[Abbreviating the brief. Approach to ultra-short versions of the Yesavage questionnaire for the diagnosis of depression]. / Abreviar lo breve. Aproximación a versiones ultracortas del cuestionario de Yesavage para el cribado de la depresión.

OBJECTIVES: To assess the validity of small questionnaires of 4,5 and 1 questions, based on the 15-question Spanish version of the Yesavage geriatric depression scale (GDS-VE), for diagnosing depression in the over-65s. DESIGN: Study to validate questionnaires. SETTING: Health centre consultations. PARTICIPANTS: 258 patients were selected to adapt and validate the original questionnaire (GDS-15). Then validity data were assessed by using a group with one question (GDS-1), a group with 4 questions (GDS-4) and a group with 5 (GDS-5). The questions were chosen for the greater sensitivity and specificity shown in the validation study of the GDS-VE. MAIN MEASUREMENTS: Inter and intra-observer reliability, internal consistency, convergent validity (Spearman's correlation coefficient: CC), criterion validity (sensitivity, S, and specificity, E), and the diagnostic capacity of each questionnaire (area under the ROC curve: AUC), at their respective 95% confidence intervals (CI), were all analysed. RESULTS: 249 patients concluded the study, with the following results (the cut-off point was taken as 2 or more points on the 4 and 5-question versions): GDS-1: S: 71.1% (61.7-80.4), E: 74.1% (67.3-80.9), AUC: 0.726 (0.659-0.793), CC: 0.679 (0.673-0.684). GDS-4: S: 73.3% (64.2-82.4), E: 77.7% (71.2-84.2), AUC: 0.821 (0.765-0.876), CC: 0.803 (0.754-0.852). GDS-5: S: 81.1% (73.1-89.1), E: 73.2% (66.3-80.1), AUC: 0.833 (0.789-0.887), CC: 0.866 (0.824-0.908). CONCLUSIONS: The sensitivity and specificity results are similar to results of other ultra-short GDS studies. The high reliability of these ultra-short versions leads us to recommend that new studies be run to enable these versions to be consolidated as a valid and very rapid option for diagnosing depression among the elderly.

Abreviar lo breve. Aproximación a versiones ultracortas del cuestionario de Yesavage para el cribado de la depresión / Abbreviating the brief. Approach to ultra-short versions of the yesavage questionnaire for the diagnosis of depression

Objetivo. Evaluar la validez de cuestionarios reducidos de 4,5 y 1 preguntas basados en la escala geriátrica de depresión de Yesavage en su versión española (GDS-VE) de 15 preguntas, para el cribado de la depresión en las personas > 65 años. Diseño. Estudio de validación de cuestionarios. Emplazamiento. Consultas de un centro de salud. Participantes. Se seleccionó a 258 pacientes para adaptar y validar el cuestionario original (GDS-15). Posteriormente se valoran los datos de validez al aplicar un grupo de 1 pregunta (GDS-1), 4 preguntas (GDS-4) y otro de 5 (GDS-5)seleccionadas por su mayor sensibilidad y especificidad obtenidas en el estudio de validación del GDS-VE. Mediciones principales. Se analiza la fiabilidad inter-observador e intraobservador, la consistencia interna, la validez convergente (coeficiente de correlación de Spearman [CC]), la validez de criterio (sensibilidad [S] y especificidad [E]) y la capacidad diagnóstica de cada cuestionario (área bajo la curva ROC [AUC]), con los respectivos intervalos de confianza (IC) del95%.Resultados. Finalizaron el estudio 249pacientes. Se han obtenido los siguientes resultados, considerando un punto de corte de ≥ 2 en las versiones de 4 y 5 preguntas:- GDS-1: S del 71,1% (61,7-80,4); E del74,1% (67,3-80,9); AUC = 0,726 (0,659-0,793); CC = 0,679 (0,673-0,684).- GDS-4: S del 73,3% (64,2-82,4); E del77,7% (71,2-84,2); AUC = 0,821 (0,765-0,876); CC = 0,803 (0,754-0,852).- GDS-5: S del 81,1% (73,1-89,1); E del73,2% (66,3-80,1); AUC = 0,833 (0,789-0,887); CC = 0,866 (0,824-0,908).Conclusiones. Los resultados de sensibilidad y especificidad son similares a los obtenidos en otros estudios de GDS ultracorta. La buena fiabilidad de estas versiones ultracortas nos hace recomendar la realización de nuevos trabajos que permitan consolidarlo como una opción válida y muy rápida para el cribado de la depresión en población anciana

Objetives. To assess the validity of small questionnaires of 4,5 and 1 questions, based on the 15-question Spanish version of the Yesavage geriatric depression scale (GDSVE),for diagnosing depression in the over-65s.Design. Study to validate questionnaires. Setting. Health centre consultations. Participants. 258 patients were selected to adapt and validate the original questionnaire(GDS-15). Then validity data were assessed by using a group with one question (GDS-1),a group with 4 questions (GDS-4) and a group with 5 (GDS-5). The questions were chosen for the greater sensitivity and specificity shown in the validation study of the GDS-VE. Main measurements. Inter and intra-observer reliability, internal consistency, convergent validity (Spearman’s correlation coefficient: CC), criterion validity (sensitivity, S, and specificity, E), and the diagnostic capacity of each questionnaire (area under the ROCcurve: AUC), at their respective 95%confidence intervals (CI), were all analysed. Results. 249 patients concluded the study, with the following results (the cut-off point was taken as 2 or more points on the 4 and5-question versions): GDS-1: S: 71.1% (61.7-80.4), E: 74.1% (67.3-80.9), AUC: 0.726(0.659-0.793), CC: 0.679 (0.673-0.684).GDS-4: S: 73.3% (64.2-82.4), E: 77.7%(71.2-84.2), AUC: 0.821 (0.765-0.876), CC:0.803 (0.754-0.852).GDS-5: S: 81.1% (73.1-89.1), E: 73.2%(66.3-80.1), AUC: 0.833 (0.789-0.887), CC:0.866 (0.824-0.908).Conclusions. The sensitivity and specificity results are similar to results of other ultrashort GDS studies. The high reliability of these ultra-short versions leads us to recommend that new studies be run to enable these versions to be consolidated as a valid and very rapid option for diagnosing depression among the elderly

[Impact of medical counseling to quit smoking during the process of dehabituation in patients with mental illness]. / El papel del consejo antitabaco en el proceso de deshabituación en enfermos mentales.

BACKGROUND: Cigarettes consumption is the most preventable cause of morbidity and mortality in developed countries. Several intervention trials have shown that medical counseling to quit smoking promotes 5-10 % of abstinence per year, which constitutes the most efficient preventable activity. This study aims to evaluate the presence and type of medical counseling to quit smoking in patients admitted to a long-stay unit of a psychiatric hospital. METHODS: This descriptive and cross-sectional study included 80 schizophrenic smoking in-patients. The presence of medical counseling to quit smoking was evaluated by a standardized questionnaire designed for this purpose. The Fagerström Test was used to measure nicotine dependence, the Richmond Questionnaire to measure motivation for smoking cessation and the Stages of Change Questionnaire to know the stage of change to give up smoking. RESULTS: A total of 60.3 % of the patients had previously received medical counseling to quit smoking, 50 % of which had been performed by the psychiatrist. The motivation for patients with medical counseling was moderate (mean score +/- SD of Richmond Questionnaire 4.4 +/- 3.5). A total of 77.1 % of these patients had tried to quit smoking on several occasions. CONCLUSIONS: Medical counseling on giving up smoking can modify the motivation to quit smoking in psychiatric patients. Systematic structured counseling, especially from psychiatry, can prevent the development of nicotine addiction or modify intensity.

El papel del consejo antitabaco en el proceso de deshabituación en enfermos mentales / Impact of medical counseling to quit smoking during the process of dehabituation in patients with mental illness

Introducción. El Tabaco constituye la principal causa de morbimortalidad susceptible de prevención en los países desarrollados. Diversos estudios de intervención han demostrado que un consejo mínimo estructurado promueve un 5-10% de abstinencias al año, constituyendo la actividad preventiva que mejor coste/beneficio presenta. El objetivo fu evaluar en los pacientes fumadores de una unidad de larga estancia de un hospital psiquiátrico la existencia y características del consejo antitabaco. Métodos. Estudio descriptivo transversal de 80 pacientes fumadores diagnosticados de esquizofrenia en los que se evaluó la presencia del consejo antitabaco mediante una entrevista diseñada a tal efecto. Se utilizó el Cuestionario de Fagerström para valorar la dependencia física e nicotina, el Cuestionario de Richmond para evaluar el grado de motivación para el abandono del consumo de tabaco y el Cuestionario de Estadios de Cambio para establecer el estadio de cambio en el que se encontraban respecto al proceso de abandono. Resultados. El 60,3% de los pacientes había recibido anteriormente consejo antitabaco, de los cuales un 50% había sido realizado por el psiquiatra. Aquellos pacientes que habían recibido consejo antitabaco tenían una puntuación media en el Cuestionario de Richmond de 4,4±3,5, correspondiente a una motivación media-alta. De éstos, el 77,1% había realizado algún intento de abandono. Conclusiones. El consejo antitabaco puede modificar la motivación del paciente psiquiátrico para el cese del consumo especialmente por parte del médico psiquiatra, puede prevenir el desarrollo de la adicción al tabaco o modificar la intensidad de la misma (AU)

Background. Cigarettes consumption is the most preventable cause of morbidity and mortality in developed countries. Several intervention trials have shown that medical counseling to quit smoking promotes 5-10% of abstinence per year; which constitutes the most efficient preventable activity. This study aims to evaluate the presence and type of medical counseling to quit smoking in patients admitted to a long-stay unit of a psychiatric hospital. Methods. This descriptive and cross-sectional study included 80 schizophrenic smoking in patients. The presence of medical counseling to quit smoking was evaluated by a standardized questionnaire designed for this purpose. The Fagerström Test was used to measure nicotine dependence, the Richmond Questionnaire to measure motivation for smoking cessation and the Stages of Change Questionnaire to know the stage of change to give up smoking. Results. A total of 60.3% of the patients had previously received medical counseling to quit smoking, 50% of which had been performed by the psychiatrist. The motivation for patients with medical counseling was moderate (mean score ± SD of Richmond Questionnaire 4.4±3.5). A total 77.1% of these patients had tried to quit smoking on several occasions. Conclusions. Medical counseling on giving up smoking can modify the motivation to quit smoking in psychiatric patients. Systematic structured counseling, especially form psychiatry, can prevent the development of nicotine addiction or modify intensity (AU)

Versión española del cuestionario de Yesavage abreviado (GDS) para el despistaje de depresión en mayores de 65 años: adaptación y validación / The Spanish version of the Yesavage abbreviated questionnaire (GDS) to screen depressive dysfunctions in patients older than 65 years

Fundamento: existen escasos cuestionarios de cribado de depresión adecuadamente validados al castellano. Objetivo: adaptar y validar al castellano la versión abreviada de la Geriatric Depression Scale de Yesavage (GDS) para su uso en el cribado de depresiones en mayores de 65 años. Diseño, material y método: el trabajo se ha realizado en consultas de un centro de salud de Atención Primaria mediante un estudio de validación de cuestionarios. Se ha realizado en tres etapas: en la primera se ha traducido y adaptado el cuestionario al castellano (GDS-VE). En una segunda fase el médico/enfermera de cada sujeto aplicó el cuestionario de forma individual. Por último, otro investigador, de forma ciega, realizó al sujeto una entrevista semiestructurada para determinar síntomas de depresión según los criterios establecidos en la CIE-10. Igualmente se realizó una evaluación del estado cognitivo y se cumplimentaron los cuestionarios de Montgomery - Asberg, Pfeiffer- VE , MEC, IQCODE-VE y la parte de valoración de actividades de la vida diaria del OARS-MFAQ. El resultado final de esta exploración fue considerado como el patrón oro de diagnóstico de depresión, siendo la referencia para el cálculo de la sensibilidad, especificidad y razones de máxima verosimilitud para un resultado positivo y negativo del test. Resultados: se ha realizado la adaptación del GDS obteniendo la versión a validar (GDS-VE).Finalizaron el estudio 249 personas mayores de 65 años, con media de edad de 74,3 años, el 67,5 per cent mujeres y un 65 per cent analfabetos o sin estudios. La fiabilidad intraobservador ha sido del 0,95 y la interobservador del 0,65, con una consistencia interna de 0,99. Se ha obtenido un área bajo la curva de 0,835. La sensibilidad alcanzada ha sido del 81,1 per cent y la especificidad del 76,7 per cent para un punto de corte de 5 o más puntos. Conclusiones: los parámetros de fiabilidad y validez para la versión adaptada han resultado aceptables y similares a los del cuestionario original. Se recomienda utilizar un punto de corte de 5 o más para considerar la posible existencia de depresión (AU)

[Spanish language adaptation and validation of the Pfeiffer's questionnaire (SPMSQ) to detect cognitive deterioration in people over 65 years of age]. / Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años.

BACKGROUND: Our aims were to develop a Spanish version of the short portable mental status questionnaire (SPMSQ) (Pfeiffer's test) and to validate the resultant Spanish version of the test among a general population aged 65 years or older. PATIENTS, MATERIAL AND METHODS: First, we developed the Spanish version of the SPMSQ by means of a cross-cultural adaptation methodology. Patients were the assessed by independent teams in two sessions the same day. The first team (two trained psychiatrists and one trained family physician) carried out a standardised neuropsychological assessment to diagnose cognitive impairment/dementia according to ICD-10 criteria which was regarded as the reference "gold standard" to calculate validity parameters (sensitivity and specificity). The second team (family physicians/nurses) assessed the presence of cognitive impairment with the Spanish version of the SPMSQ. RESULTS: 255 subjects (66.7%, females) underwent the assessment. Mean age was 74.5 years and 65.5% of them were illiterate. The inter-rater reliability and test-retest reliability of the SPMSQ Spanish version were 0.738 (p < 0.001), and 0.925 (p < 0.001), respectively,with a convergent validity of 0.74 (p < 0.001) and a discriminant validity of 0.230 (p < 0.001). The internal consistency was high with an *value of 0.82. The area under the ROC curve was 0.89. Sensitivity and specificity were 85.7 and 79.3, respectively (cut-off of 3 or more). CONCLUSIONS: The Spanish version of the SPMSQ test has a good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, the it is recommended to employ a cut-off of 4 or more.

Tratamiento farmacológico del alcoholismo / Pharmacologic treatment of alcohol dependence

Objetivo: revisar los distintos grupos farmacológicos actualmente disponibles en el tratamiento de la dependencia de alcohol a tenor de los avances producidos en los mecanismos neurobiológicos del alcohol a nivel del sistema nervioso central. Material y métodos: revisión de los estudios de eficacia del tratamiento psicofarmacológico en pacientes alcohólicos. Resultados: los primeros fármacos estudiados en el tratamiento del alcoholismo fueron los interdictores del alcohol. Desde entonces, ha aumentado el número de fármacos disponibles mejorando asimismo de forma considerable la metodología en los ensayos clínicos. Conclusiones: en la actualidad se dispone de distintos abordajes farmacológicos para el tratamiento de la dependencia de alcohol, que en combinación con los abordajes psicosociales permiten mejorar el grado de eficacia de los programas de tratamiento (AU)

[Social resources of persons over 60 years of age. Its relationship with sociodemographic and health factors (ANCO project)]. / Recursos sociales en mayores de 60 años. Su relación con factores sociodemográficos y de salud (proyecto ANCO).

OBJECTIVE: To evaluate the social situation of the over-60s and its relationship with several social, demographic and health variables. DESIGN: A descriptive, crossover study. SETTING: City of Córdoba. PARTICIPANTS: Systematic random sampling of the non-institutionalised population over 60 obtained 1,103 subjects (N = 49,674). MEASUREMENTS AND MAIN RESULTS: The multidimensional OARS-MFAQ-VE questionnaire was filled in during face-to-face home interviews. The part of the questionnaire evaluating social resources (SR) was analysed, extracting information on the quantitative, emotional and material support factors. The subjects were classified into three groups by their social situation. 14.1% (CI = 12.7-16.4) lived alone and 7.2% (CI = 5.8-8.9) thought that they would not have help available in case of illness or incapacity. CONCLUSIONS: The present study described the social situation of our elderly people and found a considerable number suffering serious to absolute deterioration. The role of the spouse, the children or some friend or trusted person is vital for good social support.

[Influence of socioeconomic factors on the course and monitoring of pregnancy]. / Influencia de factores socioeconómicos en la evolución y seguimiento del embarazo.

OBJECTIVE: To analyse variations in monitoring the pregnancy programme (PP) and in the programme's development in three population groups distinguished by their socio-demographic characteristics. DESIGN: An observational, descriptive and retrospective study. SETTING: "Occidente" Health District, Córdoba. PARTICIPANTS: Women who finalised their pregnancy in 1994 or 1995 (n = 415) and who lived in three zones distinguished geographically and socially: an Urban Area (UA), with an average population socially and economically and urban environment; a Marginal Area (MA) with a low social and economic level, high rates of unemployment and drug addiction, and a mixed population (gypsy and latin); and a Rural Area (RA), which had a rural productive way of life. MEASUREMENTS: The area of residence was related to the socio-demographic variables, history, drug consumption, PP monitoring and identified pathology. RESULTS: PP coverage reached 73.8% (CI 69.2-77.8), Pregnant women living in the MA were younger (p < 0.001), and included more adolescents (p < 0.001) and more single women (p < 0.001). CONCLUSIONS: Poorer monitoring and adherence to the PP by the MA population could be confirmed.