Importancia de las co-morbilidades en la insuficiencia cardiaca / Importance of the co morbidities in the heart failure

La insuficiencia cardíaca afecta aproximadamente a 5.1 millones de adultos en los Estados Unidos de América, con expectativas de alcanzar a casi 8 millones de adultos para 2030. Los pacientes portadores de insuficiencia cardiaca están en mayor riesgo de sufrir una mayor morbilidad y mortalidad que la población en general; además, existen co-morbilidades que pueden complicar el cuidado de estos pacientes. La diabetes mellitus, el dolor crónico y la depresión son diagnósticos que muy a menudo coexisten con la insuficiencia cardiaca. Los medicamentos con que normalmente se tratan estas co-morbilidades pueden inducir o empeorar los síntomas de la insuficiencia cardiaca, así que determinar la terapia apropiada es de vital importancia. Los médicos deben entender la relación que existe entre estas medicaciones y la insuficiencia cardiaca para mejorar la asistencia, aumentar la seguridad del paciente y reducir la morbilidad y mortalidad. Este trabajo analiza la asociación entre ciertos medicamentos usados para el tratamiento de estas co-morbilidades y su relación con la insuficiencia cardiaca. El propósito de este artículo es proporcionar una orientación farmacológica donde las opciones de tratamiento tengan especial consideración con un aumento de la supervisión médica, para evitar la descompensación o aparición de la insuficiencia cardiaca en los pacientes portadores de diabetes mellitus, dolor crónico y depresión (AU).

Heart failure affects approximately 5.1 million adults in the USA, with expectations of a rise to nearly 8 million adults by 2030. Patients with heart failure are at increased risk for morbidity/mortality, and co-morbidities can further complicate care for these patients. Diabetes mellitus, chronic pain, and depression are diagnoses that often coexist with heart failure. Medications commonly used to treat these co-morbidities may induce or worsen heart failure symptoms, so determining appropriate drug therapy is important. Healthcare providers must understand the relationship between these medications and heart failure in order to improve prescribing practices to increase patient safety and reduce morbidity and mortality. This manuscript discusses the association between certain medications used to treat the aforementioned diagnoses and their relationship to heart failure. The purpose of this article is to provide guidance on which pharmacologic options require special consideration, increased monitoring, or complete avoidance in heart failure patients with diabetes mellitus, chronic pain, and/or depression (AU).

Sintomas Depressivos em Pacientes do Ambulatório de Neurologia do Hospital Universitário Lauro Wanderley / Depressive Symptoms among patients admitted to the Outpatient Neurology Service at Lauro Wanderley University Hospital

Objetivo: Avaliar prevalência e intensidade de sintomas depressivos em pacientes admitidos no ambulatório de neurologia do HULW-UFPB por diversas outras queixas, analisando o perfil sociodemográfico e epidemiológico dessa população. Material e Métodos: Inquérito realizado de março de 2013 a agosto de 2015, com aplicação do Inventário de Depressão de Beck-II em 235 pacientes entre 17 e 59 anos de idade. A pesquisa realizada foi do tipo transversal, qualitativa e quantitativa. A análise dos dados foi realizada por meio de estatística inferencial univariada e bivariada. Resultados: O sexo feminino foi o mais frequente, 70% dos entrevistados; com média de 40,1 anos; casadas e com segundo grau completo. 48% exercem alguma atividade laboral, com jornada de dois turnos de trabalho (22,1%). Foram observados sinais de depressão mínima ou ausente em 51,9%; sintomas leves, em 23,4%; moderados em 15,7% e severos em 8,9% dos pacientes avaliados. Conclusão: Os sintomas depressivos foram cerca de 5 a 9 vezes mais prevalentes que os referidos na literatura, com uma porcentagem de sinais depressivos severos alarmantes. Esses achados configuram um importante problema de saúde pública, alertando quanto à investigação de queixas depressivas subestimadas por essa população.(AU)

Objective: To evaluate the prevalence and severity of depressive symptoms among patients admitted to the HULWUFPB outpatient neurology service due to varied complaints. The sociodemographic and epidemiological profile of this population was further evaluated. Material and Methods: This was a cross-sectional, qualitative and quantitative study carried out from March 2013 to August 2015, with the application of the Beck-II Depression Inventory in 235 patients randomly selected between 17 and 59 years of age. The data were analyzed using univariate and bivariate inferential statistics. Results: There was a prevalence of women (70% of respondents), with an average of 40.1 years, married, and with a high school education; 48% had some work activity, with a work journey of two shifts (22.1%). Signs of minimal or absent depression were observed in 51.9% of the cases; while mild, moderate and severe symptoms were found in 23.4%, 15.7%, and 8.9% of the patients evaluated. Conclusion: Depressive symptoms reported in this study were found to be about 5 to 9 times more prevalent than those reported in the literature, with an alarming percentage of severe depressive symptoms. These findings indicate the presence of an important public health problem and should further guide the investigation of the underestimated depressive complaints in this population.(AU)

Desempeño neurocognitivo de pacientes con trastorno afectivo bipolar tipo I en eutimia con y sin antecedente de psicosis de un programa de intervención multimodal: PRISMA / Neurocognitive Performance in Euthymic Bipolar I Patients With and Without History of Psychosis From a Multimodal Intervention Program: PRISMA

Introducción: Los pacientes con trastorno afectivo bipolar tipo I (TBI) tienen alta prevalencia de síntomas psicóticos, los cuales se han relacionado con un mayor deterioro cognitivo. Sin embargo, en la literatura aún no hay total claridad sobre esto. Objetivo: Determinar si la historia de síntomas psicóticos en una muestra colombiana con TBI se asocia con mayor deterioro cognitivo. Métodos: Se llevó a cabo un estudio de casos y controles, en el que se incluyó a pacientes con TBI que pertenecían al estudio mayor PRISMA (Programa de Intervención Multimodal en Pacientes con Trastorno Afectivo Bipolar y Esquizofrenia). De 203 sujetos elegibles, se incluyó a 123, 71 con historia de psicosis y 52 sin este antecedente. Se caracterizó la función cognitiva de los participantes con pruebas neuropsicológicas para evaluar coeficiente intelectual, atención, función ejecutiva, fluidez verbal, memoria auditiva y visual y localización espacial, y se comparó el desempeño neurocognitivo entre los subgrupos de pacientes con y sin psicosis. Resultados: No se encontraron diferencias en el desempeño en la mayoría de las pruebas neurocognitivas evaluadas entre los grupos al ajustar por edad, escolaridad, sexo, duración de la enfermedad en años, número de episodios y utilización de benzodiacepinas. Sin embargo, se encontró diferencia en el FAS semántico (p = 0,01), con mejor desempeño en el grupo con antecedente de psicosis. Conclusiones: Los resultados indican que no hay diferencias significativas en el desempeño neurocognitivo entre los pacientes con TBI en eutimia con y sin antecedente de psicosis.

Background: Patients with bipolar disorder type I (BDI) have an increased prevalence of psychotic symptoms, and these have been associated with higher cognitive impairment; however the issue has not been settled with the available evidence. Objective: To determine if the history of psychotic symptoms in a Colombian sample with BDI is associated with greater cognitive impairment. Methods: A case-control study was performed that included patients with BDI from the l PRISMA study. Of the 203 eligible subjects, 123 participantswere included; 71 had a history of psychosis, and 52 did not. Cognitive function was characterised by neuropsychological tests that assessed intellectual coefficient, attention, executive function, verbal fluency, auditory and visual memory, and spatial location. Results: No differences were found in most of the neuropsychological test results between the groups after adjusting for age, education, sex, duration of the disease, number of episodes, and use of benzodiazepines; however, there was differences in semantic FAS (P=.01), with a better performance in the group with a prior history of psychosis. Conclusions: The results suggest that there are no significant differences in the cognitive performance between patients with BDI in euthymic stage, with and without history of psychosis.

Reliability and Validity of the Korean Version of the Perinatal Post-Traumatic Stress Disorder Questionnaire

PURPOSE: The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was designed to measure post-traumatic symptoms related to childbirth and symptoms during postnatal period. The purpose of this study was to develop a translated Korean version of the PPQ and to evaluate reliability and validity of the Korean PPQ. METHODS: Participants were 196 mothers at one to 18 months after giving childbirth and data were collected through e-mails. The PPQ was translated into Korean using translation guideline from World Health Organization. For this study Cronbach's alpha and split-half reliability were used to evaluate the reliability of the PPQ. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and known-group validity were conducted to examine construct validity. Correlations of the PPQ with Impact of Event Scale (IES), Beck Depression Inventory II (BDI-II), and Beck Anxiety Inventory (BAI) were used to test a criterion validity of the PPQ. RESULTS: Cronbach's alpha and Spearman-Brown split-half correlation coefficient were 0.91 and 0.77, respectively. EFA identified a 3-factor solution including arousal, avoidance, and intrusion factors and CFA revealed the strongest support for the 3-factor model. The correlations of the PPQ with IES, BDI-II, and BAI were .99, .60, and .72, respectively, pointing to criterion validity of a high level. CONCLUSION: The Korean version PPQ is a useful tool for screening and assessing mothers' experiencing emotional distress related to child birth and during the postnatal period. The PPQ also reflects Post Traumatic Stress Disorder's diagnostic standards well.

The Effects of Urban Forest-walking Program on Health Promotion Behavior, Physical Health, Depression, and Quality of Life: A Randomized Controlled Trial of Office-workers

PURPOSE: This study was performed to determine the physical and psychological effects of an urban forest-walking program for office workers. For many workers, sedentary lifestyles can lead to low levels of physical activity causing various health problems despite an increased interest in health promotion. METHODS: Fifty four office workers participated in this study. They were assigned to two groups (experimental group and control group) in random order and the experimental group performed 5 weeks of walking exercise based on Information-Motivation-Behavioral skills Model. The data were collected from October to November 2014. SPSS 21.0 was used for the statistical analysis. RESULTS: The results showed that the urban forest walking program had positive effects on the physical activity level (U=65.00, p <.001), health promotion behavior (t= - 2.20, p =.033), and quality of life (t= - 2.42, p =.020). However, there were no statistical differences in depression, waist size, body mass index, blood pressure, or bone density between the groups. CONCLUSION: The current findings of the study suggest the forest-walking program may have positive effects on improving physical activity, health promotion behavior, and quality of life. The program can be used as an effective and efficient strategy for physical and psychological health promotion for office workers.

Cortical correlates of affective syndrome in dementia due to Alzheimer’s disease / Correlatos corticais da síndrome afetiva na demência da doença de Alzheimer

Neuropsychiatric symptoms in Alzheimer’s disease (AD) are prevalent, however their relationship with patterns of cortical atrophy is not fully known. Objectives To compare cortical atrophy’s patterns between AD patients and healthy controls; to verify correlations between neuropsychiatric syndromes and cortical atrophy. Method 33 AD patients were examined by Neuropsychiatric Inventory (NPI). Patients and 29 controls underwent a 3T MRI scanning. We considered four NPI syndromes: affective, apathy, hyperactivity and psychosis. Correlations between structural imaging and neuropsychiatric scores were performed by Freesurfer. Results were significant with a p-value < 0.05, corrected for multiple comparisons. Results Patients exhibited atrophy in entorhinal cortices, left inferior and middle temporal gyri, and precuneus bilaterally. There was correlation between affective syndrome and cortical thickness in right frontal structures, insula and temporal pole. Conclusion Cortical thickness measures revealed atrophy in mild AD. Depression and anxiety symptoms were associated with atrophy of right frontal, temporal and insular cortices. .

Os sintomas neuropsiquiátricos na doença de Alzheimer (DA) são prevalentes, porém suas relações com padrões de atrofia cortical não são totalmente compreendidas. Objetivos Comparar padrões de atrofia cortical entre DA e controles; verificar se há correlações entre sintomas neuropsiquiátricos e atrofia cortical. Método 33 pacientes com DA foram examinados pelo Inventário Neuropsiquiátrico. Os pacientes e 29 controles foram submetidos à RNM. Consideramos quatro síndromes: afetiva, apatia, hiperatividade e psicose. Correlações entre imagens estruturais e os scores foram feitas pelo Freesurfer. Os resultados foram significantes com um valor de p < 0,05, corrigido para múltiplas comparações. Resultados Pacientes exibiram atrofia nos córtices entorrinais, giros temporal médio e inferior esquerdos, e precuneo bilateralmente. Houve correlação entre síndrome afetiva e espessura cortical em estruturais frontais direitas, ínsula e polo temporal. Conclusão Medidas de espessura cortical revelaram atrofia na DA. Sintomas de depressão e ansiedade foram associados à atrofia dos córtices frontal direito, temporal e ínsula. .

Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women

PURPOSE: This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects. METHODS: A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL. RESULTS: Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001). CONCLUSION: Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.

Punarnavine, an alkaloid isolated from ethanolic extract of Boerhaavia diffusa Linn. reverses depression-like behaviour in mice subjected to chronic unpredictable mild stress.

Punarnavine (20 and 40 mg/kg) and fluoxetine (20 mg/kg) per se administered orally for 14 successive days significantly decreased immobility periods of both unstressed and stressed mice in forced swim test. These drugs also significantly decreased sucrose preference in both stressed and unstressed mice as compared to their respective controls, indicating significant antidepressant-like activity. The drugs did not show any significant effect on locomotor activity of mice. The alkaloid also significantly decreased monoamine oxidase (MAO-A) activity, malondialdehyde levels in both unstressed and stressed mice; and significantly reversed the stress-induced decrease in reduced glutathione and catalase activity. It also significantly attenuated the stress-induced increase in plasma nitrite and corticosterone levels. Thus, punarnavine showed antidepressant-like activity in unstressed and stressed mice probably through inhibition of brain MAO-A activity, decrease in plasma nitrite levels and due to its antioxidant activity. In addition, punarnavine also showed antidepressant-like activity in stressed mice possibly through decrease in plasma corticosterone levels.

Behavioural and neuroendocrine effects of aqueous extract of Boerhaavia diffusa Linn. in mice using tail suspension and forced swim tests – A preliminary study.

The present study was done to evaluate the effect of aqueous extract of B. diffusa on depression in mice using behavioral models such as tail suspension test (TST) and forced swim test (FST). The extract (50, 100 and 200 mg/kg, po) was administered for 14 successive days to Swiss young albino mice. On 14th day, 60 min after administration, mice were subjected to TST and FST. The administration of aqueous extract of B. diffusa (50, 100 and 200 mg/kg, po) significantly decreased immobility period in both TST and FST, indicating significant antidepressant-like activity. The lowest dose (50 mg/kg) of the extract decreased the immobility period most significantly in FST, showing most potent antidepressant-like action. The efficacy of the extract (50 mg/kg) was comparable to fluoxetine (20 mg/kg). The extract did not show any significant effect on locomotor activity. The extract showed significant monoamine oxidase -A inhibitory activity. There was no significant effect of the extract on plasma corticosterone levels. Prazosin (α1-adrenoceptor antagonist), sulpiride (selective D2-receptor antagonist), baclofen (GABAB agonist), and p-CPA (tryptophan hydroxylase inhibitor) significantly attenuated the extract-induced antidepressant-like effect, when tested in TST. The extract might produce antidepressant-like effect by interaction with α1-adrenoceptors, dopamine-D2 receptors, serotonergic, and GABAB receptors. Thus, aqueous extract of B. diffusa showed significant antidepressant-like activity in mice probably through involvement of monoaminergic and GABAergic systems.

Depressão e bem-estar em individuo idoso com úlcera venosa / Depression and wellness in elderly patients with venous ulcers

INTRODUÇÃO: A úlcera venosa assume grande importância na vida dos pacientes, pois a ocorrência de deformidade causada por este tipo de ferida pode gerar consequência advensas as causais inclui distúrbios psicossocial. Avaliar bem-estar subjetivo e depressão em pessoas idosas com úlcera venosa. MÉTODOS: Estudo clínico, primário, descritivo, analítico e multicêntrico. Participaram 55 indivíduos idosos com úlcera venosa, atendidos no Núcleo de Assistência e Ensino em Enfermagem do Hospital das Clínicas Samuel Libânio, no Ambulatório São João da Universidade do Vale do Sapucaí e nas Unidades Básicas de Saúde da cidade de Pouso Alegre. Foram incluídos pacientes com idade acima de 60 anos, ambos os sexos, índice tornozelo/braço entre 0,8 e 1,0. Os dados foram coletados no período compreendido entre dezembro de 2012 a maio de 2013, após aprovação Comitê de Ética em Pesquisa da Faculdade de Ciências da Saúde Dr. José Antônio Garcia Coutinho sob parecer 3.090.46. Os instrumentos utilizados foram: dado sócio demográfico, Escala de Depressão Geriátrica em versão reduzida de Yesavage e Escala de Bem-estar Subjetivo. Para análise estatística foi realizado os testes: Qui-Quadrado, t de Student. RESULTADOS: A Maioria, dos indivíduos, era do sexo feminino, 22(40%) tinham entre 60 e 65 anos, 27(49,10%) entre 66 e 70 anos, tinham de 1 a 2 salários mínimos e viúvo. Foram identificados 23 (41,82%) idosos com úlcera venosa nível da depressão leve ou moderada, e 26(47,28%) depressão severa. Relacionado à Escala Bem-estar Subjetivo a maioria dos participantes do estudo apresentaram alteração nos domínios: 43(78,20%), satisfação com a vida, e 40 (72,70%). CONCLUSÃO: Através deste estudo concluímos que os indivíduos que participaram da pesquisa apresentam depressão entre leve a severa e queda na qualidade de vida. Sentem-se infelizes, e insatisfeitos com a vida.

INTRODUCTION: Venous ulcers play an important role in patients' lives, as the deformities caused by this type of wound can lead to various adverse effects, including psychosocial disorders. OBJECTIVE: To evaluate subjective wellness and depression in elderly patients with venous ulcers. METHODS: This is a primary, descriptive, analytical, and multicenter clinical study involving 55 elderly patients with venous ulcers, undergoing treatment at the Nursing Assistance and Training Center of Clínicas Samuel Libânio Hospital, at the São João Outpatient Clinic of the University of Vale do Sapucaí and at the Primary Healthcare Units of Pouso Alegre city. The study included male and female patients, aged 360 years, and with an ankle-brachial index between 0.8 and 1.0. Data were collected between December 2012 and May 2013, after approval by the research ethics committee of the Faculty of Health Sciences Dr. José Antônio Garcia Coutinho, under recommendation 3.090.46. Sociodemographic data, Yesevage's reduced version of the Geriatric Depression Scale, and the Subjective Wellness Scale were used. Statistical analyses were carried out with the chi-square and Student's t tests. RESULTS: Most of the study participants were female; 22 (40%) of the patients were aged 60-65 years and 27 (49.10%) were aged 66-70 years. Their income ranged between 1 and 2 minimum wages, and most of them are widowers. Twenty-three (41.82%) elderly patients with venous ulcers had mild to moderate depression levels, and 26 (47.28%) showed severe depression. In the Subjective Wellness Scale, most study participants revealed changes in items 43 (satisfaction with life; 78.20%) and 40 (72.70%). CONCLUSION: This study revealed that study participants had mild to severe depression and decreased quality of life.

Nutritional Status and Risk Factors for Malnutrition in Low-income Urban Elders

PURPOSE: The purpose of this study was to evaluate the nutritional status of low-income urban elders by diversified ways, and to analyze the risk factors for malnutrition. METHODS: The participants in this study were 183 low-income elders registered at a visiting healthcare facility in a public health center. Data were collected using anthropometric measurements, and a questionnaire survey. For data analysis, descriptive statistics, chi2-test, t-test, Fisher's exact test, multiple logistic regression analysis were performed using SPSS 20.0. RESULTS: Regarding the nutritional status of low-income elders as measured by the Mini Nutritional Assessment (MNA), 10.4% of the elders were classified as malnourished; 57.4% as at high risk for malnutrition; and 32.2% as having normal nutrition levels. The main factors affecting malnutrition for low-income elders were loss of appetite (OR=3.34, 95% CI: 1.16~9.56) and difficulties in meal preparation (OR=2.35, 95% CI: 1.13~4.88). CONCLUSION: In order to effectively improve nutrition in low-income urban elders, it is necessary to develop individual intervention strategies to manage factors that increase the risk of malnutrition and to use systematic approach strategies in local communities in terms of a nutrition support system.

Effectiveness of the Military Mental Health Promotion Program

PURPOSE: This study was done to evaluate the Military Mental Health Promotion Program. The program was an email based cognitive behavioral intervention. METHODS: The research design was a quasi-experimental study with a non-equivalent control group pretest-posttest design. Participants were 32 soldiers who agreed to participate in the program. Data were collected at three different times from January 2012 to March 2012; pre-test, post-test, and a one-month follow-up test. The data were statistically analyzed using SPSS 18.0. The effectiveness of the program was tested by repeated measures ANOVA. RESULTS: The first hypothesis that the level of depression in the experimental group who participated in the program would decrease compared to the control group was not supported in that the difference in group-time interaction was not statistically significant (F=2.19, p=.121). The second and third hypothesis related to anxiety and self-esteem were supported in group-time interaction, respectively (F=7.41, p=.001, F=11.67, p<.001). CONCLUSION: Results indicate that the program is effective in improving soldiers' mental health status in areas of anxiety and self-esteem.

El circuito cerebral de la recompensa en los trastornos afectivos / Brain Reward Circuitry in Affective Disorders

Los síntomas conductuales de la depresión son numerosos y variados, cubriendo los dominios emocionales, motivacionales, cognitivos y fisiológicos. Estudios recientes en modelos animales de depresión y en pacientes depresivos utilizando técnicas neuropsicológicas combinadas con imagenología funcional muestran que grandes subgrupos de estos pacientes presentan deficiencias en el procesamiento de las recompensas a los estímulos emocionales positivos, que son nucleares en depresión. La proteína Rac 1, un regulador crítico de la actina del citoesqueleto, se reduce en el NAcc tanto en depresión como en modelos animales de adicción, lo que lleva al crecimiento de espinas dendríticas inmaduras en las MSNs del NAcc y esto es consecuencia de modificaciones epigenéticas selectivas en esta región, del gen que codifica Rac 1, tanto en modelos de estrés en roedores como en humanos depresivos (estudios post-mortem). El gran desarrollo de algunos de los modelos experimentales de depresión que cuentan con evidencias moleculares, sistémicas y conductuales no se han traducido en nuevos medicamentos pero al avanzar en la comprensión patofisiológica del trastorno y sus correlatos neuroimagenológicos, permitirán, junto a las modernas técnicas de investigación, buscar marcadores biológicos de los endofenotipos diferentes que se combinan para generar un trastorno que posee múltiples subtipos que los agrupan en clusters diferentes

The behavioral symptoms of depression are numerous and varied, and encompass the emotional, motivational and physiologic domains. Recent studies in animal models of depression and depressive patients, which used neuropsychological techniques combined with functional imaging, show that large subgroups of these patients display deficiencies in the processing of rewards to positive emotional stimuli, which are nuclear in depression. Rac 1 protein, a critical regulator of cytoskeleton actin, is reduced in the NAcc, both in depression as well as in animal models of addiction, which leads to the growth of immature dendritic spines in the MSNs of the NAcc, and this is the result of selective epigenetic alterations in this region, of the gene that codifies Rac1, both in models of stress in rodents as well as in depressive human beings (post-mortem studies). The great development of some of the experimental models of depression that provide molecular, systemic and behavioral evidences have not translated into new medications, but the progressive pathophysiological understanding of the disorder and its neuroimaging correlates will enable, together with the modern investigations techniques, to search for biological markers of the different endophenotypes that combine to generate a disorder which has multiple subtypes that gather in different clusters

Mecanismos neuronales en el modelo cognitivo de depresión de Beck / Neural Mechanisms in Beck's Cognitive Model of Depression

El modelo cognitivo de la depresión que fuera formulado por Beck hace más de 40 años se fundamentaba en procesamientos sesgados de la atención, memoria y el pensamiento, con rumiación y desvíos hacia los llamados “pensamientos negativos repetitivos”, como jugando roles primarios en el desarrollo y mantenimiento de la depresión. En 2011, el propio Beck y sus colaboradores hacen un resumen de los hallazgos referentes a los mecanismos neurales que subyacen a los aspectos cognitivos de la depresión. Sin embargo, sólo se consideran aquellos aspectos referentes al procesamiento cognitivo sin hacer lo mismo con el procesamiento emocional que es el endofenotipo nuclear del trastorno depresivo y se refleja en la lectura de las emociones por el cerebro emocional y la corteza de la ínsula según el esquema de Damasio actualizado por Craig (14), que deberá tenerse en cuenta como la base fundamental de las terapias cognitivo/conductuales y las cognitivo/emocionales junto al necesario tratamiento farmacológico, adecuadamente complementados en tiempo y forma

The cognitive model of depression, which was formulated by Beck more than 40 years ago, was grounded on biased processings of attention, memory and thought, with rumination and deviations towards the so-called "negative repetitive thoughts", as playing primry roles in the development and maintenance of depression. In 2011, Beck himself, as well as his collaborators, summarized the findings concerning the neural mechanisms underlying the cognitive aspects of depression. However, only those aspects relating to the cognitive processing are considered and not the emotional processing that is the nuclear endophenotype of depressive disorder and is reflected in the reading of emotions by the brain and the insular cortex, according to Damasio's scheme updated by Craig (14), which should be considered the fundamental basis of cognitive/behavioral therapies and cognitive/emotional therapies together with the necessary pharmacological treatment, adequately complimented in due time and forma

Embarazo y depresión / Pregnancy and depression

La situación clínica que representa la coexistencia de un episodio depresivo en el transcurso de un embarazo en la vida de una mujer, reviste una gran complejidad y obliga al psiquiatra a evaluar múltiples variables. La alta prevalencia de depresión en las mujeres y la coincidencia temporal con la edad fértil, hace que dicha eventualidad no sea una rareza, sino más bien un escenario posible y frecuente. En este capítulo se describen las características clínicas de la depresión antenatal, se dan pautas de tratamiento teniendo en consideración los cambios farmacocinéticos del embarazo, se discute el dilema clínico sobre el uso de la medicación psicofarmacológica en la gestación y su posible impacto en el desarrollo obstétrico y en el neonato, y se dimensionan las consecuencias de la patología psiquiátrica no tratada. Se propone un abordaje racional sobre la correcta evaluación de los riesgos de la conducta a adoptar; es decir, la valoración del riesgo de la medicación en el embarazo, el riesgo de no medicar a una embarazada cuando la depresión lo amerita y el impacto de la patología psiquiátrica sobre la mujer, el embarazo en sí y el recién nacido.

The clinical situation representing the co-existence of a depressive episode during the course of a pregnancy in a woman's life is very complex and obliges the Psychiatrist to evaluate multiple variables. The high prevalence of depression among women, and the temporal coincidence with childbearing age makes this eventuality not strange, but rather a possible and frequent scenario. In this chapter, the author describes the clinical characteristics of antenatal depression, provides the treatment guidelines taking into consideration the pharmacokinetic changes of pregnancy, discusses the clinical dilemma on the use of psychopharmacological medication during conception and its possible impact on the obstetric development and the newly born, and measures the consequences of untreated psychiatric pathoogy. The author proposes a rational approach to the correct evaluation of the risks of the behavior to be adopted; that is to say, the assessment of the risk of the medication in pregnancy, the risk of not medicating a pregnant woman when depression calls for it, and the impact of the psychiatric pathology on the woman, the pregnancy itself and the newly born.

Depression and temporal lobe epilepsy represent an epiphenomenon sharing similar neural networks: clinical and brain structural evidences / Depressão e epilepsia de lobo temporal representam um epifenômeno compartilhando redes neurais similares: evidências clínicas e de neuroimagem estrutural

The relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood. The prevalence of psychiatric disorders in persons with epilepsy is high compared to general population. It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis. Temporal lobe epilepsy is a good biological model to understand the common structural basis between depression and epilepsy. Interestingly, mesial temporal lobe epilepsy and depression share a similar neurocircuitry involving: temporal lobes with hippocampus, amygdala and entorhinal and neocortical cortex; the frontal lobes with cingulate gyrus; subcortical structures, such as basal ganglia and thalamus; and the connecting pathways. We provide clinical and brain structural evidences that depression and epilepsy represent an epiphenomenon sharing similar neural networks.

A relação entre depressão e epilepsia é conhecida desde a antiguidade; entretanto, até o momento, não é completamente compreendida. A prevalência de transtornos psiquiátricos nas pessoas com epilepsia é elevada quando comparada à população em geral. A taxa de depressão varia de 20 a 55% nos pacientes com epilepsia refratária, especialmente considerando-se aqueles com epilepsia do lobo temporal causada por esclerose mesial temporal. A epilepsia do lobo temporal é um bom modelo biológico para compreender as bases estruturais comuns entre a epilepsia e a depressão. É relevante ressaltar que a epilepsia do lobo mesial e a depressão apresentam circuitos similares envolvendo: os lobos temporais com o hipocampo, a amigdala, o córtex entorrinal e o neocortex; os lobos frontais com o giro cíngulo; estruturas subcorticais, como os núcleos da base e o tálamo, e suas vias de conexão. Postulamos por meio de evidências clínicas e estruturais que a depressão e a epilepsia representam um epifenômeno com redes neuronais similares.

Leucopenia como hallazgo en pacientes con ansiedad y depresión / Leukopenia as finding in patients with anxiety and depression

La leucopenia establecida según la Organización Mundial de la Salud (O.M.S.) se define con valores de glóbulos blancos <4.000mm³, lo que puede estar representado por diferentes causas, evaluándose en este trabajo la influencia de factores psicosomáticos como la ansiedad y depresión. Se realiza un estudio de campo, de carácter exploratorio, transversal, apoyado en una revisión documental. Se estudiaron 63 pacientes provenientes del servicio de Medicina Interna del Hospital Vargas de Caracas y de la consulta privada del Dr. Herman Wuani, a quienes se les aplicó la escala de Hamilton para depresión y ansiedad; posterior a esto se realizó una hematología completa. Se definieron 3 grupos según los síntomas encontrados en la escala de Hamilton, Grupo 1 con síntomas de ansiedad, Grupo 2 con síntomas de depresión y Grupo 3 sin alteraciones psicosomáticas; todo esto aplicado a pacientes de etnia blanca y mestiza, perteneciendo el 28,57% (n=18) al sexo masculino y 71,42% (n=45) al sexo femenino. La media de edad de los pacientes fue 29, 14 años en el total de la muestra. De los pacientes ansiosos, 20 resultaron tener leucopenia (p<0,00000001), el resto de pacientes tenían glóbulos blancos >4.000mm³ (6 ansiosos, 19 deprimidos y 18 sin alteraciones psicosomáticas). Los pacientes con valores de linfocitos < 40%: 1 ansioso, 9 deprimidos y 12 sin alteraciones psicosomáticas; aquellos con linfocitos > 40% eran: 25 ansiosos, 10 deprimidos y 6 sin alteraciones psicosomáticas (p<0,000039). El descenso de los glóbulos blancos fue estadísticamente significativo en el grupo de pacientes con ansiedad...

Leukopenia as established by the World Health Organization (W.H.O.) is defined when the leukocyte count is below 4.000/mm³, which can have different causes; in this study the influence of psychosomatic factors such as anxiety and depression were evaluated. This was an exploratory field study, supported by a literature review. We studied 63 patients from the Internal Medicine service of the Hospital Vargas de Caracas and the private practice of Dr. Herman Wuani. The Hamilton Rating Scale for depression and anxiety were administered after a full hematology test was done. According to the symptoms found and after administering the scale, there were 3 groups: group 1. anxiety symptoms, group 2. depression symptoms and group 3 unaltered. The distribution for gender 28.57% (n=18) male and 71.42% (n=45) female. The mean age of the subjects 29.14 years. In anxious patients, 20 were found to have leukopenia (p<0.00000001), the remaining patients had > 4.000mm³ (6 anxious, 19 depressed and 18 not psychosomatic). Patients with lymphocytes < 40%: 1 anxious, 9 depressed and 12 without psychosomatic disorders, Patients with Lymphocytes > 40%: 25 anxious, 10 depressed and 6 without psychosomatic disorders (p<0.000039). The decrease in white blood cells was statistically significant in the group with anxiety...

Proceso de atención de enfermería en pacientes deprimidos / Nursing care process in depressed patients

El objetivo de este artículo es dar a conocer un proceso de atención a pacientes con depresión, aplicando el modelo de atención de Dorothea E. Orem, el cual aborda las medidas preventivas más importantes que debe conocer el paciente y la familia, como son: dieta, ejercicio y conocimiento del padecimiento. El proceso se presenta en forma de cuadros para facilitar su manejo y comprensión. Asimismo, pretende dejar la inquietud sobre lo conveniente de emplear modelos de atención de enfermería en problemas de salud que requieren una atención continua por parte del equipo de salud y un conocimiento y compromiso hacia el autocuidado por parte del paciente.

The aim is to provide a process of care for patients with depression using the care model Dorothea E. Orem, this addresses the most important preventive measures that must know the patient and family, such as diet, exercise, knowledge of the condition. The process is presented in tabular form for ease of handling and understanding, is intended to make the concern about how convenient to use models of nursing care in health problems that require ongoing attention by the health team and an understanding and commitment to self-care by the patient.

Fundamentos neurobiológicos del abordaje psicofarmacológico del trastorno por déficit atencional con/sin hiperquinesia. Riesgo evolutivo y responsabilidad profesional / Neurological basis of the attention deficit disorder with hyperkinesia psychopharmacological treatment-evolution risk and professional liability

El objetivo del presente trabajo es evaluar los riesgos resultantes de no realizar el abordaje psicofarmacológico adecuado al trastorno de déficit atencional con hiperquinesia en niños. Se analiza el riesgo evolutivo y en especial, las comorbilidades que presumiblemente podrían haberse neutralizado de haberse operado un tratamiento médico precoz. El estudio de las disfunciones neurobiológicas, en especial los aspectos derivados de las neuroimágenes y de la afectación de la neurotransmisión dan un soporte neurocientífico a la necesidad de un correcto abordaje médico del trastorno. Se apela finalmente a la responsabilidad profesional para no defeccionar de actuar y no caer en la negligente inacción terapéutica.

The aim of this study is to evaluate the risks resulting from not using the appropriate psychotropic approach to Attention Deficit Disorder with hyperkinesia in children. It analyzes the evolutionary risks, especially comorbidity, which presumably could neutralize itself should it be subjetct to early medical treatment. The study of neurobiological dysfunctions, especially those aspects derived from neuroimaging and neurotransmission involvement, provide neuroscientific support to the need for a correct medical approach to this disorder. Finally, this study stresses the respnsibility of all professionals in not failing to act, and not falling to the negligence of therapeutic inaction.