Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio / Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide

La distimia incluye síntomas crónicos que interfieren en el funcionamiento y bienestar de la persona, pudiendo traer consecuencias fatales como el intento de suicidio, así como alteraciones neuropsicológicas en los procesos afectivos y cognitivos que afectan el comportamiento. En el municipio de Guisa, Provincia Granma, existe un alto número de pacientes distímicos que son infradiagnosticados, por lo que las conductas suicidas se tornan más frecuentes. Por este motivo se realizó la investigación que se muestra bajo el título “Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio”, con el objetivo de caracterizar el estado neuropsicológico de dichos procesos. Se aplicaron métodos del nivel teórico: análisis-síntesis y el inductivo-deductivo, así como las siguientes técnicas: entrevista inicial, anamnesis, observación, Inventario de Beck, test Gestáltico Bisomotor, Tarea de denominación de objetos, Tarea go/no go, Series gráficas y motoras alternantes, Test de memoria acortado y el Test de la figura compleja de Rey. A través de los cuales se obtuvo que el estado neuropsicológico de los procesos cognitivos básicos en estos pacientes está alterado, manifestando déficits en la percepción, atención y memoria, sustentados en posibles hallazgos biológicos en determinadas áreas cerebrales. Este trabajo investigativo es de vital importancia, permitirá diseñar intervenciones terapéuticas acertadas para el tratamiento, convirtiéndose de esta manera la exploración neuropsicológica en un elemento clave para el diagnóstico e intervención en los pacientes.

Dysthymia includes chronic symptoms that interfere with the functioning and well-being of the person and can bring fatal consequences such as suicide attempt, and neuropsychological alterations in affective and cognitive processes that affect behavior. In the municipality of Guisa, Granma Province there is a high number of dysthymic patients are underdiagnosed, so suicidal behavior become more frequent. For this reason, research shown under the title "Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide" in order to characterize the neuropsychological status of basic cognitive processes in these patients was performed. Analysis-synthesis and inductive-deductive and the following techniques: initial interview, anamnesis, observation, Inventory Beck, test Gestalt Bisomotor,Task object naming, Task go / no go, graphics series theoretical methods were applied and alternating motor, shortened memory test and test the complex figure of Rey. Through which was obtained that the neuropsychological status of basic cognitive processes in these patients is altered, showing deficits in perception, attention and memory, sustained in possible biological findings in certain brain areas. This research work is vital, it will allow designing successful therapeutic interventions for treatment, thus becoming the neuropsychological a key for diagnosis and intervention in these patient’s element.

Screening for depressive disorders in outpatients with mild to moderate psoriasis: A study from North India.

Background: Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. Aims: The aim of this study was to test the feasibility of using a modifi cation of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. Materials and Methods: One hundred and four out-patients with psoriasis were recruited in the study. In the fi rst stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modifi ed questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confi rmed using the Mini International Neuropsychiatric Interview. Results: The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confi dence interval = 0.72–0.89). Limitations: The sample size is small and more studies are needed with the screening questions in different languages to validate the fi ndings of the study. Conclusion: The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study / Comorbidade psiquiátrica no diabetes tipo 1: um estudo transversal observacional

Objective This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. Methods A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). Results With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). Conclusion The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident. .

Objetivo Elementos relacionados à saúde mental do paciente diabético tipo 1 são encontrados em várias pesquisas. O objetivo desse estudo é avaliar sinais e sintomas depressivos nesse grupo de pacientes, como também investigar as principais prevalências psiquiátricas que os acometem. Métodos Pesquisa realizada em 110 pacientes diabéticos atendidos em ambulatórios (média = 58.3, D = 14.5; 50 masculinos e 60 femininos) conduzida em Postos de Saúde Pública nos momentos de consulta médica com endocrinologista. A avaliação transcorreu com as escalas Mini International Neuropsychiatric Interview and Hospital Anxiety and Depression Scale (HADS). Resultados Os sintomas de ansiedade tiveram prevalência de 60% (n = 66), enquanto para depressão encontramos resultados de 53.6% (n = 59), considerando que 110 pacientes foram avaliados. Mais especificamente, nós encontramos 28,2 (n. 31) pacientes sem depressão ou ansiedade, 13,6 (n. 15) pacientes com depressão, 16,4 pacientes (n. 18) com ansiedade e 41,8 (n. 46) pacientes com depressão combinada com ansiedade. Outros transtornos comórbidos tiveram prevalência de ansiedade generalizada (22,7%), distimia (18,2%), pânico (8,2%) e fobia social (5,5%). Conclusão Sintomas ansiosos e depressivos são comuns em pacientes diabéticos do tipo 1, porém há prevalência de psicopatologias diversas nesse grupo de pacientes, levando em conta novas necessidades de pesquisas futuras para validar protocolos de tratamentos mais adequados para diabéticos do tipo 1. .

Comorbidades entre dependência química, distimia, HIV e HCV: relato de caso / Comorbidity between addiction, dysthymia, HIV and HCV: case report

INTRODUÇÃO: A comorbidade entre dependência química e doenças infectocontagiosas é bem conhecida, assim como a relação entre transtornos de humor e uso de substâncias. Entretanto, o transtorno distímico nestes pacientes recebe pouca atenção. Em parte, isso se justifica porque a realização do diagnóstico de distimia é mais difícil do que de outros transtornos do humor em razão do tempo de abstinência (2 anos) necessário para o diagnóstico, tendo em vista que toxicodependentes apresentam diversas recaídas durante o curso de suas vidas. As infecções pelos vírus HIV e HCV, frequentemente associadas ao consumo injetável de substâncias, contribuem para alterações do estado mental e o próprio tratamento pode causar diversas flutuações no humor. RELATO DE CASO: O paciente é um homem de 40 anos de idade que apresenta comorbidade entre dependência química (heroína e álcool) e distimia, complicada por recaídas, consumo injetável e status sorológico positivo aos vírus HIV-1 e HCV. CONCLUSÃO: Pacientes dependentes químicos com comorbidades psiquiátricas e infectocontagiosas são desafiadores no que tange diagnóstico, tratamento e definição de abordagens terapêuticas para os diferentes problemas apresentados. Investigar e abordar adequadamente, entretanto, traz diversos benefícios na qualidade de vida do indivíduo afetado, assim como potenciais benefícios financeiros.

BACKGROUND: Comorbidity between chemical dependence and infectious diseases is well known, as is the relationship between mood disorders and substance misuse. Nevertheless, dysthymia in these patients is not well explored. That is partly justified since the diagnoses of dysthymia is more difficult than other mood disorders due to the abstinence time (2 years) required for the diagnoses, and since addiction patients present several relapses during the course of their lifetimes. HIV and HCV infections, frequently associated to intravenous (IV) drug use, contribute to mental status deterioration and the treatment for such conditions can cause fluctuations on mood. CASE REPORT: A 40 years old patient with comorbidity between chemical dependence (heroin and alcohol) and dysthymia, complicated by relapses, IV drug use and serological status positive to HIV-1 and HCV. CONCLUSION: Addiction patients with psychiatric and infectious comorbidity are challenging to diagnose, treat and define therapeutical approaches to the different conditions. Proper clinical investigation and approach leads to benefits in health quality and potential financial benefits.

Fármacos antidepresivos / Antidepressant drugs

En el presente artículo se describen las diferentes drogas utilizadas para el tratamiento de la depresión, sus modos de acción, sus efectos adversos y las diversas precauciones y advertencias

Fenomenologia y Distimia / Dysthimia and phenomenology

El modelo médico inferencial compara lo observado directamente por el terapeuta con configuraciones sintomáticas de referencia. El modelo perceptual utilizado de forma complementaria incluye aspectos diferentes a los síntomas por medio de los cuales es posible establecer un diagnóstico. De esta forma se puede integrar más ampliamente el fenómeno observado. La distimia representa un punto de entrada privilegiado para comprender el espectro depresivo. El artículo estudia el fenómeno distímico a través de una experiencia perceptual y destaca la importancia de la relación terapéutica como punto de partida de nuestro ejercicio diagnóstico y de los objetivos del tratamiento ofrecido

Psychometric study of dysthymic patints and their first-degree relatives

Psychometric evaluation of severity of depression and personality characteristics of 20 dysthymic patients [mean age 29.05 +/- 7.08 ys.] was carried out using Hamilton Depression Rating Scale [HDRS] and Eysenck Personality Questionnaire [EPQ] and was compared with that of 20 major depressive patients [mean age 33.60 +/- 7.7ys.] and 20 normal controls [mean age 32.85 +/- 6.17 ys.]. Psychosocial stressors that might trigger depression were also looked for. All first-degree relatives [118 persons] were subjected to clinical interview for detection of dysthymia. EPQ was also applied to assess their personality characteristics. Depression among dysthymic patients was mainly of mild degree. Severe depression was found in about 55% of major depressive and none of dysthymic patients. Application of EPQ revealed high neuroticism among dysthymics and high psychoticism among major depressives. Lie scale was high for both groups. Psychosocial stressors were more reported by dysthymic patients; however they were of mild or moderate degrees. Stressors reported by major depressive patients were mainly acute and severe. Assessment of the first-degree relatives revealed that 66% of dysthymics relatives had dysthymia or high EPQ scores compared to 36% of major depressives and 22% of normals

Estudo epidemiológico em distimia / Epidemiological study in dysthymia

Este é o relato de um estudo epidemiológico para avaliaçõ das características demográficas e clínicas da distimia no Brasil, que foi realizado nos meses de junho a novembro de 1998. Participaram do estudo 500 médicos das regiões Sul e Sudeste do País, obtendo-se um total de 2.500 pacientes estudados. A distimia é uma forma de depressão crônoca, não-episódica, de menor gravidade do que os episódios depressivos maiores. Entretanto, apesar dos sintomas mais brandos, a cronicidade e a ausência do reconhecimento da doença fazerm com que o prejuízo à qualidade de vida dos pacientes seja considerado maior do que nos demais tipos de depressão. Realizamos esta estudo epidemiológico para conhecer melhos os distímicos tratados por clínicos geral no Brasil, considerando suas principais caracteristicas demográficas e clínicas. Os dados deste estudo fornecem um perfil do jpaciente distímico no Brasil, além de subsídios que auxiliam no restabelecimento da qualidade de vida destes pacientes. O estudo teve como objetivo avaliar as características demográficas e clínicas em uma população de pacientes com depressão crônica - distímicos -, assistidos por médicos clínicos gerais de diferentes regiões do Brasil em sua prática médica assistencial

Dysthymia - Review - New Findings - Treatment Guindelines

Open trials with tricyclics, classical MAOIs or Lithium in dysthymia yielded a response rate in 45 per cent of subjects. A liong-term treatment of dysthymia with 276 patients treated during four years with eithermoclobemide,tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1 per cent. The controlled studies with tricycles, classical MAOIs, RIMAs, SSRs or benzamides showed that drugs well tolerated work better in dyathymia, due to the fact that the treatment has to be long-term. Sertraline was studied versus placebo or imipramine in primary dysthymia. Moclobemide, imipramine and polacebo were also studied in 315 patients. Mean doses were 650.0 mg-day of moclobemide, 203.2 mg-day of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue