8.7% ± 1.7% and 7.4% ± 0.8% (P < 0.05) 1 year later. 16.5% of patients had been admitted to the hospital before starting CSII-rtCGM, after 1 year the admission rate was 6.0% (P < 0.05). The incidence of severe hypoglycemia at the beginning was 32%, 1 year later it was 7.1%. CONCLUSION: CSII-rtCGM therapy improves glucose control and decreases severe hypoglycemic events and hospital admission rate.

Epidemiological characterization of diabetic patients on therapy with continuous subcutaneous insulin infusion and continuous glucose monitoring in real time.

OBJECTIVE: To describe baseline characteristics of diabetic patients who were started on insulin pump and real time continuous glucose monitor (CSII-rtCGM) in a specialized center in Medellin, Colombia. MATERIALS AND METHODS: All patients with diabetes with complete data who were started on CSII-rtCGM between February 2010 and May 2014 were included. This is a descriptive analysis of the sociodemographic and clinical characteristics. RESULTS: 141 of 174 patients attending the clinic were included. 90,1% had type 1diabetes (T1D). The average age of T1D patients at the beginning of therapy was 31,4 years (SD 14,1). 75.8% of patients had normal weight (BMI<25), 21.0% were overweight (BMI 25-30) and 2,3% were obese (BMI>30). The median duration of T1D was 13 years (P25-P75=10.7-22.0). 14,2% of the patients were admitted at least once in the year preceding the start of CSII-rtCGM because of diabetes related complications. Mean A1c was 8.6%±1.46%. The main reasons for starting CSII-rtCGM were: poor glycemic control (50.2%); frequent hypoglycemia, nocturnal hypoglycemia, hypoglycemia related to exercise, asymptomatic hypoglycemia (30.2%); severe hypoglycemia (16.44%) and dawn phenomena (3.1%). CONCLUSION: Baseline characteristics of patients included in this study who were started on CSII-rtCGM are similar to those reported in the literature. The Clinic starts CSII-rtCGM mainly in T1D patients with poor glycemic control, frequent or severe hypoglycemia despite being on basal/bolus therapy.

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.

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.

Caracterización epidemiológica de pacientes diabéticos en terapia con infusión subcutánea continua de insulina y monitorización continua de glucosa en tiempo real / Epidemiological characterization of diabetic patients on therapy with continuous subcutaneous insulin infusion and continuous glucose monitoring in real time

OBJETIVO: Caracterizar los pacientes con diabetes que iniciaron terapia con bomba de insulina y monitorización continua de glucosa en tiempo real (CSII-rtCGM) en un centro especializado de Medellín, Colombia. MATERIALES Y MÉTODOS: Se evaluaron los pacientes con diabetes que recibieron entrenamiento e instalación del dispositivo en el centro entre febrero de 2010 y mayo de 2014. Se realizó un análisis descriptivo de las variables sociodemográficas y clínicas. RESULTADOS: Se incluyeron 141 pacientes de los 174 pertenecientes al programa. El 90,1% tenía diabetes tipo 1 (DT1), siendo la edad promedio al inicio de la terapia de 31,4 años (SD: 14,1). El 75,8% de los pacientes tenía peso normal (IMC < 25), el 21,0% sobrepeso (IMC = 25-30) y el 2,3% era obeso (IMC ≥ 30). La mediana de duración de la enfermedad fue de 13 años (P25-P75 = 10,7-22,0). El 14,2% de los pacientes fueron hospitalizados al menos una vez en el año previo al inicio de la terapia con CSII-rtCGM por causas relacionadas con la diabetes. El promedio de hemoglobina glucosilada era de 8,6% ± 1,46%. Las principales indicaciones para la formulación de CSII-rtCGM fueron: mal control glucémico (50,2%); hipoglucemias frecuentes, nocturnas o asociadas al ejercicio y sin síntomas de alarma (30,2%); hipoglucemias severas (16,44%) y fenómeno del alba (3,1%). CONCLUSIÓN: Las características de los pacientes que inician terapia con CSII-rtCGM son similares a las reportadas en la literatura. Los resultados muestran que el centro especializado inicia esta terapia principalmente en pacientes con DT1 con mal control glucémico a pesar de la terapia intensiva, hipoglucemias leves persistentes o hipoglucemias severas

OBJECTIVE: To describe baseline characteristics of diabetic patients who were started on insulin pump and real time continuous glucose monitor (CSII-rtCGM) in a specialized center in Medellin, Colombia. MATERIALS AND METHODS: All patients with diabetes with complete data who were started on CSII-rtCGM between February 2010 and May 2014 were included. This is a descriptive analysis of the sociodemographic and clinical characteristics. RESULTS: 141 of 174 patients attending the clinic were included. 90,1% had type 1 diabetes (T1D). The average age of T1D patients at the beginning of therapy was 31,4 years (SD 14,1). 75.8% of patients had normal weight (BMI < 25), 21.0% were overweight (BMI 25-30) and 2,3% were obese (BMI > 30). The median duration of T1D was 13 years (P25-P75 = 10.7-22.0). 14,2% of the patients were admitted at least once in the year preceding the start of CSII-rtCGM because of diabetes related complications. Mean A1c was 8.6% ± 1.46%. The main reasons for starting CSII-rtCGM were: poor glycemic control (50.2%); frequent hypoglycemia, nocturnal hypoglycemia, hypoglycemia related to exercise, asymptomatic hypoglycemia (30.2%); severe hypoglycemia (16.44%) and dawn phenomena (3.1%). CONCLUSION: Baseline characteristics of patients included in this study who were started on CSII-rtCGM are similar to those reported in the literature. The Clinic starts CSII-rtCGM mainly in T1D patients with poor glycemic control, frequent or severe hypoglycemia despite being on basal/bolus therapy