Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Sense Organs/physiopathology , Somatoform Disorders/diagnosis , Medically Unexplained Symptoms , Signs and Symptoms , Somatoform Disorders/prevention & control , Surveys and Questionnaires/statistics & numerical data , Retrospective Studies , Diagnosis, Dual (Psychiatry)/psychology , Mentally Ill Persons/psychologySubject(s)
Humans , Male , Female , Diagnosis, Dual (Psychiatry)/adverse effects , Diagnosis, Dual (Psychiatry)/psychology , Neurocognitive Disorders/complications , Alcoholism/complications , Alcoholism/prevention & control , Diagnosis, Dual (Psychiatry)/methods , Qualitative Research , Alcoholism/psychologyABSTRACT
El dolor torácico no cardiogénico se define como episodios recurrentes de dolor subesternal en pacientes que no poseen una causa cardiológica luego de un estudio acabado. Representa un dilema clínico dado que el dolor frecuentemente es indistinguible de un dolor de origen coronario llevando a extensas y costosas evaluaciones. Diversos mecanismos han sido implicados en su origen, entre ellos el reflujo gastroesofágico, alteraciones de la motilidad, hipersensibilidad visceral y comorbilidad psicológica. Junto a ello, diversos test diagnósticos están disponibles en la práctica clínica para identificar el origen del dolor, incluyendo la pH metría de 24 horas, estudios de motilidad esofágica, endoscopía digestiva alta, test de probación y tratamientos de prueba. Su tratamiento idealmente debiera estar enfocado a corregir el mecanismo subyacente y aliviar los síntomas. Inhibidores de la bomba de protones, antidepresivos, relajantes de la musculatura lisa y terapia cognitiva conductual aparecen como medidas terapéuticas de utilidad.
Noncardiac chest pain is defined by recurrent episodes of subesternal chest pain in patients lacking a cardiac cause after a comprehensive evaluation. It is a diagnostic dilemma, chest pain is often indistinguishable from cardiac cause leading to extensive and expensive evaluations. Pathophysiologically, gastroesophageal reflux disease, esophageal dismotility, esophageal hypersensitivity, and psychological comorbidities have been implicated. A variety of diagnostic tests are available in the clinical practice to identify the origin of pain, including ambulatory pH testing, esophageal motility, upper endoscopy, provocative testing and even therapeutic trails. Ideally treatment should be aimed at correcting the underlying mechanism and relieving symptoms. Proton pumps inhibitors, antidepressants, smooth muscle relaxants and cognitive behavorial therapy appear to be useful for the treatment of these patients.
Subject(s)
Humans , Chest Pain/diagnosis , Chest Pain/etiology , Esophageal Motility Disorders/complications , Esophageal Motility Disorders/therapy , Gastroesophageal Reflux/complications , Endoscopy, Digestive System , Diagnosis, Dual (Psychiatry)/psychology , Proton Pump Inhibitors , Hydrogen-Ion Concentration , ManometryABSTRACT
La patología dual es una problemática en la que se observa la coexistencia de un trastorno psiquiátrico y el consumo de sustancias psicoactivas, simultáneamente. Es de difícil diagnóstico y tratamiento. Se observa en los estados depresivos, los trastornos de ansiedad, la esquizofrenia, el trastorno bipolar y los trastornos de conducta. El abordaje debe ser integral e incluir tratamiento psicofarmacológico, psicoterapéutico cognitivo-conductual, psicoterapia grupal y orientación a la familia, asimismo, lograr un compromiso del paciente, los familiares y los amigos en el cumplimiento estricto del tratamiento. El tratamiento puede realizarse en forma ambulatoria, en hospital de día, con internación breve para la desintoxicación o en comunidades terapéuticas, la elección dependerá del tipo de patología psiquiátrica y del nivel bajo, medio o alto de consumo de sustancias concomitante.
Dual pathology is a problem in which a psychiatric disorder and the consumption of psychoactive substances coexist at the same time. It is difficult to diagnose and to treat. This pathology is observed in depressive states, anxiety disorders, shizophrenia, bipolar disorder and behavior disorders. Its approach should be integral and include psychopharmacological, psychotherapeutic, cognitive-behavioral treatment, group psychotherapy and family guidance, and it should achieve commitment on the part of the patient, relatives and friends, in the strict compliance of such treatment. Treatment can be performed externally, at a day hospital, through brief hospitalization for desintoxication or in therapeutic communities, the choice will depend on the type of psychiatric pathology and on the low, medium or high concomitant level of consumption of substances.