Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención / Predictors of remission from major depressive disorder in secondary care

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Características clínicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención / Clinical features of major depressive disorders treated in secondary health care facilities in Chile

Background: Depression is considered the second leading cause of disability worldwide. Aim: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE). Material and Methods: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied. Results: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features. Conclusions: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.

Comorbilidad del paciente hospitalizado en el servicio de geriatría en la fundación hospital san carlos

La comorbilidad es la existencia de una entidad clínica adicional a una enfermedad bajo estudio, que ocurre durante la hospitalización de un paciente. Genera prolongación en la estancia hospitalaria, impactando sobre la terapéutica, el pronóstico de la enfermedad a mediano y largo plazo y la demanda del servicio en salud. Se realizó un estudio cuantitativo de tipo analítico, retrospectivo. Se revisaron 93 historias clínicas y se aplicó un análisis de varianza, utilizando el lenguaje de programación R, para determinar la prevalencia de diagnósticos de comorbilidad en la población evaluada. Se identificaron 151 diagnósticos de egresos. Las más representativas fueron: Hipertensión Arterial: 10,4%; Enfermedad Pulmonar Obstructiva Crónica: 6,1%; Diabetes Mellitus Tipo II: 4,1%; Infección de Vías Urinarias: 3,6%. El análisis de la prevalencia mostró la presencia de 32 diagnósticos que prolongaron la estancia hospitalaria, principalmente: Enfermedad Renal Crónica, Neumonía Asociada al Cuidado de la Salud, Fístula Recto Vaginal, Hipoalbuminemia y Obstrucción Urinaria. La comorbilidad encontrada en pacientes geriátricos hospitalizados en la Fundación Hospital San Carlos corresponde a enfermedades agudas y crónicas de aparición repentina durante la estancia hospitalaria. Su vínculo con los estados de salud iniciales se debe aún establecer.

Comorbidity is the existence of a clinical entity in addition to a disease under study. It occurs during a patient hospitalization and generates longer hospitalization time, impacts therapeutic, mediumand long-term disease prognosis as well as the health service demand. A quantitative study of analytical, retrospective was carried out. Ninety-three medical records were reviewed and a variance analysis, using the programming language R, to determine the prevalence of comorbid diagnoses in the study population was performed. 151 discharge diagnoses were determined, being the most representative: Hypertension 10.4%, Chronic Obstructive Pulmonary Disease 6.1%, Type II Diabetes Mellitus 4.1%, and Urinary Tract Infection 3.6%. The prevalence analysis showed the presence of 32 diagnoses that led to the prolongation of hospital stay. Most importantly: Chronic Kidney Disease, Pneumonia Associated with Health Care, Recto Vaginal Fistula, Hypoalbuminemia, and Urinary obstruction. The data found indicated that comorbidity found in geriatric patients hospitalized in the Hospital San Carlos Foundation, correspond to sudden onset of chronic and acute illness during the hospital staying. Whether they are linked to the initial health status, is to be determined.