Determination of the phenotypic age in residents of Mexico City: effect of accelerated ageing on lung function and structure.

INTRODUCTION: Phenotypic age better represents age-related biological dysregulation than chronological age. Recently, a multisystem-based ageing measure, which integrates chronological age and nine biomarkers, was proposed. METHODS: Phenotypic age was determined in 774 residents of Mexico City over 60 years old and without respiratory problems. We arbitrarily classified as "accelerated" ageing, those showing >4 years compared with their chronological age, and "slowed" ageing, those with <4 years compared with chronological age. Demographic risk factors were analysed with structured questionnaires. Lung structure was evaluated by high-resolution computed tomography and functional competence was analysed by forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), diffusion capacity of carbon monoxide (D LCO), and the 6-minute walk test (6MWT). RESULTS: Overall, 13% of this cohort showed accelerated ageing, which was corroborated with four independent biomarkers of ageing, 42% had normal ageing and 46% had slowed ageing. Risk factors associated with accelerated ageing were male sex (OR 4.4, 95% CI 2.4-7.9; p<0.01), diabetes mellitus (OR 9.7, 95% CI 5.5-17.2; p<0.01), and long-term sleep duration (OR 2.9 95% CI 1.34-6.35, p<0.01). Among smokers, there was a slight but significant association with the number of pack-years. Subjects with accelerated ageing showed decreased FVC (p<0.0001), FEV1 (p<0.0001), D LCO (p<0.02) and walking distance in the 6MWT (p=0.0001). Slowed-ageing subjects presented less frequently with emphysematous lesions compared with those with accelerated ageing. CONCLUSIONS: A small but significant proportion of residents of Mexico City age rapidly, which is associated with male sex, diabetes, and long-term sleep duration. They exhibit lower levels of lung function and develop emphysema more frequently.

Neurocognitive subtypes of schizophrenia.

OBJECTIVE: To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. METHODS: Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. RESULTS: We identified four neurocognitive subtypes: 1) “Global cognitive deficit”, 2) “Memory and executive function deficit”, 3) “Memory and facial emotion recognition deficit,” and 4) “Without cognitive deficit.” In comparison with the subtype “without cognitive deficit,” we found that the “memory and executive function deficit subtype” and the “global cognitive deficit subtype” had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the “global cognitive deficit subtype” the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The “memory and facial recognition deficit subtype” had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). CONCLUSION: Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction.

Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms.

OBJECTIVE: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. METHODS: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for "negative symptoms" and "disorganization" was performed afterwards. RESULTS: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. CONCLUSION: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia.

Memoria de trabajo verbal en individuos con esquizofrenia y sus familiares de primer grado: Relación con los sintomas negativos y desorganizados / Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms

Objetivo: Determinar si hay diferencias en la memoria de trabajo verbal entre sujetos con esquizofrenia, familiares de primer grado y controles, y evaluar la influencia que pueden tener en estas diferencias los síntomas del trastorno, como un paso para establecer si esta función cognitiva es un endofenotipo. Métodos: A 197 sujetos con esquizofrenia, 197 familiares de primer grado y 200 controles comunitarios, se les hizo evaluación psiquiátrica y se les aplicó la prueba sucesión de letras y números (SLN). Se comparó el desempeño de los tres grupos ajustando por edad, sexo y escolaridad, y luego se ajustó también por síntomas negativos y desorganizados. Resultados: Los sujetos con esquizofrenia mostraron un menor desempeño en la SLN con respecto a sus familiares de primer grado no-afectados y los controles, con tamaños de efecto de 0,75 y 1,18 respectivamente. Hubo una diferencia pequeña pero significativa entre familiares y controles (tamaño de efecto =0,38). Estas diferencias siguieron siendo significativas después de ajustar por síntomas negativos y desorganizados, pero los tamaños de efecto disminuyeron a: 0,26 para familiares vs sujetos con esquizofrenia, 0,56para controles vs sujetos con esquizofrenia y 0,33 para familiares vs controles. Entre los sujetos con esquizofrenia, el desempeño en la SLN no se asoció significativamente con duración del trastorno, edad de inicio, uso de antipsicóticos, ni historia de episodios depresivos o trastornos por uso de sustancias. Conclusión: Los resultados sugieren que la memoria de trabajo verbal puede ser considerada un endofenotipo de la esquizofrenia (AU)

Objective: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. Methods: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for “negative symptoms” and “disorganization” was performed afterwards. Results: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. Conclusion: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia (AU)

Tratamiento psicofarmacológico en medicina psicosomática / Psychopharmacologic Treatment in Psychosomatic Medicine

El psiquiatra de enlace se enfrenta a una variedad de situaciones clínicas, como las complicaciones psiquiátricas derivadas de condiciones médicas o de sus tratamientos, manifestaciones neurosiquiátricas de condiciones médicas, manifestaciones médicas de trastornos neurosiquiátricos y coexistencia de enfermedad médico-quirúrgica y enfermedad mental. Las patologías médico-quirúrgicas pueden alterar los procesos farmacodinámicos y farmacocinéticos de los psicofármacos. Éstos, a su vez, pueden contribuir a generar dificultades en la caracterización y diagnóstico de la enfermedad médico-quirúrgica (patología de base), su curso y tratamiento; pero, sobre todo, pueden interactuar con los medicamentos que recibe el paciente para su patología de base. Por ello es importante que el psiquiatra de enlace tenga un conocimiento amplio de los diagnósticos duales y las características farmacológicas de los psicofármacos, así como de aquellos fármacos más utilizados en los servicios de hospitalización del hospital general. Este artículo intenta dar una visión general del uso de los psicofármacos en pacientes con patologías médico-quirúrgicas. Incluye aspectos como psicofármacos y alteración de órganos como el hígado y los riñones, psicofármacos en el período perioperatorio, así como riesgo de interacciones entre medicamentos, incluidos los “naturales” y alternativos. Finalmente, se dan algunas recomendaciones básicas para el uso racional de psicofármacos en el área de psiquiatría de enlace.

Consultation-liaison psychiatrists face several clinical situations, such as, psychiatric complications from medical conditions or its treatments, psychiatric symptoms of medical ill patients, medical symptoms of neuropsychiatric disorders, and patients with comorbid medical and psychiatric conditions. Medical/chirurgical pathologies can alter the pharmacodynamic and pharmacokinetic of psychotropic drugs. At the same time use of psychotropic drugs can contribute to hinder the diagnosis of the surgical-medical diseases, its course and treatment, and mainly they can interact with other medicines used by patients. For those reasons it is of utmost importance that the consulting psychiatrist has a very good knowledge in dual diagnoses and in pharmacological actions of psychotropic drugs, and also on more frequently prescribed drugs in most of the services in general hospitals. This article provides a brief overview about using psychotropic drugs in medical/surgical patients. It includes topics such as psychotropic drugs and hepatic and renal diseases, psychotropic drugs in the peri-operative period, risk of drug-drug interactions including “natural” and alternative medicines. Finally, we suggest some basic guidelines for rational use of psychotropic drugs in consultation-liaison Psychiatry.

Estabilidad del Diagnostico Psiquiatrico en pacientes de consulta externa / Psychiatry diagnosis in outpatients

El presente estudio es la primera aproximación que se hace en Colombia a la estabilidad del diagnóstico psiquiátrico. Pretende establecer la frecuencia de este fenómeno en un servicio de atención ambulatoria, teniendo en cuenta el tipo de entidad clínica, la edad y el género, como posibles variables que afecten la estabilidad del diagnóstico psiquiátrico. Objetivos: establecer el tiempo que el diagnóstico índice permanece sin cambio en pacientes psiquiátricos de consulta extema. Establecer la probabilidad de cambio de diagnóstico en un grupo de pacientes psiquiátricos ambulatorios. Determinar qué variables influyen en el tiempo que el diagnóstico psiquiátrico permanece sin cambio. Diseño: se realizó un estudio de cohorte retrospectivo con pacientes evaluados durante 1997 en el Servicio de Consulta Externa de Psiquiatría del Hospital San Juan de Dios de Bogotá. Se midió el cambio de diagnóstico índice, tiempo que el diagnóstico índice permanece sin cambio y variables independientes (edad, género, número de consultas, diagnóstico psiquiátrico y comorbilldad). Por último, se realizaron asociaciones divariadas y análisis de sobrevida. Resultados: las características de las variables demográficas y de diagnóstico estudiadas en este grupo corresponden a lo descrito en otros estudios: los trastornos depresivos, ansiosos y adaptativos son más frecuentes en mujeres; los trastornos psicóticos y por uso de sustancias son más frecuentes en hombres; los pacientes con trastornos orgánicos y depresivos tienen mayor edad. El cambio de diagnóstico se presentó en el 11,01 por cientode los casos evaluados, con una tasa de incidencia de 0,039 cambios por mes. La función de riesgo de cambio de diagnóstico tiene distribución Weibull. Se encontró que las variables que favorecen la estabilidad del diagnóstico son: tener enfermedad bipolar, tener psicosis y ser mayor de sesenta años

TOC en niños y adolescentes / OCD in children and adolescents

Utilizando la entrevista clínica y varias escalas de evaluación se realizó la caracterización de un grupo de 28 niños con TOC en la ciudad de Bogotá. Estos hallazgos fueron contrastados con lo reportado en la literatura mundial