Actitudes, conocimientos y prácticas de internos de medicina frente a la interrupción voluntaria del embarazo en Medellín, Colombia / Attitudes, knowledge and practices of internal medicine against the voluntary interruption of pregnancy in Medellin Colombia

Resumen La interrupción voluntaria del embarazo es una opción legal en algunos países bajo circunstancias especiales. Se quiso explorar las actitudes, los conocimientos y las prácticas de internos de medicina frente a la interrupción voluntaria del embarazo en Medellín-Colombia. Se realizó un estudio observacional descriptivo de corte. Se analizaron variables sociodemográficas, actitudes, conocimientos y prácticas frente a la interrupción voluntaria del embarazo. Se realizó un análisis descriptivo de las variables. La información se analizó con el software SPSS® versión 21.0. Se obtuvo consentimiento informado y aprobación del comité de ética universitario. El principal motivo para realizar la interrupción voluntaria del embarazo, fue por riesgo para la salud mental de la madre. Acerca de la objeción de conciencia el 54,7 % la tiene, 21 % objetó conciencia durante el pregrado y el 86,7 % conoce correctamente el proceso a seguir para hacerlo. La totalidad de los encuestados identifica las circunstancias en las cuales el aborto está despenalizado en Colombia, el 96 % conoce el objetivo de la sentencia C355 y el 41 % desconoce que no se establece edad gestacional para practicarla. De los internos que presenciaron IVE el 25,7 % tuvo una repercusión emocional severa con recuerdos frecuentes de lo ocurrido y el 48,7% tristeza con otras emociones.

Abstract Voluntary Interruption of Pregnancy (VIP) is legal under special circumstances in some countries. The objective of this study was to evaluate the skills, knowledge and attitudes about VIP in medical interns from a private university in Colombia. A cross-sectional study with primary data collection was preformed. A descriptive analysis was done for the variables; socio-demographic, skills, knowledge and attitudes about VIP. The SPSS® software, version 21.0, was used for the statistical analysis. A written consent was signed and approved by the research ethics committee. The primary circumstance to practice a VIP was if the mother´s mental health was at risk. 54,7 % of the interns endorsed having a conscientious objection and 21 % applied it during their internship year. 86,7 % of the students answered correctly about how to proceed in a VIP case. All of them identified the special circumstances, in which VIP can be done in Colombia, and 96 % recognized the law, but only 41 % knew details about gestational time limits. 25,7 % of the students report having emotional consequences after witnessing a VIP; 48,7 % presented with depressed mood.

Ciberacoso y comportamiento suicida. ¿Cuál es la conexión? A propósito de un caso / Cyberbullying and Suicidal Behavior: What is the Connection? About a Case

Resumen Introducción: La victimización a través de las redes sociales se ha asociado con problemas de salud mental como depresión y comportamiento suicida. Objetivo: Presentar el caso clínico de una adolescente víctima de cyberbullying con síntomas depresivos y comportamiento suicida. Metodología: Reporte de caso y revisión no sistemática de la literatura relevante. Resultados: Se presenta un reporte de caso, tratado en un hospital de Medellín debido a dos intentos de suicidio relacionados con las redes sociales. Discusión: En la actualidad, existen múltiples recursos de los medios sociales. El advenimiento de Internet y teléfonos inteligentes no es solo una estrategia para mejorar las interacciones sociales, sino que también contribuye a deteriorar la salud mental de algunas personas jóvenes vulnerables. Conclusión: Este caso nos sensibiliza sobre la relación entre el crecimiento de redes sociales y el acoso cibernético. No podemos establecer la causalidad, pero podríamos deducir que algunos contenidos en la web podrían propiciar un mayor riesgo de enfermedad mental para los jóvenes que están expuestos y vulnerables.

Abstract Introduction: Social networks have increased in recent decades, and with them the bullying, causing difficulties in young people's mental health expressed through depressive symptoms, suicidal ideation and suicide attempts. Up next, we present a case that exemplifies this situation. Objective: To describe a case report that exemplifies this new outlook in young people and how it affects their mental health. Methodology: Case report and non-systematic literature review. Results: One case report, treated at a hospital in Medellin due to two suicide attempts related to social networks is presented. Discussion: Currently, there are multiple social media resources, the advent of internet and smartphones is not only a strategy for improving social interactions, but it also contributes to impair mental health of some vulnerable young people. Conclusion: This case sensitize us, about the relationship between the growing social networking and cyberbullying as well as suicidal thoughts / attempts; thanks to this case and the available literature, we can't establish causality but we could deduce that the internet utter a increased risk for young people who are exposed and more vulnerable.

[Cyberbullying and Suicidal Behavior: What is the Connection? About a Case]. / Ciberacoso y comportamiento suicida. ¿Cuál es la conexión? A propósito de un caso.

INTRODUCTION: Social networks have increased in recent decades, and with them the bullying, causing difficulties in young people's mental health expressed through depressive symptoms, suicidal ideation and suicide attempts. Up next, we present a case that exemplifies this situation. OBJECTIVE: To describe a case report that exemplifies this new outlook in young people and how it affects their mental health. METHODOLOGY: Case report and non-systematic literature review. RESULTS: One case report, treated at a hospital in Medellin due to two suicide attempts related to social networks is presented. DISCUSSION: Currently, there are multiple social media resources, the advent of internet and smartphones is not only a strategy for improving social interactions, but it also contributes to impair mental health of some vulnerable young people. CONCLUSION: This case sensitize us, about the relationship between the growing social networking and cyberbullying as well as suicidal thoughts / attempts; thanks to this case and the available literature, we can't establish causality but we could deduce that the internet utter a increased risk for young people who are exposed and more vulnerable.

[Integrated management of patients with schizophrenia: beyond psychotropic drugs]. / Manejo integral del paciente con esquizofrenia: más allá de los psicofármacos.

INTRODUCTION: Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. THEME DEVELOPMENT: It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. DISCUSSION: It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. CONCLUSIONS: The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential.

Manejo integral del paciente con esquizofrenia: más allá de los psicofármacos / Integrated management of patients with schizophrenia: beyond psychotropic drugs

Introducción: La esquizofrenia es una enfermedad compleja con graves repercusiones funcionales, por lo que amerita un tratamiento que vaya más allá de los fármacos. Desarrollo del tema: Se requiere un enfoque que, considerando el proceso de diátesis estrés, incluya la rehabilitación, estrategias psicoterapéuticas para los síntomas cognitivos, negativos y psicóticos persistentes, psicoeducación del paciente y las comunidades, estrategias para la adaptación en comunidad como introducción a la fuerza laboral y el modelo comunitario como cambio del paradigma manicomial. Discusión: Es necesario que se establezcan iniciativas privadas y públicas para la atención integral de la esquizofrenia en el país, abogando por el bienestar de quienes la padecen. Conclusiones: El manejo integral del paciente con esquizofrenia requiere una mirada global de este y su enfermedad y es imperativo su desarrollo.

Introduction: Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. Theme development: It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. Discussion: It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. Conclusions: The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential.

[Sensitivity and specificity between the Composite International Diagnostic Interview Version 3.0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012]. / Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3.0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012.

INTRODUCTION: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. OBJECTIVE: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. METHODOLOGY: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. RESULTS: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. CONCLUSIONS: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

[Intervention of Schizophrenia From the Community Model]. / Intervención de la esquizofrenia desde el modelo comunitario.

INTRODUCTION: Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. METHODOLOGY: Case report. RESULTS: This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. DISCUSSION: The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. CONCLUSIONS: A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.

Intervención de la esquizofrenia desde el modelo comunitario / Intervention of Schizophrenia From the Community Model

Introducción: La esquizofrenia es una enfermedad compleja cuyo manejo farmacológico es una medida terapéutica insuficiente para garantizar la adaptación a la comunidad y el restablecimiento de la calidad de vida del paciente, por lo que es necesario un manejo multidimensional, propuesto por las intervenciones comunitarias. Metodología: reporte de caso. Resultados: Se trata de un caso clínico que ilustra la respuesta a un tratamiento multidisciplinario basado en el modelo comunitario de atención a la salud mental en Envigado, Colombia. Discusión: El manejo de la esquizofrenia exige intervenciones multimodales que incluyan la detección en comunidad, la psicoeducación de los individuos, sus familias y la sociedad, y el abordaje de distintas áreas de funcionamiento que permitan la adaptación del sujeto a su ambiente social. Conclusiones: Es necesaria una intervención integradora que el modelo comunitario puede proporcionar implementando políticas que permitan su aplicación.

Introduction: Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. Methodology: Case report. Results: This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. Discussion: The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. Conclusions: A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.

Sensibilidad y especificidad entre la Entrevista Diagnóstica Internacional Compuesta versión 3. 0 (World Mental Health, CIDI) con la Evaluación Clínica Estandarizada versión I (SCID-I) en la Encuesta de Salud Mental de la ciudad de Medellín, 2012 / Sensitivity and specificity between the Composite International Diagnostic Interview Version 3. 0 (World Mental Health, CIDI) and the Standardised Clinical Evaluation version I (SCID-I) in a mental health survey of the city of Medellin, 2012

Introducción: El abordaje de los problemas de salud mental de la población colombiana hace necesario disponer de instrumentos diagnósticos válidos, fáciles de aplicar y comparables (local e internacionalmente). Objetivo: Comparar la sensibilidad y la especificidad diagnóstica entre el CIDI 3.0 y el SCID-! para el trastorno depresivo mayor, el trastorno afectivo bipolar I y II y el trastorno por dependencia de sustancias. Metodología: Estudio transversal que comparó en 100 sujetos las prevalencias de vida de tres trastornos mentales por medio del CIDI 3.0 y el SCID-I. La investigación fue aprobada por el Comité de Ética Institucional. Se midieron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo (con sus respectivos intervalos de confianza del 95%) de las dos entrevistas diagnósticas. Para el análisis de la información se utilizó el software SPSS® versión 21.0. Resultados: La mediana de edad fue 43,5 [intervalo intercuartílico, 30] anos. La sensibilidad (Se) y la especificidad (Es) más altas se observaron en el diagnóstico de trastorno por dependencia de drogas -Se, 80% (IC95%, 34,94%-100%); Es, 98,46% (IC95%, 94,7%-100%)-. Conclusiones: El SCID-I y el CIDI 3.0 mostraron diferentes niveles de sensibilidad y especificidad para los tres trastornos estudiados así: altas para el trastorno por dependencia de sustancias, moderadas para el trastorno afectivo bipolar I y II y bajas para el trastorno depresivo mayor.

Introduction: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. Objective: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. Methodology: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. Results: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. Conclusions: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.

Síndrome de hipersensibilidad a los anticonvulsivos: reporte de un caso / Anticonvulsant Hypersensitivity Syndrome: A Case Report

El síndrome de reacción cutánea con eosinofilia y síntomas sistémicos (DRESS) es una reacción idiosincrásica a medicamentos que se caracteriza por erupción cutánea, fiebre, linfadenopatía y disfunción de órganos internos. Se revisa el caso de una paciente con trastorno afectivo bipolar (TAB) que sufrió una respuesta inflamatoria sistémica asociada al uso de ácido valproico y, además, tuvo una importante reactivación de los síntomas al usar otros medicamentos cuyos mecanismos de acción farmacológicos son diferentes. El diagnóstico de DRESS es principalmente de exclusión, por lo que puede tardarse en detectarlo y terminar en una entidad potencialmente mortal.

DRESS syndrome (skin reaction with eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterized by rash, fever, lymphadenopathy, and internal organ dysfunction. This case report is on a patient with bipolar affective disorder who presented with a systemic inflammatory response associated with the use of valproic acid, and an important activation of symptoms when used with other drugs with a different pharmacological action mechanism. The diagnosis of DRESS syndrome is primarily by exclusion, and its detection may be difficult, which could potentially become fatal for the patient.

[Anticonvulsant Hypersensitivity Syndrome: A Case Report]. / Síndrome de hipersensibilidad a los anticonvulsivos: reporte de un caso.

DRESS syndrome (skin reaction with eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterized by rash, fever, lymphadenopathy, and internal organ dysfunction. This case report is on a patient with bipolar affective disorder who presented with a systemic inflammatory response associated with the use of valproic acid, and an important activation of symptoms when used with other drugs with a different pharmacological action mechanism. The diagnosis of DRESS syndrome is primarily by exclusion, and its detection may be difficult, which could potentially become fatal for the patient.