Luis Eduardo Jaramillo

DSM-5: ¿Cambios significativos?

El DSM-5 salio a la luz en mayo de 2013, generando gran expectativa y controversia por sus cambios e inclusiones, como la eliminacion de los ejes diagnosticos, la organizacion del manual en un modelo de “ciclo vital”, la aparicion de nuevas entidades y el ajuste en los criterios de diagnostico de muchos trastornos. El objetivo del presente articulo es presentar una aproximacion al manual desde una perspectiva latinoamericana, exponiendo las opiniones personales de los autores respecto a los principales cambios.

Factores relacionados con el número de rehospitalizaciones en pacientes psiquiátricos

Resumen Objetivo Evaluar el efecto que un grupo de variables demograficas, clinicas y de tratamiento tienen en la rehospitalizacion. Metodo Se efectuo un estudio de cohorte en el que se siguieron a 218 pacientes durante doce meses. El desenlace principal fue el numero de hospitalizaciones durante el seguimiento. Se uso un modelo de regresion binomial negativa para evaluar el efecto que el grupo de variables tienen en el numero de hospitalizaciones. Resultados El porcentaje de rehospitalizaciones esta en el limite superior del rango reportado en otros estudios. El uso de sustancias psicoactivas esta fuertemente asociado con el numero de rehospitalizaciones. La duracion de la estancia y el numero de episodios previos tambien se asociaron con la rehospitalizacion. La salida voluntaria y la comorbilidad con enfermedades medicas actuaron como factores protectores. Conclusion Es llamativo el elevado indice de rehospitalizacion, ya que influye significativamente en los pacientes, la familia y el sistema de salud; asi como en la necesidad de intervenir sobre los factores de riesgo, sobre todo el consumo de sustancias psicoactivas.

Edad de inicio como marcador de subtipos de enfermedad maniacodepresiva

Introduction: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. Objective: To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. Methods: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. Results: According to age at onset, three distributions haveINTRODUCTION Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. OBJECTIVE To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. METHODS Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. RESULTS According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. CONCLUSIONS In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.

Age of onset symptoms and gender in schizophrenic spectrum disorders

INTRODUCTION Food borne diseases are a serious public health problem. Poultry are often associated with these outbreaks. OBJECTIVE A systematic review of the literature is provided concerning the distribution and frequency of food borne outbreaks associated with consumption of chicken contaminated with Salmonella spp., Listeria monocytogenes and Staphylococcus aureus. MATERIALS AND METHODS The search for studies of outbreaks associated with Salmonella, S. aureus and L. monocytogenes was conducted in Medline, PubMed, Science Direct, Scielo, Cochrane Library (CCRT), Virtual Health Library (VHL), Highwire, HINARI and MedicLatina. Data were obtained for the calculation of odds ratio (OR) by preparing contingency tables using the RevMan5 program. RESULTS Seven articles met the inclusion criteria; however, no reports of L. monocytogenes were obtained. The overall OR was 3.01 (95% CI: 2.37, 3.81); this was interpreted as a significant association between the consumption of contaminated chicken and food poisoning. In the included studies heterogeneity (p= 0.03) was presented, so it took a subgroup analysis of microorganisms, in the case of Salmonella OR was 2.67 (95% CI: 2.09 -3.41). No analysis was made for S. aureus reported a single article. CONCLUSIONS The OR indicated a strong association between chicken consumption and acquisition of salmonellosis. The main risk factor for acquiring salmonellosis is the consumption of chicken from grill restaurants.INTRODUCTION Some controversy exists concerning whether the onset of schizophrenia and some clinical characteristics of the disorder are different between males and females. OBJECTIVE The relationship between sex, age at onset and negative symptoms was evaluated in patients with schizophrenic spectrum disorders. MATERIALS AND METHODS A sample of 225 patients (89 women and 136 men) were diagnosed for schizophrenia between 2008 and 2009. Each was compared for age at onset of symptoms and SANS score (Scale for the Assessment of Negative Symptoms). Kernel density estimators were used to evaluate characteristics of age of onset with respect to gender. Parameters of the mixed distributions were estimated via maximum-likelihood algorithms. Relationships between negative symptoms score and age of onset were evaluated using multiple regression analysis. RESULTS A significant difference was found in age at onset across gender (mean age of 24.5 years in men, 27.5 years in women). An association was found between gender and early onset of symptoms, with early onset occurring more frequently in male patients. Density estimates for age at onset suggested a mixture model with three components having as parameters: m1=21.55 +/- SD 5.25; m2=29.54 +/- SD 7.22; m3=40.01 +/- 3.98. When density estimates took into account gender, two bimodal structures were found--(1) men with the lowest mean (18.0 years) and (2) the highest mean in middle-aged women (41.0 years). Regression coefficients suggested an increase in negative symptoms as time of disease increased. CONCLUSION The hypothesis was supported that a relationship exists between age of onset of symptoms, gender and clinical characteristics in patients with schizophrenic spectrum disorders, showing that men have an early onset an a more deteriorating course than women.

Evaluación de la labilidad afectiva como síntoma del síndrome maniaco

Introduction: Mood lability is not considered a clinical symptom in diagnostic systems such as the DSM-IV or the ICD-10. However, some studies have described the presence of this symptom in patients with affective disorders. Objective: To evaluate mood lability as a representative symptom of the manic syndrome. Methods: An evaluation system for measuring mood lability has been developed and included in the EMUN scale. A total of 202 patients with manic, hypomanic, or mixed episode were assessed. The performance of the symptoms

Caracterización de tres polimorfismos del gen de la triptófano hidroxilasa 2 en una muestra de población colombiana con trastorno depresivo mayor

OBJECTIVE Identify whether rs11179000, rs136494 and rs4570625 polymorphisms of the tryptophan hydroxylase 2 gene, are associated with a major depressive disorder in a sample of the Colombian population. METHODS Case-control study was conducted in which a comparison was made between subjects diagnosed with major depressive disorder at some point in adulthood or active symptoms at the time of evaluation, and subjects with no psychiatric disease. Subjects were studied in the Department of Psychiatry, Faculty of Medicine and the Institute of Genetics at the National University of Colombia. Polymorphisms were genotyped using Taqman probes in real time PCR. As well as studying the association between major depressive disorder and these (single nucleotide polymorphisms (SNPs), the association with other factors previously associated with depression were also analysed. RESULTS No statistically significant association between genotypic and allelic frequencies of each polymorphism and major depressive disorder was found. Association between sex and complication during pregnancy / childbirth and major depressive disorder was observed. Association between sex and complication during pregnancy / childbirth and major depressive disorder was observed. CONCLUSIONS There was no association between any polymorphism and major depressive disorder.

Psychiatric morbidity in medically ill patients by means of the Spanish version of the Global Mental Health Assessment Tool - Primary Care (GMHAT/PC)

ABSTRACT This study aims at assessing psychiatric morbidity in medically ill patients, as well as examining the employability of the Global Mental Health Assessment Tool - Primary Care (GMHAT-PC) Spanish version in a general health setting. The participants in this study are recruited patients who were hospitalized at the services of Internal Medicine, Surgery and Gynaecology and Obstetrics for a period of one month. The diagnosis of a medical illness was supported by specialists in each service. Also, a trained general practitioner conducted a psychiatric assessment of all the participants making use of GMHAT-PC. It is worth noting that every single interview was carried out at the patient’s bedside. With regards to specific numbers, out of 455 medically ill patients, 4.8% had a mental illness identified by dint of the GMHAT-PC interview. Anxiety, depression and mental organic disorders were the most frequently identified mental disorders in internal medicine and surgery. On the other hand, cancer had a significantly higher prevalence of comorbid mental illness. In this study, the proportion of medically ill subjects with mental disorders was markedly lower in contrast with other studies. It was determined that GMHAT-PC is more likely to identify not only clinical cases of mental illness, but also patients who need help. Thus, it can be argued that GMHAT-PC is more of a diagnostic instrument than a screening instrument. It goes without saying that physicians and practitioners can be trained to identify mental illnesses using computer-assisted tools such as GMHAT-PC. A holistic approach of providing care to such patients may improve their overall outcome and quality of life.

Evaluación y seguimiento metabólico del paciente con diagnóstico de esquizofrenia

OBJECTIVES To determine the laboratory tests, related to metabolic risk that should be practiced to adult patients diagnosed with schizophrenia. To assist the clinician decision-making process about complementary diagnostic evaluation strategies in adult diagnosed with schizophrenia. METHODS A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. RESULTS The risk of overall mortality in schizophrenia is higher than in the general population excluding suicide. Results related with mortality associated to antipsychotics showed contradictory results. Metabolic outcomes showed a higher incidence and association with schizophrenia and treatment with antipsychotics (AP). The diagnosis of dyslipidemia in men with schizophrenia appears to be lower in comparison with the general population. However, changes in weight, blood sugar levels, HDL cholesterol and triglycerides are influenced by the use of antipsychotics in general there is a higher risk of developing diabetes mellitus in adults with schizophrenia. CONCLUSION Based on the evidence found a plan was formulated for the evaluation of physiological and paraclinical variables during and before the management with AP in adult diagnosed with schizophrenia. The overall quality of evidence is low considering that most of the reports come from observational studies that have risk of bias and some designs have methodological limitations.

El proceso de Recertificación es una realidad

En Colombia hay 58 Facultades de Medicina, aproximadamente 83400 médicos, casi 150 especialidades médicas reconocidas, en contraste con 40 en Europa. En Psiquiatría hay 17 programas de formación, y más o menos 1300 psiquiatras. Cada vez hay una mayor cantidad de médicos con calidad de formación y experticias muy variables, y un modelo de salud que no favorece los procesos de actualización de los profesionales, siendo la medicina una de las áreas de mayores avances, que requiere por tanto procesos de actualización permanentes para poder brindar la mejor atención a los pacientes. Hay diferentes maneras de garantizar de alguna manera este propósito. Una de ellas es a través de los procesos de recertificación o “Manteinance of Certification”. Este es un proceso que en otros países ya tiene bastante años y está muy bien cimentado. En Estados Unidos se inició en el año 1933 y se realiza a través de los conocidos Boards, actualmente son 25. En el caso particular de nuestra especialidad es el “Board of Psychiatry and Neurology”. En Europa y otros países de América Latina como México, Argentina y Brasil, también tiene modelos de Boards y Recertificación aunque con diferencias. En nuestro país hace aproximadamente 12 años se inició al interior de la Asociación Colombiana de Sociedades Científicas y de otras asociaciones una discusión sobre la necesidad de realizar un proceso de recertificación. Este proceso no ha estado exento de dificultades, de intereses particulares que abogaban por réditos. Sin embargo, con el apoyo de la Asociación Colombiana de Sociedades Científicas se logró crear un grupo de trabajo para hacer realidad el proceso de recertificación de los médicos colombianos bajo tres principios fundamentales: Que fuera realizado por pares, Que fuera Voluntario y Que estuviera libre de interferencias políticas.

Evaluación del riesgo de suicidio en la guía de práctica clínica para diagnóstico y manejo de la depresión en Colombia

INTRODUCTION Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. OBJECTIVES To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. METHOD Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. RESULTS Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included.