Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3. 0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012 / Sensitivity and specificity between the Composite International Diagnostic Interview Version 3. 0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012

Introducción: El abordaje de los problemas de salud mental de la población colombiana hace necesario disponer de instrumentos diagnósticos válidos, fáciles de aplicar y comparables (local e internacionalmente). Objetivo: Comparar la sensibilidad y la especificidad diagnóstica entre el CIDI 3.0 y el SCID-! para el trastorno depresivo mayor, el trastorno afectivo bipolar I y II y el trastorno por dependencia de sustancias. Metodología: Estudio transversal que comparó en 100 sujetos las prevalencias de vida de tres trastornos mentales por medio del CIDI 3.0 y el SCID-I. La investigación fue aprobada por el Comité de Ética Institucional. Se midieron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo (con sus respectivos intervalos de confianza del 95%) de las dos entrevistas diagnósticas. Para el análisis de la información se utilizó el software SPSS® versión 21.0. Resultados: La mediana de edad fue 43,5 [intervalo intercuartílico, 30] anos. La sensibilidad (Se) y la especificidad (Es) más altas se observaron en el diagnóstico de trastorno por dependencia de drogas -Se, 80% (IC95%, 34,94%-100%); Es, 98,46% (IC95%, 94,7%-100%)-. Conclusiones: El SCID-I y el CIDI 3.0 mostraron diferentes niveles de sensibilidad y especificidad para los tres trastornos estudiados así: altas para el trastorno por dependencia de sustancias, moderadas para el trastorno afectivo bipolar I y II y bajas para el trastorno depresivo mayor.

Introduction: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. Objective: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. Methodology: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. Results: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. Conclusions: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

El diagnóstico de los trastornos alimentarios del DSM-IV-TR al DSM-5 / Eating disorders diagnostic: from the DSM-IV to DSM-5

El presente trabajo tiene por objetivo analizar los cambios del DSM-IV-TR al DSM-5 en los trastornos alimentarios, en cuanto a sus criterios diagnósticos y sus implicaciones en el ámbito clínico. Para ello se realizaron tablas de comparación para cada uno de los trastornos alimentarios incluidos en el DSM-5: pica, rumiación, trastorno de la evitación/restricción de alimentos, anorexia nerviosa, bulimia nerviosa, trastorno de atracones , otro trastorno de la conducta alimentaria o de la ingesta de alimentos especificado y no especificado . En conclusión podemos observar importantes cambios en su concepción, como en el tiempo de inicio, por ende su definición considera a la conducta alimentaria y añade los problemas en la absorción de los alimentos, además de explicitar áreas de deterioro. En particular, los trastornos de la evitación/restricción de alimentos y anorexia nerviosa son los que mayores cambios presentan.

The purpose of this study is to analyze the changes in the eating disorders diagnostic criteria and its implications for clinical and research work. Comparison tables were done for each eating disorder included in DSM-5: pica, rumination, anorexia nervosa, bulimia nervosa, avoidant /restrictive food intake disorder, binge eating disorder, other feeding and eating disorder specified and unspecified . As a conclusion important conceiving changes can be observed, as in the onset time, therefore its definition considers feeding behavior, and the absorption of food problems were added, as well as worsening areas are specified. Particulary the avoidant /restrictive food intake disorder and anorexia nervosa are those that more changes present.

Bipolar disorder prevalence: a systematic review and meta-analysis of the literature

Objective: Bipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV). Methods: We searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants. Results: The pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001). Conclusion: This meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD. .

Revisão da Dimensão Conscienciosidade do Inventário Dimensional Clínico da Personalidade / Revision of the Conscientiousness Dimension of the Dimensional Clinical Personality Inventory / Revisión de la dimensión Escrupulosidad del Inventario Dimensional Clínico de la Personalidad

O objetivo deste estudo foi revisar a dimensão Conscienciosidade do Inventário Dimensional Clínico da Personalidade (IDCP). O estudo foi dividido em seis etapas, desde a revisão da literatura e seleção dos construtos relevantes, até a operacionalização dos construtos e seleção final de novos itens para aplicação. Para a revisão da dimensão, foram consideradas a proposta para a quinta edição do Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM-5) e o Personality Inventory for DSM-5 (PID-5), o modelo SWAP e o modelo de Anna Clark. Com base nisso, como resultado, um conjunto de 34 novos itens foi estabelecido na etapa final. Estudos futuros devem buscar investigar as propriedades psicométricas da dimensão revisada, tendo como expectativa índices de fidedignidade por consistência interna mais altos e itens mais patológicos em comparação à dimensão original.

The aim of this study was to review the Conscientiousness dimension of the Dimensional Clinical Inventory (DCPI). The study was divided into six stages, from literature review and selection of relevant constructs, to the operationalization of the constructs and final selection of new items for application. For the dimension review, we considered the proposal (section 3) for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Personality Inventory for DSM-5 (PID-5), the SWAP model and model of Anna Clark. Based on this, as a result, a new set of 34 items was established as a final step. Future studies should seek to investigate the psychometric properties of the revised dimension, expecting higher reliability indices for internal consistency and more pathological items compared to the original dimension.

El objetivo de este estudio fue revisar la dimensión Escrupolosidad del Inventario Dimensional Clínico de la Personalidad (IDCP). El estudio se divide en seis etapas, desde la revisión de la literatura y la selección de los constructos pertinentes, a la operacionalización de los constructos y selección final de los nuevos items para su aplicación. Para la revisión de la dimensión, se consideró la propuesta (sección 3) de la quinta edición del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5) y el Personality Inventory for DSM-5 (PID-5), el modelo SWAP y el modelo de Anna Clark. Basado en esto, como resultado, se estableció un conjunto de 34 nuevos items como paso final. Los estudios futuros deben tratar de investigar las propiedades psicométricas de la dimensión revisada, esperando más altos índices de confiabilidad de consistencia interna y items más patológicas en comparación con la dimensión original.

Psychometric properties of the revised conscientiousness dimension of Inventário Dimensional Clínico da Personalidade (IDCP) / Propriedades psicométricas da versão revisada da dimensão conscienciosidade do Inventário Dimensional Clínico da Personalidade (IDCP)

This study investigated the psychometric properties of the revised scale of conscientiousness of a clinical personality inventory (Inventário Dimensional Clínico da Personalidade, IDCP). One hundred and twenty participants (68 women; 56.7%) aged 18 to 53 years (mean = 22.58, standard deviation = 6.19) were recruited by convenience and answered the IDCP and the NEO Personality Inventory - Revised. The analysis of internal structure, association with external variables and reliability of the dimension under review confirmed its validity. The psychometric characteristics of the revised dimension seem to be more adequate than those of the original version and more focused on pathological functioning, which was expected and desirable (AU)

O presente estudo teve como objetivo investigar as propriedades psicométricas da versão revisada da dimensão conscienciosidade do Inventário Dimensional Clínico da Personalidade (IDCP). Para tanto, participaram da pesquisa 120 sujeitos, recrutados por conveniência, com idade variando entre 18 e 53 anos (média = 22,58; desvio padrão = 6,19), sendo 68 mulheres (56,7%). Todos os sujeitos responderam o IDCP e o Inventário de Personalidade NEO-PI Revisado. Os dados encontrados no estudo foram favoráveis quanto às evidências de validade com base na estrutura interna e na relação com variáveis externas, bem como em relação à fidedignidade da dimensão revisada do instrumento. A partir disso, aponta-se que a dimensão revisada é mais adequada do ponto de vista psicométrico quando comparada com a versão original da mesma e, além disso, apresenta conteúdos mais voltados para o funcionamento patológico, o que era esperado e desejável (AU)

Evidências de validade para o IDTP baseadas em variáveis externas / Validity evidences for PDDI based on external variables / Evidencias de validez del IDTP basadas en variables externas

O presente estudo teve como objetivo buscar evidências de validade baseadas na relação com variáveis externas ao Inventário Dimensional dos Transtornos da Personalidade (IDTP), nomeadamente validade convergente e discriminante correlacionando-o, com o Millon Clinical Multiaxial Inventory III (MCMI-III) e de critério, buscando-se predizer a presença de transtornos psiquiátricos. Foram participantes 350 pessoas, cujas idades variaram entre 18 e 67 anos, sendo 71,7% do sexo feminino. Os participantes foram divididos em dois grupos: Grupo Não Psiquiátrico (GNP; n= 276) e Grupo Psiquiátrico (GPS; n= 74). Todos os participantes responderam ao IDTP e ao MCMI-III. Os dados encontrados apontam para convergência entre os resultados dos instrumentos, bem como para capacidade do IDTP em discriminar pessoas com funcionamento da personalidade mais patológico e mais saudável. Também foram encontrados bons índices de sensibilidade para o instrumento, mas não muito favoráveis para especificidade...

This study aimed to find evidence of validity based on the relationship with external variables to Personality Disorders Dimensional Inventory (PDDI), including convergent and discriminant validity by correlating the test with the Millon Clinical Multiaxial Inventory III (MCMI-III) and criterion validity seeking to predict the presence of psychiatric disorders. The participants were 350 people, whose ages ranged between 18 and 67 years, and 71.7% were female. Participants were divided into two groups: Group Not Psychiatric (GNP, n= 276) and Psychiatric Group (PSG, n= 74). All participants answered both, PDDI and MCMI-III. The data found in the analysis point to convergence between the instruments, as well as the PDDI ability to discriminate people with pathological personality functioning and healthier people. We also found good sensitivity for the instrument, but not so much favorable for the specificity of PDDI...

Este estudio tuvo como objetivo buscar evidencias de validez con base en la relación con variables externas al Inventario Dimensional dos Trastornos da Personalidad (IDTP), más específicamente validez convergente y discriminante correlacionándolo con el Millon Clinical Multiaxial Inventory III (MCMI-III), y de criterio buscando predecir la presencia de trastornos psiquiátricos. Participaron 350 personas, con edades variando entre 18 y 67 años, siendo 71,7% del sexo femenino. Los participantes fueron divididos en dos grupos: Grupo No Psiquiátrico (GNP; n= 276) y Grupo Psiquiátrico (GPS; n= 74). Todos los participantes respondieron el IDTP y el MCMI-III. Los datos encontrados en los análisis apuntan una convergencia entre los instrumentos IDTP y MCMI-III, así como también una capacidad del IDTP para discriminar personas con funcionamiento patológico de la personalidad y personas más saludables. También fueron encontrados buenos índices de sensibilidad para el instrumento, pese a no haber sido muy favorables para la especificidad del IDTP...

La amenorrea como criterio diagnóstico de la anorexia nerviosa / Amenorrhea as a Diagnostic Criterion for Anorexia Nervosa

La amenorrea es un criterio para el diagnostico de la anorexia nerviosa (AN) según el DSM-IV-TR. Sin embargo, al comparar grupos de pacientes que cumplen todos los criterios de este manual para la AN con grupos de mujeres que los presentan todos salvo la amenorrea, algunos estudios no han encontrado diferencias significativas en la psicopatología típicamente asociadas con la AN. El propósito de nuestro estudio ha sido comparar variables demográficas, antropométricas, psicológicas y psicopatológicas, en ambos grupos. No se observaron diferencias estadísticamente significativas entre ambos grupos en las variables evaluadas, pero el grupo con amenorrea tenía un índice de masa corporal significativamente más bajo. Nuestros datos apoyan la hipótesis de que la amenorrea podría no ser un criterio diagnóstico útil para la AN.

Amenorrhea is a current criterion for the diagnosis of anorexia nervosa (AN) according to the DSM-IV-TR. Nevertheless, when comparing groups of patients who fulfill all the criteria of this manual for AN and groups of women who show them all but amenorrhea, some studies did not find significant differences in the psychopathology typically associated with AN. The purpose of our study was to compare both groups in demographic, anthropometric, psychological and psychopathological variables. There were no statistically significant differences between both groups in the analyzed variables, but the group with amenorrhea had a significantly lower body mass index. Our data support the hypothesis that amenorrhea could not be a useful criterion for AN.

The prevalence of personality disorder in a psychiatric and substance abuse population in Jamaica / Prevalencia de los trastornos de la personalidad en una población psiquiátrica y adicta al abuso de sustancias en Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the psychiatric wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the psychiatric wards of the UHWI were assessed for personality disorder using the gold standard of a consultant assessment using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S), and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 51% consultant DSM-IV-TR assessment, 57% JPDI and 86% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the consultant DSM IVTR instruments in Jamaica is comparable to the prevalence rate of studies in other countries in a similar population.

OBJETIVO: Determinar la prevalencia de los trastornos de la personalidad en pacientes ingresados en las salas de psiquiatría del Hospital Universitario de West Indies (HUWI). MÉTODO: Los pacientes (n = 100) secuencialmente ingresados a las salas de psiquiatría del UHWI, fueron evaluados en relación con trastornos de personalidad, utilizando los criterios de diagnóstico del estándar de oro de la evaluación consultante con el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición revisada (DSM-IV-TR), el cuestionario de tamizaje del Examen Internacional de Trastornos de la Personalidad (IPDE-S), y el Inventario de Trastornos de la Personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de trastornos de personalidad en la cohorte de pacientes como sigue: 51% en la evaluación del consultante del DSMIV- TR, 57% en el JPDI, y 86% en el IPDE-S. La tasa de prevalencia identificada por el IPDE-S fue significativamente mayor que la de los instrumentos locales (p < 0.000). CONCLUSIONES: La prevalencia del trastorno de personalidad evaluado por el JPDI y los instrumentos de consultante de DSM IV-TR en Jamaica, es comparable a la tasa de prevalencia de estudios en otros países en una población similar.

The prevalence of personality disorder in a general medical hospital population in Jamaica / Prevalencia de los trastornos de personalidad en una población del hospital de medicina general de Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the general medical wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the general medical wards of the UHWI were assessed for the diagnosis of personality disorder using the gold standard of a consultant assessment based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S) and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 21% consultant DSM IV-TR assessment, 28% JPDI and 70% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the IPDE-S and the consultant DSM IV-TR instruments in Jamaica is significantly higher than the prevalence rate of studies in other countries.

OBJETIVO: Determinar la prevalencia de los trastornos de personalidad en los pacientes ingresados en las salas de medicina general del Hospital Universitario de West Indies (HUWI). MÉTODO: Pacientes (n = 100) secuencialmente ingresados en las salas de medicina general del UHWI fueron sometidos a una evaluación encaminada a diagnosticar trastornos de personalidad. Para la misma se utilizó el método estándar de referencia usado en las evaluaciones realizadas por los consultores. Dicho método se basa en los criterios diagnósticos para los trastornos de personalidad, tomados de la cuarta edición revisada del Manual diagnóstico y estadístico de los trastornos mentales (DSM IV-TR), el cuestionario de tamizaje del Examen Internacional de los trastornos de la personalidad (IPDE-S), y el Inventario de los trastornos de la personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de los trastornos de la personalidad en la cohorte de pacientes, de 21% con la evaluación DSM IV-TR de los consultores, 28% con el JPDI, y 70% con el tamizaje del IPDE-S. La tasa de prevalencia identificada por el IPDE-S, fue significativamente mayor que la de los instrumentos locales usados (p < 0.000). CONCLUSIONES: La prevalencia de los trastornos de la personalidad, evaluada por el inventario JPDI y el tamizaje del IPDE-S, así como por los instrumentos DSM IV-TR de los consultores en Jamaica, es significativamente mayor que la tasa de prevalencia en los estudios de otros países.

Shakatani: the phenomenology of personality disorder in Jamaican patients / Shakatani: la fenomenología del trastorno de personalidad en pacientes Jamaicanos

OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSMbased personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.

OBJETIVO: Examinar la distribución y los patrones clínicamente significativos de la fenomenología de una cohorte de pacientes jamaicanos con diagnóstico de trastornos de personalidad de eje II según el Manual Estadístico Diagnóstico (DSM), y aclarar las deficiencias diagnósticas convencionales de categorías de trastorno de la personalidad basadas en DSM. MÉTODOS: Se describe cualitativamente la fenomenología de una cohorte de 351 pacientes con diagnóstico de trastorno de la personalidad de eje II DSM, en un estudio de caso control a partir de un contexto clínico naturalista en una práctica psiquiátrica privada de Kingston, Jamaica, entre 1974 y 2007. Dicha fenomenología fue comparada cuantitativamente con la de un grupo control de pacientes con un diagnóstico clínico de eje I DSM, pareados por edad, género y clase socio-económica. RESULTADOS: Hubo 166 varones (47.3%); 238 (67.8%) de los pacientes tenían entre edades entre 18 y 39 años. Étnicamente, 325 (92.6%) eran negros, 10 (2.8%) blancos, y 16 (4.6%) étnicamente diversos. La mayoría de los pacientes (20,7%) tenía un diagnóstico DSM-IV de trastorno de personalidad dependiente. Los pacientes con un diagnóstico de eje II tuvieron significativamente más probabilidades de mostrar síntomas de una 'tríada clínica' de manejo del poder, dependencia y problemas psicosexuales. El análisis cualitativo de los síntomas fenomenológicos de los pacientes diagnosticados con trastorno de personalidad, sugiere interconexiones etiológicas basadas en experiencias de la niñez temprana, tal cual lo explican la teoría de la relación de objetos y la teoría del apego. CONCLUSIONES: El enfoque fenomenológico de los trastornos de personalidad puede ser un substituto viable para la clasificación de cuatro clústeres de DSM-IV en una población jamaicana con la tríada clínica denominada Shakatani, término derivado de las palabras Swahili shaka (problema) y tani ("poder"). Este enfoque fenomenológico puede ofrecer mayor utilidad clínica a los profesionales.

Therapeutic drug monitoring in psychiatry: An important step in clinical practice.

TDM in psychiatry is a tool to optimize the therapeutic regimens in clinical practice. Psychopharmacology encompasses those drugs which metabolize and their metabolites also are active in the body. CYP-450 of antipsychotics is unique as the drugs are lipid soluble and the heterogeneous class of drugs act on different types of receptors and produce variable responses. Various techniques are involved to estimate the drug levels of those drugs. HPLC is a golden standard to assay the serum drug concentration of these drugs. The metabolites can also be assayed along with the parent drug. TDM of these drugs if applied at tertiary care, individualization of dosage regime of these drugs can help the outcomes of therapy and even drug-drug interaction can display the PK/PD nature of such drugs.

A prevalência de comorbidades psiquiátricas em pacientes com transtornoafetivo bipolar atendidos em um ambulatório de pesquisa clínica em psiquiatria / The prevalence of psychiatric comorbidity in patients with bipolar affective disorder seen in the ambulatory clinical research in psychiatry

Introdução: Comorbidades psiquiátricas em pacientescom transtorno bipolar se revelam muito frequentese esta coocorrência está associada com efeitos negativossobre o curso e prognóstico da doença. Objetivos:Conhecer a prevalência de comorbidades psiquiátricase sua relação com as características do transtorno bipolartipo I, em pacientes atendidos no ambulatório depesquisa. Metodologia: Realizamos um estudo exploratório,transversal, observacional e prospectivo, no períodode fevereiro a setembro de 2011. A amostra foicomposta por 24 pacientes diagnosticados com transtornobipolar tipo I avaliados quanto à comorbidadespsiquiátricas através da Entrevista Clínica Estruturadapara Transtornos do Eixo I do DSM-IV, enquanto os outrosdados clínicos dos pacientes foram avaliados porquestionários aplicados, a fim de caracterizar a doença.Resultados: A maioria dos pacientes (62,5%) fechavacritérios diagnósticos para pelo menos uma comorbidade,sendo mais comum a coocorrência de uma ou maiscomorbidades passadas (58,3%) que as atuais (37,5%).Os transtornos de ansiedade se mostraram os mais prevalentes(45,8%), seguidos por transtornos do uso desubstâncias (25,0%), somatoformes (16,7%) e alimentares(4,2%). A associação entre o curso da doença e apresença de comorbidades psiquiátricas não apresentaramrelação significativa. Conclusão: Este estudo mostrouque pacientes bipolares possuem alta prevalênciade comorbidades psiquiátricas do eixo I do DSM-IV,sendo mais comuns os transtornos ansiosos e por usode substâncias, consoante ao encontrado em estudosanteriores. No entanto, diferindo da literatura a relaçãoentre as características da evolução do transtorno bipolare a ocorrência de comorbidades não apresentoudiferença significativa.

Background: Psychiatric comorbidities in patientswith bipolar disorder to reveal a high frequent and thisco-occurrence is associated with negative effects onthe course and prognosis of this pathology. Objective:Know what is the prevalence of psychiatric comorbiditiesand their relation with the characteristics of bipolardisorder type I in patients attended in outpatient clinicof research in the UNESC. Methods: This study was conductedas exploratory, transversal, observational andprospective, in the period from February to September2011. The sample is composed for 24 patients diagnosedwith bipolar disorder I and assessed for psychiatriccomorbidity, through the Structured Clinical Interviewfor Axis I of DSM-IV, as well was applied questionnairesin order to obtain the characteristics of disease. Results:The majority of bipolar patients (62.5%) had diagnosticcriteria closed at least one comorbidity, and the co-occurrenceof one or more longtime comorbidities weremost common (58.3%) than with the current (37.5%).Anxiety disturbances were the most prevalent (45.8%),followed by use of substance disturbance (25.0%), somatoform(16.7%) and eating disorder (4.2%). The relationshipbetween the course of disease and the presenceof psychiatric comorbidities were not significant.Conclusions: Patients with bipolar disorder have a highprevalence of psychiatric comorbid based in Axis I ofDSM-IV, the most common disorders are anxiety andsubstance use. The relationship between the characteristicsof evolution of disease and the occurrence ofcomorbidities did not show different significant.

A model for pediatric and neuropsychological screening assessment of children with learning disabilities / Modelo de triagem neuropsicológica e pediátrica para escolares com dificuldades de aprendizagem

Objectives: The high frequency of learning difficulties, attention disorders or developmental delay in childrenin the early years of schooling has resulted in a greater demand for pediatric services. Such services generally includeassessments covering various specialties, are lengthy and often inaccessible to families due to prohibitively high cost. Thispaper presents an economically efficient model of interdisciplinary diagnosis. Methods: A group of 109 Brazilian studentsfrom public schools aged between 5 and 14 years old, referred by teachers for a history of learning disabilities, behavioralchanges or language problems, was evaluated at the NANI (Nucleo de Atendimento Neuropsicologico Infantil). Assessmentswere performed simultaneously during a single days attendance and comprised clinical-genetic examination, behavioral assessment and neuropsychological screening, specially developed for the process. The multiaxial system of DSM-IVwas adopted for diagnostic description. Results: The results revealed heterogeneity in diagnoses which included specificlearning disorders (25.7%), mild intellectual disabilities (17.43%), as well as suspected dysmorphic features (11.93%).Logistic regression showed good sensitivity of neuropsychological screening in the detection of predictive factors for specificdevelopmental disorders, while working memory (p=0.05) and language (p=0.02) problems were found to be higher risk. Conclusions: The model adopted proved to be useful for defining the diagnosis of several conditions in infancy, and can beincorporated into specialized clinics such as psychiatric or developmental pediatric services.

Objetivos: A alta frequência de dificuldades de aprendizagem, distúrbios atencionais ou atraso no desenvolvimentocognitivo, em crianças nos primeiros anos de escolaridade, vem acarretando grande demanda por serviços de saúde.Tais serviços em geral abrangem avaliações em diversas especialidades, realizadas em períodos de tempo prolongados,frequentemente de pouca acessibilidade para as famílias devido ao alto custo. Neste trabalho apresenta-se um modelo dediagnóstico interdisciplinar economicamente viável. Métodos: Foram avaliados os dados de um grupo de 109 alunos darede pública de ensino entre 5 e 14 anos de idade, encaminhadas ao NANI (Nucleo de Atendimento Neuropsicológico Infantil)pelas professoras por apresentarem história de dificuldades de aprendizagem, alterações comportamentais ou problemasde linguagem oral. As avaliações foram realizadas conjuntamente em um único dia de atendimento e abrangeram exameclínico-genético, avaliação comportamental e uma triagem neuropsicológica qualitativa, especialmente desenvolvida parao processo. Adotou-se o sistema multiaxial do DSM-IV na descrição diagnóstica. Resultados: Os resultados revelaram umaheterogeneidade de diagnósticos, incluindo transtornos específicos de aprendizagem (25,7%), deficiência intelectual leve(17,43%) e presença de dismorfias a esclarecer (11,93%). Análises de regressão logística evidenciaram boa sensibilidadeda triagem neuropsicológica na detecção de fatores preditivos para transtornos específicos do desenvolvimento, sendo queproblemas de memória operacional (p=0,05) e de linguagem (p=0.02) se evidenciaram como de maior risco. Conclusões:O modelo adotado mostrou-se útil, assim, na delimitação diagnóstica de queixas de diversas condições na infância, podendoser incorporado em clínicas especializadas tais como psiquiátricas ou pediátricas.

DSM e psicanálise: uma discussão diagnóstica / DSM and psychoanalysis: a diagnostic discussion / DSM y el psicoanálisis: una discusión de diagnóstico

Este artigo visa discutir duas vertentes diagnósticas a partir da discussão de um caso clínico atendido em um Centro de Atenção Psicossocial (CAPS) municipal. O caso foi analisado em concordância com os pressupostos do DSM-IV-TR e posteriormente sob uma perspectiva psicanalítica. Foi realizada uma discussão sobre a atual lógica diagnóstica adotada pela psiquiatria que apresenta a tendência de substituir as grandes categorias diagnósticas por descrições especificadas operacionalizadas de fenômenos objetivos. Por outro lado, foi apresentada a lógica psicanalítica que pretende ir além dos fenômenos objetivos cujo cerne é fazer emergir o sujeito a partir de sua fala. Neste artigo, pretende-se evidenciar as consequências trazidas na condução do tratamento pelas diferentes lógicas diagnósticas.

This paper discusses two aspects from the diagnostic discussion of a clinical case treated in a Centre for Psychosocial Care (CAPS). The case was analysed in accordance with the assumptions of the DSM-IV-TR and later under a psychoanalytic perspective. We present a discussion on the rationale adopted by psychiatric diagnosis that has a tendency to replace the major diagnostic categories specified by description of phenomena operationalised goals. On the other hand, we present the psychoanalytic logic which attempts to go beyond objective phenomena in order to bring the subject from his speech. In this article, we intend to highlight the consequences ensued in treatment conducted with both different diagnostic logics.

Este trabajo analiza dos aspectos de la discusión de diagnóstico de un caso clínico tratado en un Centro de Atención Psicosocial (CAPS, en Portugués) de la ciudad. El caso fue analizado de acuerdo con las condiciones del DSM-IV-TR y después sobre una perspectiva psicoanalítica. Se presenta una discusión de los principios adoptados por el diagnóstico psiquiátrico que tiene una tendencia a reemplazar las principales categorías de diagnóstico especificadas en las descripciones de los objetivos de los fenómenos en práctica. Por otro lado, se presenta la lógica psicoanalítica de la codicia más allá de su fenómeno objetivo central que es hacer surgir el sujeto a partir de su habla. En este artículo pretendemos poner en evidencia las consecuencias obtenidas en la conducción del tratamiento por las diferentes lógicas diagnosticas.

Classificação e diagnóstico de transtornos alimentares na infância: nem DSM, nem CID-10 / Classification and diagnostic of children's eating disorders: neither DSM, nor ICD-10

Este artigo descreve as principais dificuldades e limitações para diagnosticar transtornos alimentares na infância sob os critérios do DSM-IV e CID-10. São revistos todos os critérios de cada tipo de transtorno e paralelamente à sua indicação são apontados os principais pontos frágeis e de críticas. Em seguida, é feita uma explanação acerca dos transtornos subclínicos que, apesar de serem de difícil detecção, também prescindem de um diagnóstico precoce. Ao final, se apresenta um sistema de classificação ainda pouco difundido no Brasil: GOS, que é uma sistematização dos tipos de transtornos alimentares infantis e seus sintomas, baseada em achados de investigações. Deste modo, o propósito é de trazer novas possibilidades para discutir o refinamento do diagnóstico infantil.

This article summarizes the main limitations and difficulties of classification of eating problems and disorders in childhood based on DSM-IV and ICD-10's criteria. Each eating disorder's criterion is revised and problems with current classification schemes are identified and discussed. Subclinical eating disorders are recognized as another finding that makes an early diagnostic even hard. As the current classifications have their weak points, a new classification system is presented: GOS. It is an alternative system, built on scientific researches conducted in this age, that meets children's specific eating disorders and its symptoms. Thus, the purpose is to bring a range of possible discussions to refine the classification strategies for eating disorders in children and adolescents.

Role of psychiatric disorders and irritable bowel syndrome in asthma patients

OBJECTIVES: The goals of the study were the following: 1) to determine the frequency of psychiatric disorders and irritable bowel syndrome in patients with asthma and 2) to compare the frequency of these disorders in patients with asthma to their frequency in healthy controls. INTRODUCTION: Patients with asthma have a higher frequency of irritable bowel syndrome and psychiatric disorders. METHODS: We evaluated 101 patients with bronchial asthma and 67 healthy subjects. All subjects completed the brief version of the Bowel Symptoms Questionnaire and a structured clinical interview for DSM-IV axis disorders (SCID-I/CV). RESULTS: There were 37 cases of irritable bowel syndrome in the group of 101 stable asthma patients (36.6 percent) and 12 cases in the group of 67 healthy subjects (17.9 percent) (p = 0.009). Irritable bowel syndrome comorbidity was not related to the severity of asthma (p = 0.15). Regardless of the presence of irritable bowel syndrome, psychiatric disorders in asthma patients (52/97; 53.6 percent) were more common than in the control group (22/63, 34.9 percent) (p = 0.02). Although psychiatric disorders were more common in asthma patients with irritable bowel syndrome (21/35, 60 percent) than in those without irritable bowel syndrome (31/62, 50 percent), the difference was not significant (p = 0.34). In asthma patients with irritable bowel syndrome and psychiatric disorders, the percentage of forced expiratory volume in 1 s (FEV1) was lower than it was in those with no comorbidities (p = 0.02). CONCLUSIONS: Both irritable bowel syndrome and psychiatric disorders were more common in asthma patients than in healthy controls. Psychiatric disorders were more common in asthma patients with irritable bowel syndrome than in those without irritable bowel syndrome, although the differences failed to reach statistical significance. In asthma patients with IBS and psychiatric disorders, FEV1s were significantly lower than in other asthma patients. It is important for clinicians to accurately recognize that these comorbid conditions are associated with additive functional impairment.

Desempeño diagnóstico del cuestionario lista de síntomas del DSM IV para el tamizaje del trastorno de hiperactividad con déficit de atención (TDAH) en niños y adolescentes escolares / Diagnostic utility of the DSM IV symptoms list for screening attention-deficit hyperactivity disorder (ADHD) in children and adolescent students

Introducción. El trastorno de hiperactividad con déficit de atención (TDAH) constituye el problema neurocomportamental más común en la infancia, con prevalencia en nuestro medio de 15,8%. El diagnóstico requiere una buena anamnesis y la aplicación de numerosos test. Es indispensable conocer el rendimiento diagnóstico de estas pruebas en el proceso diagnóstico. Objetivos. Evaluar el desempeño diagnóstico del cuestionario de tamizaje para TDAH del DSM IV en población escolar. Materiales y métodos. Muestra representativa, al azar, polietápica, proporcional al tamaño de los grupos, de escolares entre 4 y 17 años. Medición en 2 etapas: primero la aplicación del formulario de tamizaje según criterios del DSM IV, luego entrevista estructurada y prueba de Conners e inteligencia, en aquellos que fueron positivos y en una muestra de los negativos. El análisis estadístico se realizó mediante Epidad versión 3.0. Resultados. Los valores de sensibilidad fueron mediocres cuando el cuestionario fue diligenciado por padres y maestros. La especificidad y el VPP del cuestionario en manos de los padres mostraron valores de 93,6% y 87,8%, respectivamente. El LR positivo fue de 8,9 cuando el tamizaje fue realizado los padres, en contraste con 1,5 cuando lo respondieron los maestros. Conclusión. Se requieren más estudios que ilustren sobre el comportamiento del cuestionario lista de síntomas del DSM IV para TDAH en diferentes escenarios, particularmente en tamizaje de un trastorno de alta prevalencia que repercute en el éxito escolar.

Introduction. Attention-deficit hyperactivity disorder (ADHD) is the most common neuro-behavioral problem in childhood, with a prevalence of 15.8% in Colombia. Diagnosis requires a good history and implementation of several tests. It is essential to know the diagnostic utility of these tests in the diagnostic process. Objetive. Evaluate the diagnostic utility of DSM IV-ADHD screening questionnaire in school population. Materials and methods. Representative, random, multistage sample, proportional to the size of the groups of school children between 4 and 17 years old. Measurement in 2 stages: first the implementation of the screening form as the DSM IV criteria; and then structured interview, Conners and intelligence tests, for those who were positive and in a negative subjects sample. Statistical analysis was performed using Epid version 3.0. Results. Sensitivity values were poor when the questionnaire was filled out by parents and teachers. The specificity and PPV of the questionnaire in the hands of the parents showed values of 93.6% and 87.8% respectively. The positive LRwas 8.9 when the screening was conducted on parents, compared with 1.5 when teachers responded. Conclusiones. Further studies are needed to illustrate utility of DSM IV-ADHD screening questionnaire in different settings, particularly in screening studies of high-prevalence populations, for a disorder which affects school success.

Estudio de la estructura latente del síndrome maníaco mediante técnicas de escalamiento multidimensional / The study of the latent structure of the manic syndrome using multidimensional scaling techniques

Introducción y objetivo: Hasta este momento, algunos reportes sobre las dimensiones que conforman el síndrome maniaco sugieren que la importancia de los síntomas afectivos resulta controvertida. El objetivo del presente estudio fue investigar la estructura de variables latentes del síndrome maniaco utilizando métodos de análisis factorial para variables ordinales y escalamiento multidimensional. Método: Se estudiaron 404 pacientes admitidos consecutivamente y que cumplieron criterios DSM-IV para trastorno bipolar, episodio maniaco, hipomaniaco o mixto, usando la escala EMUN. Se efectuaron análisis factoriales para variables ordinales y análisis mediante escalamiento multidimensional. Resultados: El análisis factorial evidenció cuatro factores clínicamente interpretables: activación, cognoscitivo, afectivo y depresivo. La activación resultó ser el dominio más importante. El escalamiento multidimensional confirmó que la activación es un factor identificable y que es el elemento constitutivo central del síndrome. Los síntomas afectivos resultaron ser componentes secundarios del síndrome. La hipersexualidad parece ser un síntoma aislado que probablemente sea el reflejo de otras dimensiones latentes. Conclusión: La manía es la expresión de cuatro dimensiones. El dominio nuclear del síndrome es la activación. Aunque los síntomas depresivos no son el componente principal, es esencial su evaluación durante el abordaje de pacientes con episodios maniacos, hipomaniacos o mixtos...

Introduction and Objective: To date, some reports about dimensions of mania suggest that the importance of affective symptoms is controversial. The objective of this study was to investigate the latent structure of the manic syndrome by using classical methods of factor analysis for ordinal variables and multidimensional scaling. Method: 404 consecutively admitted patients with DSM-IV criteria for bipolar disorder, manic, hypomanic or mixed were analyzed using the EMUN scale. Factor analysis for ordinal variables and multidimendional scaling were carried out. Results: Factor analysis evidenced four clinically interpretable factors (activation, cognitive, affective, depression) with activation being the most important domain. Multidimensional scaling confirmed activation as an identifiable factor that is a central constituent of the syndrome, and affective symptoms as a secondary component. Hipersexuality seems to be an isolated symptom, probably reflecting other latent dimensions. Conclusion: Mania is the expression of four dimensions. The core domain of the syndrome is activation. Although depressive symptoms are not the main component, its evaluation during manic, hypomanic or mixed states is essential...

Prevalencia del trastorno de personalidad antisocial en pacientes consumidores de heroína, ubicados en cuatro barrios de la ciudad de Armenia, Quindío / Prevalence of antisocial personality disorder in heroin-consuming patients, located in four neighborhoods in the city of Armenia, Quindío

Se planteó indagar acerca de la existencia de trastorno de personalidad antisocial en consumidores de heroína, tomando una muestra de 10 heroinómanos, con edades comprendidas entre los 18 y 45 años, para lo cual se realiza un estudio cuantitativo ­ descriptivo de corte transversal, cuya población era de estrato socio-económico bajo, perteneciente a 4 barrios de la ciudad de Armenia. Para ello, se empleó un cuestionario elaborado bajo los criterios del Trastorno de Personalidad DisociaI/Antisocial evaluados por el Manual Diagnóstico y Estadístico de Trastornos Mentales (DSM-IV TR), valorado por expertos antes de su aplicación. Teniendo en cuenta los resultados más representativos, el 90% coincidió en ser impulsivos/agresivos y permaneció fuera de casa por un largo periodo de tiempo a pesar de las prohibiciones paternas, iniciando este comportamiento antes de los 13 años de edad. Asimismo el 80% hurtóobjetos sin generar daño a otro, presentó dificultad para mantener un empleo y mintió para satisfacer necesidades personales. De acuerdo a las cifras encontradas se sugiere la implementación de estrategias de prevención e intervención en políticas de salud mental.

One considered to investigate about the existence of upheaval of antisocial personality in heroin consumers, taking a sample from 10 heroin addicts,with ages between the 18 and 45 years, for which a quantitative study is realised - descriptive of it cross section, whose population era of low socio-economic layer, pertaining to 4 districts of the city of Armenia. For it, a questionnaire made under the criteria of the Upheaval of Antisocial DisociaI Personality was used/evaluated by the Manual Statistical Diagnosis and of Mental Upheavals (DSM-IV TR), valued by experts before its application. Considering the most representative results, 90% agreed in being impulsive/aggressive and remained abroad by a long period of time in spite of the paternal prohibitions, initiating this behavior before the 13 years of age. Also 80% stole objects without generating damage to another one, presented/displayed difficulty to maintain a use and lay to satisfy personal needs. According to the found numbers the implementation of strategies of prevention and intervention in policies of mental health is suggested.

Similarities and Differences between DSM-IV Brief Psychotic Disorder and ICD-10 Acute and Transient Psychotic Disorder / 신경정신의학

Time is the most important factor in defining the diagnostic concepts of DSM-IV brief psychotic disorder (BPD) and ICD-10 acute and transient psychotic disorder (ATPD). Time factor is more complicated in ICD-10 ATPD than in DSM-IV BPD because he first time factor in ICD-10 ATPD concerns the development of symptoms (acute onset within 2 weeks), and the second factor, the duration of an episode, depends on the subtypes of ICD-10 ATPD. For instance, the duration of an episode in acute polymorphic psychotic disorder (APPD) with symptoms of schizophrenia must not exceed I month, while APPD without symptoms of schizophrenia may occur forup to three months. Despite the differences with respect to time factor in DSM-IV BPD and ICD-10 ATPD, it is not necessary to consider them as separate diagnostic entitie because they are identical in almost all of the essential clinical parameters. The strict criterion of episode duration in DSM-IV BPD should therefore be reconsidered. The APPD within ICD-10 ATPD subtypes, which is very similar to both cycloid psychosis and bouffee delirante, has a significant diagnostic concordance with DSM-IV BPD, and can be distinguished more clearly from schizophrenia and bipolar schizoaffective disorder. In contrast, ASPD not only has similarities to schizophrenia but also to bipolar schizoaffective disorder. This means that ASPD could function as a bridge between one end of the psychotic continuum occupied by schizophrenia and the opposite end occupied by major affective disorder. Taking this into consideration, ICD-10 ATPD could be much more homogeneous if APPD was not combined with ASPD. On the other hand, the symptomatologic polymorphism carries the most relevant distinguishing power in differentiating the subtypes of ICD-10 ATPD, so the distinction of APPD with and without symptoms of schizophrenia is not needed.