Psychotic disorders in the diagnostic stability of a Portuguese ward - Diagnostic retrospective analysis / Trastornos psicóticos en la estabilidad diagnóstica de un barrio portugués - Análisis retrospectivo diagnóstico

ABSTRACT Objectives: Psychiatric diagnosis is based on clinical manifestations, resulting from patients' internal state, their life situation, the evolution of their condition and the response to our interventions. There are currently few objective data which help to establish the diagnosis which is why this is based on diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines entities by their diagnostic stability, however there are several causes of variability as categorised by Spritzer et al. (1987): subjects variance (changing in patients), occasions variance (different episodes), information variance (new information) and observation variance (different interpretations). This paper aims to determine the diagnostic stability of patients with Psychotic Disorders among patients readmitted to our Psychiatric Unit. Methods: Retrospective analysis of the diagnoses of patients with Psychotic Disorders who had been readmitted to our unit. We analysed data from the last 12 years - 5422 admission episodes with 507 patients with a relevant diagnosis in this period. Results: Psychiatric diagnosis does evolve over time, nevertheless some diagnostic groups show a relatively significant stability over time - Bipolar Disorder and Schizophrenia with 69% and 77% stability, respectively. Diagnosis such as Depressive Psychosis and Drug-induced psychosis show a significantly lower stability (8% and 21%, respectively). Conclusions: Knowing our own reality can make us aware that a cross-sectional view of patients can be insufficient and only time can determine a clear diagnosis. This study may help us to understand how psychotic disorders evolve.

RESUMEN Objetivos: El diagnóstico psiquiátrico se basa en las manifestaciones clínicas, consecuencia del estado interno del paciente, de su situación vivencial, de la evolución de su enfermedad y de la respuesta a nuestras intervenciones. Actualmente, existen pocos datos objetivos que ayudan a establecer el diagnóstico por lo que éste se basa en criterios diagnósticos como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM). La DSM define diagnósticos por su estabilidad, sin embargo, existen varias causas de variabilidad caracterizadas por Spritzer et al. (1987): variación en el sujeto (cambio en el paciente), variación ocasional (diferentes episodios), variación en la información (nueva información) y variación en la observación (diferentes interpretaciones). Este trabajo pretende evaluar la estabilidad diagnóstica de los pacientes con Trastornos Psicóticos reinternados en nuestro internamiento psiquiátrico. Métodos: Análisis retrospectivo de los diagnósticos de los pacientes con Trastornos Psicóticos con reingresos en nuestro servicio. Se analizaron datos de los últimos 12 anos - 5422 admisiones con 507 pacientes con diagnóstico de interés en ese período. Resultados: El diagnóstico psiquiátrico se altera con el tiempo, sin embargo, algunos grupos revelan una mayor estabilidad a lo largo del tiempo - Perturbación Afectiva Bipolar y Esquizofrenia con el 69% y el 77%, respectivamente. Los diagnósticos como la depresión psicótica y la psicosis tóxica, revelan una estabilidad significativamente menor (8% y 21% respectivamente). Conclusiones: Conocer nuestra realidad nos hace conscientes de que una mirada transversal a los enfermos puede ser insuficiente y sólo el tiempo puede determinar un diagnóstico claro. Este trabajo puede ayudarnos a entender cómo evolucionan las enfermedades psicóticas.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents / Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: crianças e adolescentes

ABSTRACT The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

RESUMO O Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: crianças e adolescentes foi elaborado com a participação de nutricionistas, médicos nutrólogos e médicos hematologistas pediátricos de 10 centros brasileiros que são referência em transplante de células-tronco hematopoiéticas. O objetivo foi salientar a importância do estado nutricional e da composição corporal durante o tratamento, bem como as principais características relacionadas à avaliação nutricional do paciente. As intenções, ao se estabelecer o consenso, foram aprimorar e padronizar a terapia nutricional durante o transplante de células-tronco hematopoiéticas. O consenso foi aprovado pela Sociedade Brasileira de Transplante de Médula Óssea.