Depressão em indivíduos transgêneros atendidos em um hospital universitário / Depression in transgender individuals assisted at a university hospital / Depresión en individuos transexuales atendidos en un hospital universitario

O objetivo deste estudo foi avaliar a presença e a gravidade de sintomas depressivos em indivíduos transexuais atendidos em um ambulatório de sexualidade. Caracteriza-se como descritivo, transversal e quantitativo, adotando amostra por conveniência (n=46). Foi realizado nas dependências do HUUFMA mediante aplicação do Inventário de Depressão de Beck (BDI-II) e formulário sociodemográfico. Os dados foram abordados no EpiInfo. Os resultados demostraram indivíduos na maioria jovens, de cor parda, solteiros, com ensino médio completo, estudantes, residiam com pais e/ou parentes, não religiosos, e metade com vínculo empregatício. A depressão moderada e grave esteve presente em 37% dos pacientes e a ideação suicida em 34,8%. Identificou- se relevância estatística na relação entre em depressão e vínculo empregatício (depressão moderada 39,2% e grave 21,7%). Então, observou-se relevantemente sintomas depressivos e, por vezes, a ideação suicida, todavia, o suporte social e o vínculo de trabalho foram importantes na redução de seu adoecimento.

The aim of this study was to assess the presence and severity of depressive symptoms in transsexual individuals treated at a sexuality outpatient clinic. It is characterized as descriptive, transversal and quantitative, adopting a convenience sample (n=46). It was carried out at the HUUFMA premises by applying the Beck Depression Inventory (BDI-II) and a sociodemographic form. The data were approached in EpiInfo. The results showed mostly young individuals, of brown race, single, with complete secondary education, students, living with parents and/or relatives, non-religious, and half with employment. Moderate and severe depression was present in 37% of patients and suicidal ideation in 34.8%. Statistical relevance was identified in the relationship between depression and employment (moderate depression 39.2% and severe depression 21.7%). So, depressive symptoms and, sometimes, suicidal ideation were observed relevantly, however, social support and the work bond were important in reducing his illness.

El objetivo de este estudio fue evaluar la presencia y la gravedad de los síntomas depresivos en individuos transexuales atendidos en un ambulatorio de sexualidad. Se caracteriza por ser descriptivo, transversal y cuantitativo, adoptando una muestra de conveniencia (n=46). Se realizó en las instalaciones del HUUFMA aplicando el Inventario de Depresión de Beck (BDI-II) y un formulario sociodemográfico. Los datos fueron abordados en EpiInfo. Los resultados mostraron individuos mayoritariamente jóvenes, de raza morena, solteros, con estudios secundarios completos, estudiantes, que vivían con sus padres y/o familiares, no religiosos, y la mitad con empleo. La depresión moderada y grave estaba presente en el 37% de los pacientes y la ideación suicida en el 34,8%. Se identificó relevancia estadística en la relación entre depresión y empleo (depresión moderada 39,2% y depresión grave 21,7%). Así, se observó relevancia de los síntomas depresivos y, en ocasiones, de la ideación suicida, sin embargo, el apoyo social y el vínculo laboral fueron importantes en la reducción de su enfermedad.

Nosografia dos Transtornos Afetivos: um recorte histórico de Kraepelin ao DSM-5 / Nosography of Affective Disorders: A historical review from Kraepelin to DSM-5 / Nosographie des troubles affectifs: un aperçu historique de Kraepelin au DSM-5 / Nosografia de los trastornos afectivos: un corte histórico de Kraepelin al DSM-5

A nosografia dos transtornos do humor e do afeto relaciona-se diretamente com as formas de apreensão dos quadros clínicos em cada contexto histórico. É indagado se o resgate histórico contribuiria para melhor compreensão e utilização da atual nosologia dos transtornos de humor. Objetiva-se realizar uma revisão histórica e crítica acerca de suas transformações conceituais e nosológicas com enfoque ao campo médico-psiquiátrico. O recorte pretendido se inicia com a proposição da "Insanidade Maníaco-Depressiva" por Emil Kraepelin em 1899, que é confrontada com as propostas pós-kraepelianas, em especial as de Karl Leonhard. Analisa-se a influência dessas na criação dos sistemas diagnósticos operacionalizados, DSM e CID. O "Transtorno Bipolar" foi um constructo introduzido pelo DSM-III e se mantém em uso até os dias atuais. Aborda-se também propostas posteriores, como a do "Espectro Bipolar".

Nosography of mood and affective disorders is directly related to how clinical pictures are understood in each historical context. Inquiring on whether a historical recollection would contribute to a better understanding and use of the current nosology of mood disorders, the study carries out a historical and critical review of its conceptual and nosological transformations on the medical-psychiatric field. Starting from Emil Kraepelin's "Manic-Depressive Insanity," proposed in 1899, the text confronts this concept with post-Kraepelian proposals, especially those of Karl Leonhard. It then analyzes their influence in the creation of two operationalized diagnostic systems — DSM and ICD. "Bipolar Disorder," a construct introduced by the DSM-III, remains in use today. Later proposals are also addressed, such as the "Bipolar Spectrum".

La nosographie des troubles de l'humeur et des troubles affectifs est directement liée à la manière dont les tableaux cliniques sont compris dans chaque contexte historique. En se demandant si un rappel historique contribuerait à une meilleure compréhension et utilisation de la nosologie actuelle des troubles de l'humeur, l'étude procède a un examen historique et critique de ses transformations conceptuelles et nosologiques dans le domaine médico-psychiatrique. Partant de la "Folie maniaco-dépressive" d'Emil Kraepelin, proposée en 1899, l'article confronte ce concept aux propositions post-Kraepeliennes, notamment celles de Karl Leonhard. On analyse ensuite leurs influence dans la création de systèmes de diagnostic opérationnalisés — le DSM et la CIM. Le "trouble bipolaire", une construction introduite par le DSM-III, est toujours utilisé aujourd'hui. D'autres propositions sont égalemment abordées, comme le "spectre bipolaire".

La nosografía de los trastornos afectivos está directamente relacionada con las formas en que se aprehenden las condiciones clínicas en cada contexto histórico. Se pregunta si la revisión histórica contribuiría a una mejor comprensión y uso de la nosología actual de los trastornos del humor. El objetivo de este artículo es realizar una revisión histórica y crítica de sus transformaciones conceptuales y nosológicas con un enfoque en el campo médico-psiquiátrico. El recorte comienza con la propuesta en el texto "Locura maníaco-depresiva", de Emil Kraepelin, en 1899, que se enfrenta a propuestas postkraepelianas, especialmente las de Karl Leonhard. Se analiza la influencia de estas propuestas en la creación de sistemas diagnósticos operacionalizados, el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) y la Clasificación Internacional de Enfermedades (CID). El "trastorno bipolar" es una construcción introducida por el DSM-3 y sigue en uso hoy. También se abordan propuestas posteriores, como la del "espectro bipolar".

Typological Profiles of Depression of College Students: Latent Classes and Controlling for Response Bias of the Baptista Depression Short-Scale (EBADEP-short) / Perfis Tipológicos de Depressão de Universitários: Classes Latentes e Controle de Viés de Resposta da Escala Reduzida Baptista de Depressão - (EBADEP-short) / Tipología de la Depresión de Estudiantes Universitarios: Clases Latentes y Control del Sesgo de Respuesta de la Escala Reducida Baptista de Depresión (EBADEP-short)

Abstract Response styles and non-linearity might reduce the validity of scores on depression inventories. To address both issues, we explored the latent class structure of the Baptista's Depression Scale (EBADEP), and the influence of extreme response bias. In total, 1,137 Brazilian college students (M = 26 years, SD = 7.3) participated in this study. Taxometric analysis yielded ambiguous results, without clear support for either a dimensional or a categorical representation of the data. We found three latent classes: one comprising participants with a tendency to endorse items about sadness, angst, pessimism, and low self-efficacy; another with individuals scoring low on all symptoms; and a third with intermediate scores. We found no relationship between the composition of latent classes and extreme response. Participants who reported having received a diagnostic of depression were more likely to belong to the first latent class. These findings validate the clinical usefulness of a latent class structure for the EBADEP.

Resumo Respostas extremas e ausência de linearidade podem reduzir a validade de escores de depressão. Para abordar esse problema, este estudo teve por objetivo explorar a estrutura de classes latentes da Escala Baptista de Depressão (EBADEP) e a influência do viés de respostas extremas. Participaram 1.137 estudantes universitários brasileiros (M = 26 anos, DP = 7,3). A análise taxométrica indicou resultados ambíguos, sem um ajuste explicitamente melhor para uma estrutura dimensional ou categórica. Foram identificadas três classes latentes: a primeira, composta de participantes que tenderam a endossar itens de tristeza, angústia, negativismo e baixa autoeficácia; a segunda, de indivíduos com níveis baixos de sintomas; a terceira, com escores intermediários nos itens. Não foram encontradas relação entre as classes latentes e o estilo de respostas extremas. Participantes que relataram um diagnóstico de depressão apresentaram maior probabilidade de pertencer à primeira classe latente. Os resultados evidenciam a utilidade clínica da estrutura de classes latentes para a EBADEP.

Resumen Las respuestas extremas y la falta de linealidad pueden reducir la validez de los escores de depresión. Al abordar este problema, este estudio pretende explorar la estructura de clases latentes de la Escala de Depresión Baptista (EBADEP) y la influencia del sesgo de respuesta extremo. Participaron 1.137 universitarios brasileños (M = 26 años, DE = 7,3). El análisis taxométrico indicó resultados ambiguos, sin un ajuste explícitamente mejor para una estructura dimensional o categórica. Se identificaron tres clases latentes: la primera, compuesta por participantes que tendían a obtener altas puntuaciones en los ítems tristeza, angustia, negativismo y baja autoeficacia; la segunda, de individuos con bajos niveles de síntomas; y la tercera, con puntuaciones intermedias en los ítems. No se encontró relación entre las clases latentes y el estilo de respuestas extremas. Los participantes que informaron estar con diagnóstico de depresión tenían más probabilidades de pertenecer a la primera clase latente. Los resultados muestran la utilidad clínica de la estructura de clases latente para EBADEP.

Variables diferenciadoras del nivel de gravedad de la depresión mediante el Sistema Comprehensivo Rorschach / Differentiated variables of the seriousness level of the depression by means of the Rorschach Comprehensive System

RESUMEN Se desarrolló una investigación descriptiva transversal, con un enfoque cuantitativo, en la que la muestra fue seleccionada de manera intencional pura, no probabilística, según criterios establecidos por los autores del estudio. Quedó constituida por las variables del Sistema Comprehensivo Rorschach pertenecientes a 120 protocolos de sujetos con trastornos depresivos, de ellos 82 presentaron depresión moderada, y 38 depresión severa. Se aplicaron los siguientes métodos empíricos: entrevista, observación, Autoescala de Zung y Conde, y el Psicodiagnóstico de Rorschach. Los estadígrafos que se utilizaron fueron el Test de Kolmogorov- Smirnov, el Test de Comparación de Proporciones y la prueba de Mann-Whitney. Como principales resultados se obtuvo que las variables del Sistema Comprehensivo Rorschach, que establecieron diferencias estadísticas altamente significativas entre los grupos de sujetos fueron: Lambda alta, Proporción afectiva baja, total de respuestas, las respuestas globales, Suma Ponderada de respuestas con el determinante color cromático y la Experiencia accesible.

ABSTRACT A transverse descriptive investigation was developed, with a quantitative approach, in that the sample was selected in a pure intentional way, not probabilistic, according to criteria established by the authors of the study. It was constituted for the variables of the Rorschach Comprehensive System belonging to 120 protocols of individuals with depressive disorders, of them 82 presented moderate depression, and 38 severe depression. The following empirical methods were applied: interview, observation, Auto-scale of Zung and Conde, and Psycho-diagnosis of Rorschach. The statisticians used were the Test of Kolmogorov - Smirnov, the Test of Comparison of Proportions and the Mann-Whitney test. As main results, it was obtained that the variables of the Rorschach Comprehensive System, which established highly significant statistical differences between the groups of individuals were: tall Lambda, low affective proportion, whole of answers, the global answers, exaggerated sum of answers with the determinant chromatic color and the accessible experience.

Avaliando "depressões": dos critérios diagnósticos às escalas psicométricas / Evaluating "depressions": from diagnostic criteria to psychometric scales / Evaluación de las "depresiones": desde los criterios diagnósticos hasta las escalas psicométricas

O termo "depressão" pode ser utilizado para se referir a uma gama bastante abrangente de diagnósticos e expressões de sintomas, de maneira que duas pessoas podem apresentar sintomas completamente diferentes uma da outra e, mesmo assim, ambas terem diagnóstico semelhante. Nesse sentido, as escalas podem ser fundamentais no processo de rastreio, auxílio no diagnóstico e intervenção de pacientes com sintomatologia clinicamente significativa de depressão. Este artigo tem como objetivo discutir duas temáticas atuais que envolvem a avaliação psicológica. A primeira se refere a diferentes apontamentos (descrição, importância, críticas) sobre os critérios dos manuais psiquiátricos referentes aos transtornos depressivos. Na segunda temática, são discutidas características das escalas que avaliam sintomatologia depressiva e suas especificidades, já que elas podem ser distintas entre si, em vários aspectos, como teorias de base, dimensionalidade, número de itens, tipo de resposta, especificidades do ciclo de vida, formas de aplicação, dentre outros. (AU)

The term "depression" can be used to refer to a fairly wide range of diagnoses and expressions of symptoms, so that two people may have completely different symptoms from each other, and yet both may have a similar diagnosis. Therefore, scales can be fundamental in the screening process, aiding in diagnosis and intervention with patients presenting clinically significant symptoms of depression. This article aims to discuss two current issues in psychological assessment. The first refers to different notes (description, importance, criticism) regarding the criteria in psychiatric manuals related to depressive disorders. The second theme discusses characteristics of the scales that evaluate depressive symptomatology and their specificities are discussed, since they may differ from each other, in several aspects such as basic theories, dimensionality, number of items, response type, life cycle specificities, application forms, among others. (AU)

El término "depresión" puede ser utilizado para referirse a una gama bastante amplia de diagnósticos y expresiones sintomáticas, de tal forma, que dos personas pueden presentar síntomas completamente diferentes una de la otra y, aun así, ambas pueden tener un diagnóstico similar. En este sentido, las escalas pueden ser fundamentales en el proceso de rastreo, ayuda en el diagnóstico e intervención en pacientes con sintomatología clínicamente significativa de depresión. Este artículo tiene como finalidad discutir dos temáticas de actualidad, que involucran a la evaluación psicológica. La primera se refiere a diferentes apuntes (descripción, importancia, críticas) sobre los criterios de los manuales psiquiátricos referentes a los trastornos depresivos. En la segunda temática, se discuten características de las escalas que evalúan la sintomatología depresiva y sus particularidades, dado que las mismas pueden ser muy diferentes entre sí en varios aspectos, tales como teorías de base, dimensionalidad, número de ítems, tipo de respuesta, particularidades del ciclo de la vida, formas de aplicación, entre otros. (AU)

Epidemiología del intento de suicidio / suicidio consumado / Epidemiology of attempted suicide / suicide

El suicidio en la Provincia de Buenos Aires, al igual que en el resto del país, viene en aumento en los últimos años y continua siendo la segunda causa de muerte traumática en edades infanto juveniles. Se evaluaron prevalencia del intento de suicidio , principales causas, métodos, distribución en la provincia. Se tiene en cuenta las adicciones como desencadenantes del mismo en casi el 50% de los suicidios.(AU)

Síndrome cerebeloso cognitivo-afectivo / Cerebellar cognitive affective syndrome

Introducción. El diagnóstico de síndrome cerebeloso cognitivo afectivo se debe realizar en aquellos pacientes con lesiones cerebelosas y con déficit cognitivo asociado a deficiencias neuropsicológicas visoespaciales o ejecutivas, trastornos del lenguaje expresivo y trastornos afectivos. Caso clínico. Adolescente de 16 años diagnosticada con trastorno por déficit de atención e hiperactividad a los 7 años, que presenta inestabilidad emocional, apatía y discurso y lectura poco fluidos. Se observan deficiencias visoespaciales en los tests neuropsicológicos. Se realiza una resonancia magnética cerebral por presentar alteración de la coordinación y motricidad fina, y se evidencia atrofia de vermis cerebeloso. La sintomatología es compatible con síndrome cerebeloso cognitivo afectivo. Clásicamente, el cerebelo es conocido por su rol motor. Sin embargo, está implicado en funciones cognitivas superiores, en la expresión emocional y en la regulación conductual. El síndrome cerebeloso cognitivo afectivo es una entidad no bien conocida que debemos incluir en el diagnóstico diferencial de trastornos neuropsiquiátricos con lesión cerebelar.

Introduction. The diagnosis of Cerebellar Cognitive Affective Syndrome should be considered in patients with cerebellar lesions who also suffer cognitive deficits associated with visuospatial or executive neuropsychological disorders, expressive language disorders and affective disorders. Clinical case. A 16 year old adolescent diagnosed with Attention Deficit Hyperactivity Disorder at the age of 7 presents with emotional instability, apathy, and speech and reading difficulties. Neuropsychological tests show visuospatial difficulties. A brain magnetic resonance imaging is performed due to impaired coordination and fine motor movements and shows atrophy of the cerebellar vermis. The clinical picture suggests a diagnosis of Cerebellar Cognitive Affective Syndrome. The cerebellum is mostly known for its motor role. However, it is also involved in higher cognitive functions, expression of emotion and behavioral regulation. Cerebellar Cognitive Affective Syndrome is a relatively unknown diagnosis and should be included in the differential diagnosis of neuropsychiatric disorders with cerebellar lesion.

Características sociodemográficas y comorbilidad de sujetos con juego patológico e intento de suicidio en España / Sociodemographic Traits and Comorbidities in Pathological Gamblers With a Suicide Attempt in Spain

Objetivo: El suicidio se sitúa en España como la primera causa de muerte no natural, y el juego patológico es uno de sus principales factores de riesgo de los trastornos adictivos. El estudio realizado tiene como objetivo describir y comparar las características sociodemográficas, la comorbilidad y las características del intento en pacientes con intentos de suicidio que cumplen criterios de juego patológico frente a pacientes con intento de suicidio sin criterios de juego patológico. Métodos: Para los distintos análisis se empleó una muestra de 345 pacientes con intento de suicidio recogida a partir de las admisiones en el servicio de Urgencias de un Hospital Universitario de la Comunidad Autónoma de Madrid durante el periodo comprendido entre 1999 y 2004. Para describir y comparar las características sociodemográficas, de comorbilidad y las relacionadas con el intento de suicidio, se utilizaron modelos de regresión logística ajustados por sexo y edad. Resultados: Los resultados muestran que los pacientes con intento de suicidio que cumplen criterios de juego patológico son predominantemente varones, con bajo nivel de estudios y con mayor tendencia a tener descendencia. Además presentan mayor prevalencia en determinadas comorbilidades: dependencia global de sustancias, dependencia de nicotina, dependencia de cocaína y dependencia de opiáceos. Conclusiones: En este estudio se muestra cierta evidencia sobre la existencia de un subtipo de suicida (jugador patológico suicida) con ciertas características propias, similares a las encontradas en muestras de jugadores patológicos.

Objective: Suicide is the first cause of non-natural death in Spain. Among addictive disorders, pathological gambling is one the most significant independent risk factors for suicidal behavior. The objective of this study is to describe and compare the sociodemographic traits, comorbidity and attempt characteristics, between suicide attempters who fulfill diagnostic criteria for pathological gambling and those who do not. Methods: A total of 345 patients admitted to the emergency department of a University Hospital in Madrid between 1999 and 2004 were interviewed for this study. To describe and compare the demographic characteristics, comorbidity and those related to attempted suicide, using logistic regression models adjusted for sex and age were used. Results: Suicide attempters who fulfilled diagnostic criteria for pathological gambling were predominantly male, with a low education level, and had more offspring. Furthermore, these patients had more comorbidities, such as: global substance dependence, nicotine, cocaine and opioid dependence. Conclusions: The present study suggests that pathological gamblers represent a distinct subgroup among suicide attempters, with particular characteristics, similar to those found in pathological gamblers in the general population.

IRT Application to Verify Psychometric Properties of the Beck Depression Inventory (BDI) / Aplicación de la TRI para verificar las propriedades psicométricas del Inventario de Depresión de Beck

The aim of this study was to evaluate the performance of the Brazilian version of the Beck Depression Inventory (BDI) using Rasch-based person and item analysis. For this purpose, 271 participants were recruited, between 18 and 51 years of age (M = 23.61; SD=6.12), 187 (69%) female and 84 men, all Brazilian college students. Participants responded to the BDI on the assessment of depressive symptoms. Results suggest the adequacy of the psychometric properties of the instrument and demonstrate the Rasch model's applicability for clinical practices. Among the important tools offe -red by the Rasch model, we explore the use of the person-item map, which visually presents the intuitively understandable psychological construct along the dimensional scale of the instrument.

El objetivo de este estudio fue evaluar el desempeño de la versión brasileña del Inventario de Depresión de Beck (BDI) usando el modelo de Rasch. Para ello 271 participantes fueron reclutados, entre 18 y 51 años de edad (M = 23,61; SD = 6.12), 187 (69%) mujeres y 84 hombres, todos son estudiantes universitarios brasileños. Los participantes respondieron a la BDI sobre la evaluación de los síntomas de la depresión Los resultados sugieren la adecuación de las propiedades psicométricas del instrumento y demuestran la aplicabilidad del modelo de Rasch en prácticas clínicas. Entre las herramientas más importantes que ofrece el modelo de Rasch se explora el uso del mapa persona-artículos, que presenta visualmente la construcción psicológica intuitivamente comprensible a lo largo de la escala dimensional del instrumento.

Desarrollo de una escala de auto-reporte para medición de síntomas maníacos / Development of a self-report scale to measure manic symptoms

Resumen Antecedentes. No existen instrumentos de auto-reporte en español para medir síntomas de trastorno bipolar. La perspectiva del paciente puede dar información complementaria de utilidad para el diagnóstico y manejo de la enfermedad. Objetivo. Desarrollar una escala de auto-reporte para medir síntomas maníacos, a partir de la escala EMUN. Materiales y métodos. Los ítems de la escala EMUN se transformaron a un lenguaje en primera persona por parte de dos psiquiatras. Esta versión preliminar en primera persona fue analizada en un estudio piloto y ajustada de acuerdo con los resultados de la evaluación. Se realizó un segundo estudio piloto con 20 pacientes con enfermedad bipolar, aplicando la versión ajustada. Resultados. Se generó una escala con 26 ítems que incorporan síntomas del episodio mixto. La escala mide tres dimensiones de importancia clínica en salud mental: frecuencia, intensidad y grado de desadaptación producido por los síntomas. Conclusión. El instrumento desarrollado puede ser de utilidad en áreas de investigación y en escenarios clínicos para intervenciones psicoeducativas y seguimiento del paciente.

Summary Background. In Spanish language, no self-report instruments have been specifically developed to measure symptoms of bipolar disorder. The patient's perspective provides valuable information useful to diagnose and treat the disorder. Objective. Develop a self-report scale for measuring manic symptoms making use of the EMUN scale. Materials and methods. The items of the EMUN scale were transformed into a first person language by two psychiatrists. This preliminary version was evaluated in a pilot testing and adjusted according to this evaluation. A second pilot study applying the adjusted version to 20 patients having bipolar disorder was performed. Results. A 26 items scale including symptoms of mixed episode was developed. This scale measures three clinical relevant dimensions in mental health: frequency, severity and maladaptive effect of symptoms. Conclusions. The instrument developed can be a useful tool for researchers and in clinical settings to support educational interventions and patient's follow-up.

Escala Multidimensional de trastornos afectivos-EMTA: análisis desde la teoría clásica de los test y la teoría de respuesta al ítem / Multidimensional scale for affective disorders-Msad: analysis from the classic tests theory and the item response theory

La presente investigación responde a una de las fases del proceso de diseño y estandarización de la Escala Multidimensional de Trastornos Afectivos (EMTA), cuyo propósito fue su análisis desde la Teoría Clásica de los Test (TCT) y la Teoría de Respuesta al Ítem (TRI) a partir de una muestra de 384 estudiantes vinculados a tres instituciones de educación superior de Barranquilla, cuyas edades oscilaron entre los 17 y los 26 años de edad. Los datos fueron recolectados a través de la administración de tres instrumentos: la Escala Multidimensional de Trastornos Afectivos, el Inventario de Depresión de Beck (a= .791) y la Escala Autoaplicada de Altman (a= .566). Se reportaron resultados ajustados a los parámetros de ambos modelos. En el análisis desde la TCT, se evidenciaron índices alfa de Cronbach significativos para ambas subescalas (a = .942 para la Subescala de Depresión y a = .864 para la Subescala de Manía), una alta consistencia interna con correlaciones ítem escala superiores a .3 para todos los ítems. Desde la TRI, se reportó una fiabilidad en el caso de la Depresión de .88 (personas) y .99 (ítems), mientras que en lo referente a Manía, los índices fueron de .84 (personas) y .87 (ítems). A lo largo de los resultados se conservó un ajuste monotónico creciente, con lo cual se corrobora el cumplimiento del principio de la invarianza en la medición del rasgo latente.

This research responds to one phase of the process for the design and standarization of the MSAD Multidimentional Scale of Affective Disorders -EMTA in Spanish-, whose purpose was to analyze MSAD, from the Classical Test Theory (CTT) and the Item Response Theory (TRI), from a sample of 384 students enrolled to three universities in Barranquilla, aged between 17 and 26 years. This is considered an instrumental study, due to its purpose. The data were collected through he administration of three instruments: Scale Multidimensional Affective Disorder, The Beck Depression Inventory (a= .791) and the self-administered Altman Scale (a= .566). Finally, results were reported as adjusted to the parameters of both models. Analysis from the TCT showed high Cronbach alpha indexes for both subscales (a= .942 for the Depression Subscale and a= .864 for the Subscale Mania), as well as high internal item-scale correlations above .3 for all items. Since the TRI, reliability in the case of Depression .88 (individuals) and .99 (items) were reported, while rates regarding Mania were .84 (persons) and .87 (items). Results retained an increasing monotonic configuration; thus the principle of invariance in measuring the latent trait is corroborated.

Diseño de la Escala Multidimensional de Trastornos Afectivos (emta): análisis psicométrico de confiabilidad y validez / Design of multidimensional scale emta affective disorders: psychometric analysis of reliability and validity

El propósito de esta investigación fue construir y validar una escala que mide trastornos afectivos. La muestra piloto estuvo conformada por 100 sujetos de la Corporación Universidad de la Costa (Barran-quilla, Colombia): 81% mujeres y 19% hombres, con edades entre 18 y 44 años. Inicialmente, la escala contenía en la Subescala de Depresión los ítems 1-57 y en la Subescala de Manía los ítems 5893. La escala final cuenta con la evaluación de síntomas depresivos (ítems 1-47); la segunda de ellas busca evaluar, a su vez, síntomas de corte maniaco (ítems 52-80). Los síntomas contemplados en los ítems 48 al 51 y 81 al 85, respectivamente, buscan evaluar intensidad y cronicidad de una manera más específica. El procesamiento estadístico de los datos se realizó con el software SPSS. Se estimaron los índices Alfa de Cronbach obtenidos en la Subescala de Depresión (a: 0.942) y en la Subescala de Manía (a: 0.834). Adicionalmente se estimaron los niveles de correlación ítem - escala y se desarrolló un análisis factorial para profundizar en la valoración de la validez del constructo. Igualmente se generaron rangos de clasificación de los puntajes obtenidos; para identificar el nivel de Manía o Depresión de los sujetos, cada una de la subescalas evalúa rangos de nivel bajo, medio y alto. En el caso de la Subescala de Depresión, se pudo identificar que los rangos de clasificación están a un nivel bajo para el 81% de los casos y medio para el 19%. En la Subescala de Manía, los rangos de clasificación están a un nivel bajo para el 82% de los casos y medio para el 18%, los cuales son consistentes con la naturaleza de la muestra piloto, que fue de corte no clínica.

The purpose of this research was to construct and validate a scale for measuring affective disorders. The sample was taken with 100 students of the Corporación Universidad de la Costa (Barranquilla, Colombia): 81% women and 19% men between 18 and 44 years of age. Initially, the scale contained items from 1 to 57 in the Depression Subscale and items from 58 to 93 in the Mania Subscale. The final scale has items (from 1 to 47) to valuate depressive symptoms and others (from 52 to 80) for mania symptoms. Items from 48 to 51 and from 81 to 85 were made to valuate intensity and chronicity in a more specific way. Statistical data processing came ahead from expected with the SPSS software. Indicating the Cronbach Alpha index obtained in the Depression Subscale, that was equal to (a: 0.942) and in the Mania Subscale was equal to (a: 0.834). In addition, correlated values were estimated from item-scale and a factorial analysis was developed to reach deep in the grade validity of the construct, in order to identify the subjects' level of Mania or Depression. Each subscale valuates low, medium and high ranges. With the Depression Subscale 81% of the sample showed low level results and 19% showed medium level results. With the Mania Subscale at 82% of the sample, showed low level results and 18% showed medium level results, which are consistent with the nature of the original sample from non-clinical approach.

Tics: los trastornos del movimiento más frecuentes en los niños / Tics: the most frequent movement disorders in children

Los tics son los trastornos del movimiento más frecuentes en los niños y su mayor prevalencia es en la edad escolar. La mayoría son transitorios, pero algunos pueden tener repercusiones negativas en los ámbitos escolar, familiar y social, que pueden llevar a fracaso escolar, baja autoestima y disfunción social. Algunos de los tics se relacionan con el trastorno de déficit de atención e hiperactividad (TDAH) y con otras enfermedades que requieren diagnóstico oportuno y adecuado tratamiento. En esta revisión sobre los tics se incluyen los siguientes aspectos: epidemiología, etiología, factores de riesgo, caracterización, enfermedades asociadas, diagnóstico, tratamiento y pronóstico.

Tics are the most frequent movement disorders during childhood; their highest prevalence occurs during school age. Most tics are transient but some of them may have serious repercussions from the educational, familial, and social points of view, leading to school failure, low self-esteem, and social dysfunction. Some tics are related to the attention-deficit hyperactivity disorder, and to other diseases that should be opportunely and adequately treated. In this review on tics the following aspects are included: epidemiology, etiology, risk factors, characterization, associated diseases, diagnosis, treatment, and prognosis.

La detección de casos de trastorno bipolar por medio de un instrumento de tamizaje: el Cuestionario de Trastornos del Animo versión en español

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Summary Bipolar spectrum disorder which includes bipolar I, bipolar II, ciclothymia and bipolar disorder, not otherwise specified often goes unidentyfied, underdiagnosed, or confounded with major depressive disorder. There are several considerations that try to explain this frequent omission. One crucial aspect is that, the first mood episode at onset is often a depressive one, and some bipolar patients present multiple depressive episodes prior to their first episode of mania. Additionally, long-term evaluation of patients with bipolar I or II disorders, reveal that depressive symptoms occur more common than manic or hypomanic symptoms. Another plausible explanation is that bipolar patients frequently underreport symptoms of mania. Thus it is not surprising to find that in many patients, may elapse about 10 years from the first time for they seek treatment until a clinician finally makes the correct diagnosis. As a consequence, such patients may suffer poorer outcomes, subsyndromal symptoms and a course of illness marked by more sever symptoms, chronic mood episodes, increased recurrence and more impaired psychosocial functioning. The correct diagnosis of bipolar disorder becomes an important and crucial issue, if it is considered that there is a current trend to understand better this affective illness as a spectral disorder. This concept helps to identify different subtle subtypes of bipolarity which often are unrecognized, by means of the actual diagnostic criteria. This diagnostic reformulation is based on the phenomenological manifestations of the entities, as well as in other specific clinical aspects, such as comorbidity, predominant episodes, genetic information and treatment response to among others. Thus, correct recognition of bipolar disorder will bring an important benefit to patients and may reduce erratic treatments and improve outcome. Several epidemiological studies report that the global prevalence of bipolar I disorder is around 1%, in the general population, but when considering all subtypes included in the bipolar spectrum, this lifetime prevalence increases up to 5%. As a consequence of an incorrect diagnosis, patients are often undertreated or receive an erroneous pharmacological treatment, mainly with antidepressants, which complicate outcome by promoting manic or hypomanic reactions and may have devastating consequences in the further clinical intents to stabilize the disorder. In order to increase the recognition of an illness, the correct utilization of a clinical screening procedure is mandatory. Several screening instruments exist for a variety of psychiatric disorders. However, only until recently, some of them have been developed specifically to identify bipolar disorders. The Mood Disorder Questionnaire, was the first screening instrument specifically developed to detect bipolar cases in clinical settings. It is a self-report, single-page, paper and pencil inventory than can be quickly and easily scored by a physician, a nurse or by trained medical staff assistance. It is composed of 13 questions which are answered with a positive or negative fashion, elaborated from the bipolar diagnostic criteria and clinical experience and inquires about possible manic symptoms. In the original report of its development and validation, it was concluded that it is a useful screening instrument for bipolar spectrum disorders, with a good sensitivity (0.73) and a very good specificity (0.90). Method: The questionnaire has been translated to other languages and has been used in non-clinical settings, with very good standards of performance. Since there is not a Spanish version of it, we decided to translate this instrument and to design a trial for the following purposes: 1) to obtain a validated and understandable Spanish version of the questionnaire. 2) To determine its sensibility and specificity in a sample of patients with affective disorders. 3) To identify its optimal cutoff score for screening purposes. The first step in our study consisted in the development of a translated version of the instrument. For that purpose a translation- retranslation procedure was utilized, in which four clinical psychiatrists with experience in treating bipolar patients made each one a separate translation. Then, all the versions were discussed until a consensus was reached in a final version. This version was retranslated to English and, after making some adjustments, the final version in Spanish was concluded. The study aimed to determine the clinimetric parameters of the Mood Disorder Questionnaire in its Spanish version, was conducted at the outpatient affective disorders clinic in the National Institute of Psychiatry Ramón de la Fuente, in México City. Patients with an age of 18 years and over who looked for psychiatric consultation, due to the presence of affective disorder were invited to participate. After explaining the procedure and the purposes of the study, all those who accepted to participate, signed 51 an informed consent document. This study was approved by the Ethical Committee of our institution. All patients completed the Mood Disorder Questionnaire. Two experienced clinical psychiatrists, blind to the questionnaire results, applied the Structural Clinical Interview for DSM-IV (SCID) to obtain the specific affective diagnosis in all the patients. Clinical and demographic data, as well as results from the clinical interview and questionnaire's scores, were obtained and then analyzed. Sensitivity and specificity for each Mood Disorder Questionnaire score, were plotted by using results from the SCID interview as a standard. Sensitivity (percent of criterion standard diagnosis correctly diagnosed by the questionnaire) and specificity (percent of criterion standard noncases correctly identified as noncases by the questionnaire) were obtained by using different symptoms, threshold that ranged from 5 to 10 points in order to determine the optimal screen threshold. Results: A total of 100 patients were included in the study. Mean age for the complete group was 35.3 years and 64% were female. According to the SCID results, 49 patients had a diagnosis within the bipolar spectrum disorder and 51 had a unipolar affective diagnosis. Each group included patients with both first and recurrent episodes, and with and without comorbidities. The questionnaire was completed by the total sample of patients covering the total range of answer's possibilities, from non-positive responses (1% of the sample) to 13 positive responses (15% of the sample). Mean score (± SD) was 8.06 (3.5) with a significant difference between patients in the bipolar group (10.3 ± 2.7) and patients in the unipolar group (5.8 ± 2.7); t = -8.2, 98 gl, p<0.001. Using different cutoff scores sensitivity and specificity were calculated, observing that with a 10 point cutoff score, equilibrated sensitivity (0.71) and specificity (0.92) levels were obtained. Conclusions: The study was aimed to obtain an adequate translated version into Spanish of the Mood Disorder Questionnaire, and to determine its sensitivity and specificity, according to an optimal cutoff score, for correctly detecting bipolarity from a sample of affective disorder patients. With a reliable procedure of translation process, we obtained a satisfactory, understandable and easy to use version for patients. Similar to other reports, a structured clinical interview was utilized to obtain the patients diagnoses. After evaluating with different cutoff scores, we found that a score of 10, gives an adequate distribution for levels of sensitivity and specificity. However, lower scores (between 7 and 9), also give adequate levels of sensitivity and specificity. It is important to consider, that our study was done in a very specific sample of patients who had only affective disorders. With these type patients it is necessary to raise the bar sufficiently to obtain adequate results. In other studies that included non-affective patients the questionnaire worked well with lower cutoff points. The operating characteristics of the Mood Disorder Questionnaire in its Spanish version are sufficiently good to consider its application as a reliable screening instrument for detecting bipolar spectrum disorders at least, in an affective disorders clinical setting. Further studies are needed to evaluate whether the instrument would be useful in other psychiatric settings as well as in community or primary care samples, and also to determine the best cutoff point depending in the characteristics of the population in which it is being used.

Perfil epidemiológico y clínico de los pacientes hospitalizados en la Clínica Psiquiátrica Nuestra Señora del Sagrado Corazón, durante septiembre de 2003 (Medellín) / Epidemiological and Clinical Profile of Hospitalized Patients in the Psychiatric Clinic “Nuestra Señora del Sagrado Corazón” during September 2003-Medellín.

Introducción y objetivo: La hospitalización es fundamental para el tratamiento de enfermedades psiquiátricas graves; por ello es importante el conocimiento que los servicios de salud tengan sobre la población que atienden, a fin de que puedan planear la atención, la docencia y la investigación. Así, la información de cada institución ayuda a conformar el panorama epidemiológico nacional. Este trabajo describe las características sociodemográficas y clínicas de pacientes agudos hospitalizados en una clínica psiquiátrica. Materiales y métodos: estudio observacional, descriptivo, con fuentes secundarias de información (historias clínicas) de los ingresos de septiembre de 2003. Se usó en el programa SPSS 10 para el análisis de datos. Resultados: la edad promedio fue 36,9 años (DE 15,1); 22 pacientes (32,4%) eran hombres y 46 (67,6%), mujeres. La mayoría (63,2%) era de Medellín. Los diagnósticos más frecuentes fueron: trastorno depresivo mayor (22 = 23,4%), trastorno bipolar (27 = 39,7%) y trastornos psicóticos (14 = 20,6%). El promedio de estancia fue 8,8 días (DE 5,3). Conclusión: la mayoría de pacientes fue mujeres, de edad adulta media, con trastorno depresivo mayor o trastorno bipolar, de Medellín, lo cual facilitaría su inclusión en programas ambulatorios que incluyan terapia cognitivo-conductual y psicoeducación.

Introduction and objective: Hospitalization is fundamental in the treatment of severe psychiatric disorders, the health service';s knowledge about it';s target population is basic for planning attention, education and investigation. Information from every institution is useful to conform the national epidemiological map. This paper describes the sociodemographic and clinical characteristics of acute patients hospitalized in a psychiatric hospital. Materials and methods: Descriptive research, using secondary information sources (clinical histories) of patients hospitalized in September of 2003. SPSS 10 software was used for data analysis. Results: The mean age was 36,9 years (DE 15,1), 22 (32,4%) patients were men and 46 (67,6%) women, mostly (63,2%) from Medellín. The most frequent diagnosis were: major depressive disorder, 22 (23,4%) patients; bipolar disorder, 27 (39,7%); psychotic disorders, 14 (20,6%). The mean length of stay was 8,8 days (DE 5,3). Conclusion: Most of the patients were adult middle age women with major depressive disorder or bipolar disorder, from Medellín, making it easier to include them in out-patient care programs including cognitive behavior therapy and psycho-education.

Validación de la entrevista diagnóstica para estudios genéticos (DIGS) en Colombia / Validation of the Diagnostic Interview for Genetic Studies (DIGS) in Colombia

Objetivo: validar la entrevista diagnóstica para estudios genéticos (DIGS 3.0) en Colombia. Métodos: se hicieron dos traducciones del inglés al español del DIGS y se hizo traducción en sentido inverso (al inglés) de cada una. Un comité de revisión verificó la equivalencia translingüística y transcultural. Se evaluó la confiabilidad examen-reexamen e interevaluador del DIGS 3.0 en 65 y 91 pacientes, respectivamente, mediante el cálculo de kappa de Cohen. Resultados: el DIGS 3.0 mostró ser comprensible, con validez de apariencia y de contenido. La confiabilidad interevaluador fue excelente para esquizofrenia (kapa=0,81, IC95%: 0,68-0,93), trastorno bipolar (kapa=0,87, IC95%: 0,75-0,99), trastorno depresivo mayor (kapa=0,86, IC95%: 0,7- 1) y ausencia de trastorno psiquiátrico (kapa=0,88, IC95%: 0,71-1); fue buena para otro diagnóstico psiquiátrico (kapa=0,65, IC95%: 0,41-0,89) y pobre para trastorno esquizoafectivo (kapa=0,37, IC95%: -0,02-0,76). La confiabilidad examen-reexamen fue excelente para todos los diagnósticos (kapa>0,8), excepto para otro diagnóstico psiquiátrico (kapa=0,64, IC95%: 0,31-0,96), donde fue buena. Conclusiones: la versión en español del DIGS para Colombia mostró comprensibilidad, validez de apariencia y de contenido, y confiabilidad examen-reexamen e interevaluador. Es una herramienta útil para estudios genéticos en esquizofrenia y en trastornos afectivos.

An interview tool, Diagnostic Interview for Genetic Studies (DIGS 3.0), was translated into Spanish for application in studies of psychiatric disorders in Colombia. Two Spanish translations of the original English version of DIGS were prepared and backtranslated into English. A review committee verified the linguistic and cultural equivalence of the translations. The evaluator and test-retest reliability were assessed calculating Cohen’s kappa for samples of 65 and 91 patients respectively. DIGS proved valid in both appearance and content. The confidence interval (C.I.) was excellent for schizophrenia (kappa=0.81, C.I. 95% = 0.68-0.93), bipolar disorder (kappa=0.87, C.I. 95% = 0.75-0.99), major depressive disorder (kappa=0.86, C.I. 95% = 0.70-1.00), and for a normal diagnosis (kappa=0.65, C.I. 95% = 0.41-0.89); it was good for other psychiatric diagnosis (kappa=0.65, C.I. 95% = 0.41-0.89) and poor for schizoaffective disorder (kappa=0.37, C.I. 95% = -0.02-0.76). Test-retest reliability was excellent for all diagnoses (kappa>0.8), except for "other psychiatric diagnoses" (kappa=0.64, C.I. 95% = 0.31-0.96). The Spanish translation of the DIGS was comprehensible, with face and content validity, and good test-retest and evaluator reliability. This translation will be a useful tool for genetic studies of psychiatric disorders in Latin America, particularly where schizophrenia and affective disorders are involved.