Experiencias luego del diagnóstico de demencia: aportes desde la perspectiva de los pacientes / Experiences following the diagnosis of dementia: contributions from the patients' perspective

INTRODUCCIÓN: Comunicar el diagnóstico de demencia es un importante desafío médico, por lo que tiende a ser una práctica poco frecuente no obstante el derecho de los pacientes a ser informados de sus diagnósticos. En Chile, existe investigación que describe las implicancias del diagnóstico de demencia en el sistema familiar y cuidadores informales, pero no se ha abordado esta experiencia desde la perspectiva de los pacientes, por lo que sus implicancias son también desconocidas. OBJETIVO: Describir las experiencias luego del diagnóstico de demencia desde la perspectiva de los pacientes. MATERIAL Y MÉTODO: Estudio cualitativo. Se realizó entrevistas a 11 personas, 6 hombres y 5 mujeres, con edad promedio 70 años (64-82), quienes recibieron el diagnóstico de demencia tipo Alzheimer en etapa leve y fueron informados de su diagnóstico por Neuróloga tratante. Las entrevistas transcritas fueron analizadas mediante análisis de contenido con codificación abierta, usando software NVivo 11.0 Pro. RESULTADOS: Las siguientes cinco categorías temáticas genéricas fueron producidas a partir del análisis de las entrevistas, describiendo la experiencia de los pacientes luego de recibir el diagnóstico: rol capacitante de la familia, ser informado/a sobre la demencia, autoestigma, ambivalencia en contar el diagnóstico, y estrategias de adaptación al diagnóstico. CONCLUSIONES: Los resultados de este estudio informan de necesidades específicas de los pacientes luego de ser informados del diagnóstico de demencia tipo Alzheimer. Se presentan consideraciones para el abordaje local del diagnóstico por equipos de salud y apoyo social que enfrentan el desafío de planificar la atención de personas con trastornos cognitivos y sus familias.

INTRODUCTION: Communicating the diagnosis of dementia is a medical challenge. Despite the the patients' right to be informed of their diagnosis, diagnostic disclosure is globally underperformed. In Chile, previous research has addressed the implications of diagnosis from the perspectives of families and family caregivers, but the perspectives and implications from the patients' perspectives remain unknown. OBJECTIVE: To describe the experiences of patients following the diagnosis of dementia. MATERIAL AND METHODS: Qualitative study. Interviews were performed to 11 individuals who had received the diagnosis of early-stage dementia of the Alzheimer's type, 5 women and 6 men, average age 70 years old (64-82). Interviews transcripts were analyzed using content analysis with open coding, using software NVivo 11.0 Pro. RESULTS: The following five generic categories were produced from the interpretation of interviews to describe the experience of patients after being informed of a diagnosis of dementia: the enabling role of families, being informed about dementia, self-stigma, ambivalence on sharing the diagnosis, and coping strategies. CONCLUSIONS: Findings report specific unmet needs of patients who have been communicated of the diagnosis of dementia of the Alzheimer's type. Suggestions are presented to inform local health care and social support teams that face the challenge of developing interventions to support people with dementia and their families.

Diferencias individuales en dietantes crónicos: Influencia de los sistemas motivacionales en la alimentación / Differences among chronic restrained eaters: the influence of motivational systems

Background: Restrained eaters (RE) are individuals who restrain their food intake on a regular basis as they are frightened to gain weight. However, they tend to overeat under conditions of anxiety. It has been shown that RE possess a behavioral inhibition system that is more active in tonic terms, which would partially explain their affective vulnerability. Even so, the influence of variations in the activation levels of the emotional systems on the eating behavior of a RE is still unknown. Our hypothesis is that variations of such systems will give place to two types of RE: a successful or a non-successful one. Aim: To assess the influence of variations on the activation of motivational systems in food intake of RE. Materials and methods: As part of a factorial experimental design, 105 undergraduate university students were part of an experimental test for inducting food intake. Then they reported their levels of dietary restraint and their emotional behavioral preferences. Results: Differences in the activation of motivational systems were significantly related to differences in food intake (F= 7.210; p= 0.001). Additionally, food intake for those RE with a predominant inhibition system tended to be higher than for those with a more active approach system, though the latter did not reach a significant difference (F=0.718; p=0.399). Conclusions: Although more investigations are required, our data suggest that the success of retaining the diet among the RE would depend on their profile of affective reactivity (affective style). There are putative implications for research on anorexia and obesity.

Modelos neurocognitivos en la esquizofrenia: rol del córtex prefrontal / Neurocognitive models of schizophrenia: the prefrontal cortex role

Los modelos neurocognitivos han dado lugar a un importante avance en la comprensión de diversos desórdenes mentales tales como la esquizofrenia (EQZ). En ese contexto, la disfunción del córtex prefrontal (CPF) es un hallazgo central para explicar su sintomatología. Se ha observado que los niveles anormales de activación de la CPF, así como disfunciones en la conectividad con otras estructuras cerebrales, juegan un importante rol en la delimitación de la enfermedad. Material y Métodos: A través de una revisión teórica, empírica y clínica se describirán cinco aproximaciones neurocognitivas de la esquizofrenia. Conclusiones: Aunque la etiología de la EQZ es probablemente múltiple, un desorden de la interconectividad neuronal, y especialmente de la CPF explican un amplio espectro de su sintomatología.

Introduction: Neurocognitive models gave place to an important improvement in our understanding of several mental disorders such as schizophrenia. In this context, Prefrontal cortex (PFC) dysfunction is an essential variable for its symptomatology account. It has been observed that abnormal level of PFC activation, as well as connectivity dysfunctions with other cerebral structures, play a central role in the delimitation of the disease. Materials and Methods: Through a theoretical, empirical, and clinical review, five neurocognitive approach of schizophrenia will be described. Conclusion: Although schizophrenia etiology is probably multiple, neural interconnectivity disorders and specially those related to PFC, explain a broad range of its symptoms.

Enfermedad de Alzheimer: Actualización en terapia farmacológica / An update on the pharmacological treatment of Alzheimer disease

Dementia in general, especially Alzheimer disease and vascular dementia, are diseases of high prevalence with severe socio-economic consequences in all countries. In recent years, due to the obtention of new pharmaceutical products acting on different brain neurotransmitters, there has been important changes in the therapy of these diseases. Although these drugs do not stop disease progression, there is consistent evidence of their usefulness in cognitive, behavioral and functional domains and of their pharmaco-economical justification. This article reviews the main drugs available for Alzheimer disease and some future therapeutic perspectives.

Estudio de eficiencia diagnóstica del DSM-III-R y de la CIE-10 en el trastorno límite de personalidad / Diagnostic efficiency study of DSM-III-R and ICD-10 for borderline personality disorder

Se analizaron 71 historias clínicas de pacientes psiquiátricos ambulatorios con trastornos de personalidad y se les aplicó los criterios diagnósticos de DSM-III-R para trastorno límite de personalidad y de la CIE-10 para trastorno de inestabilidad emocional de la personalidad de tipos límite e impulsivo. El tipo límite de la CIE-10 fue más restrictivo que el trastorno límite del DSM-III-R. El tipo impulsivo de la CIE-10 se superpuso ampliamente con el trastorno límite del DSM-III-R. De los ocho criterios diagnósticos de DSM-III-R, el criterio 5§ (amenazas suicidas y conducta automutilante) tuvo la mayor especificidad, y el criterio 3§ (inestabilidad afectiva) la mayor sensibilidad. Se discute la necesidad de otorgar un mayor valor para el diagnóstico a esos criterios