Revista Colombiana de Psiquiatria最新文献

Introduction and objectives

Psychoneuroimmunoendocrinology is a field of science that documents bidirectional communication originating on a physiological level between the mind and the nervous, immune and endocrine systems, and centres on the effects of stress on these systems. Various studies have shown that stress and certain emotions such as anger, anxiety and depression affect clinical outcomes in conditions such as cardiovascular diseases, autoimmune diseases, cancer and human immunodeficiency virus infection. This paper focuses on rheumatoid arthritis as a paradigmatic autoimmune disease and documents the changes that occur from a psychoneuroimmunoendocrinology perspective and the effects of stress on the activity of the disease.

Methods

Literature indexed to date describing the effects of stress on the onset or course of rheumatoid arthritis was reviewed.

Results

In the stress response system, patients with rheumatoid arthritis present dysfunction of the hypothalamic–pituitary–adrenal axis, predominance of the sympathetic nervous system, increased pro-inflammatory interleukins, marked dysbiosis and dual immunomodulatory effects of melatonin.

Conclusions

In an era in which medicine is divided into multiple subspecialisations, it is important to return to the concept of health as a complex state based on a dynamic balance among biopsychosocial factors of mind/body/environment interaction in disease processes. For this reason, a psychoneuroimmunoendocrinological approach to individuals and their illnesses constitutes an important challenge in the treatment of patients with autoimmune diseases.

Introduction and objectives

Mental disorders in Latin America constitute a growing public health problem. Until now, the approach to them has focused on Evidence-Based Practices (EBP) reinforced by new public health policies. The authors aim to introduce implementation science principles, a scientific perspective focused on the study of the factors and processes that influence the diffusion, adoption, implementation and sustainability of EBP.

Methods

The method adopted in this text is argumentative, such as practical reasoning and inductive logic.

Results

The implementation of the National Mental Health Policy in Colombia is proposed as an illustrative case. The promised results are far from coming to fruition in our region, mainly due to implementation problems.

Conclusions

We conclude by emphasising the importance of implementation science if health systems are to function under increasingly dynamic conditions, as well as investments in research to maximize the value of medical care and improve public health.

Introduction

Hypernatraemia is a very common and potentially serious electrolyte disorder, especially in the context of the management of psychiatric illnesses. Although it is recognised as multicausal, psychogenic polydipsia and drug-induced syndrome of inappropriate antidiuretic hormone secretion are the most common causes.

Methods

Case report.

Results

This was a woman under psychiatric management who in the context of an episode of psychological stress developed an acute confusional state due to severe hyponatraemia in which there was no identifiable organic cause.

Conclusions

After ruling out more common organic causes, among the various conditions that can lead to the development of hyponatraemia in psychiatric patients, psychological stress should be considered.

Introduction and objectives

The prevalence of mixed dementia (MixD), defined as the coexistence of Alzheimer's disease (AD) and vascular dementia (VaD), is likely to increase as the population ages. The five-word test (5WT) is a neuropsychological test that differentiates between major and mild neurocognitive disorder (NCD). The objective of the study is to validate 5WT for the detection of MixD.

Methods

230 participants were evaluated: cognitively healthy (CH) (n = 70), mild NCD (n = 70), and major NCD (n = 90): AD (n = 30), VaD (n = 30), and MixD (n = 30). The Spearman's coefficient, d Sommer and ROC curves were used to determine the construct validity of the 5WT. The linear regression model was performed to determine the association between age and education with 5WT performance.

Results

The mean age was 79 ± 7.7 years (P≤.001), 58% were female (P = .252), and the mean education was 9 ± 5.3 years (P≤.001). Construct validity when comparing 5WT and MMSE was: Spearman's correlation ρ=.830 (P< .001) and d Sommer = .41 (P< .001). The area under the curve in the total weighted score (TWS) for MixD was .985, with 98% sensitivity (95%CI, 0.96-1.00) and 99% specificity (95%CI, 0.94-1.00), PPV of 88% (95%CI, 0.82-0.89), NPV of 100% (95%CI, 0.96-1.00), and cut-off point ≤16/20 (P< .001).

Conclusions

5WT is a rapid test with neuropsychological validation for the exploration of cognitive characteristics in major NCD type MixD, regardless of age and education.

Introduction

Health systems have not been able to provide an adequate response to the growing prevalence and burden of disease of mental disorders. It has been proposed that this gap be reduced by strengthening and making use of community resources. This study explores the feasibility and one-year outcomes of a novel volunteer programme for patients with bipolar disorder and schizophrenia.

Methods

In a non-controlled trial with a total of 30 patients, we instigated activities in groups of 5 people with severe mental disorders and individuals from the community. Symptoms, quality of life and social functioning before the intervention and after six and 12 months were assessed and compared using Student's t-test.

Results

The volunteer intervention was feasible in the Colombian context. Social functioning after 6 months was improved, mainly due to an improvement in the domains of employment and friendship. However, the difference was no longer statistically significant after 12 months.

Conclusions

In a country where there is a large gap in coverage and access to specialized mental health services, it is important to integrate effective and low-cost interventions that improve the mental health of the population through community resources. This intervention improved the social functioning of the patients, which indicates an effective and feasible intervention for implementation in our context. Nevertheless, the intervention may have to be continued beyond six months to maintain the reported improvements.

Introduction

Sleep disorders are very common in university students. In Colombia and in the world, they have been studied mainly in medical students; they have seldom been addressed in other health contexts. The objective of this study was to identify factors related to sleep quality in university students in the health and rehabilitation faculty of a university in Cali, Colombia.

Methods

A descriptive cross-sectional study was conducted in which a structured questionnaire — the Pittsburgh Sleep Quality Index, Colombian version (PSQI-CV) — was administered to students enrolled in the health and rehabilitation faculty of a university in Cali. A binary logistic regression model was developed with statistically significant or theoretically important variables.

Results

A total of 292 students were enrolled in the study; seven out of 10 students were women and half of the population was 18-20 years old. On adjusting for the different variables in the logistic regression model, it was found that the risk of poor sleep quality increased among students who slept for fewer than seven hours (adjusted odds ratio [AOR] 4.81; 95% CI, 2.36-9.80), were women (AOR 3.62; 95% CI, 1.51-8.66) and perceived that they had a worse state of health (AOR 2.92; 95% CI, 1.33-6.39).

Conclusions

Factors related to poor sleep quality among university students in a health and rehabilitation faculty were being women, actively working, having longer sleep latency perceiving themselves to have a worse state of health.

Background

Healthcare workers facing the COVID-19 pandemic have experienced unexpectedly traumatic situations associated with concerns about the possibility of acquiring the infection, excessive workloads, and the increased inpatient mortality rates. The objective was to make changes in hospital practices that facilitate spaces for the well-being of healthcare worker teams.

Methods

We conducted an ongoing intervention during the first year of this outbreak. We established peer support groups by videoconference and individual virtual interventions for specialist physicians, resident physicians, nurses, and support personnel, focusing on problems and emotions related to the psychological impact of being on the clinical front line working with patients with pneumonia due to SARS-CoV-2 (COVID-19).

Results

The group work helped the expression of feelings, peer support, and validation of personal emotional experience. The participants expressed the need for physical and psychological security in the battle against COVID-19 and the need for interpersonal ties and giving meaning to their experiences.

Conclusions

Based on our findings, we consider it necessary to investigate the potentially traumatic experiences of healthcare workers and provide evidence-based knowledge that can generate novel approaches in psychosocial support work structures for this group.

Introduction

Delusions of pregnancy are not often reported in geriatric patients and it is possible that they are psychogenetically explainable.

Methods

Case report and non-systematic review of the relevant literature.

Case presentation

A 78-year-old woman, diagnosed with paranoid schizophrenia, developed the delusion of being pregnant in a relapse of her disease. After this relapse, she and her husband got back together and the family was reunited again. The interpretation of this delusion was psychotherapeutically fruitful.

Literature review

Psychogenesis is probably one of the central phenomena of psychopathology and delusions of pregnancy, surrounded by social and cultural factors of first order, are an example of such a pathogenetic mechanism.

Conclusions

Delusions of pregnancy are frequently a type of psychogenic delusion. This causal phenomenon must be considered in the comprehensive approach to the psychotic patient.

Introduction

Although informal employment is increasingly prevalent in Latin America and the Caribbean, detailed evidence regarding people's perception of their mental health and how it is related to their working and environmental conditions is still lacking. The objective was to determine the sociodemographic, work-related, environmental and health conditions that explain depressive symptoms in workers with subsistence jobs in the centre of Medellín, Colombia in 2016.

Methods

Cross-sectional study with analytical intent, and primary source of information, taken through a survey to a census of 686 workers, after obtaining informed consent. We included people aged >18 who had been in their job for ≥5 years and were informed about the study, and selection and information biases were controlled for. Univariate, bivariate and multivariate analysis.

Results

The workers were aged 50 and mainly male (56.7%). They worked 10 hours/day, six days/week, with >20 years in their trade. Air pollution and noise affected their health, 15.5% had moderate/severe depressive symptoms, and they considered their work an emotional support. Not having a work permit, being exposed to chemical substances and seeing their health affected by noise pollution were associated with a higher prevalence of these symptoms. The majority of the symptoms were associated with: being exposed to chemicals (APR = 1.58; 95%CI, 1.04-2.11); becoming ill from the noise (PR = 2.20; 95%CI, 1.38-3.50); and having to shout to communicate (APR = 1.74; 95%CI, 1.01-3.00).

Conclusions

The depressive symptoms in these workers could be reversed with joint actions of the State and the workers, and they should be considered when formulating public policies aimed at improving their living and working conditions.

Our aim with this study was to compile the available scientific evidence on tardive syndromes, their phenomenology, diagnosis and treatment. For this, a systematic review of the literature was carried out by searching indexed databases (PsycINFO, OvidMEDLINE, PubMed, EMBASE, and Scielo), for articles published from January 2009 to March 2020. Tardive syndromes are a group of movement disorders caused by prolonged exposure to dopamine receptor blocking drugs. They typically appear several months and even years after starting the medication and persist for at least one month after discontinuing the drug. Orofacial dyskinesias have classically been described, but the phenomenological spectrum is wide, including dystonia, chorea, tics, myoclonus and akathisia. Treatment is indicated when symptoms interfere with activities of daily living, including withdrawing the offending drug, while the underlying pathologies allow it, changing to another neuroleptic, or considering pharmacological management. In cases refractory to conventional treatment, functional surgery with globus pallidus deep brain stimulation has shown efficacy for tardive dystonia, although with limited evidence.