Revista Colombiana de psiquiatria (English ed.)最新文献_第3页

“¿De dónde venimos? ¿Qué somos? ¿A dónde vamos?” "我们从哪里来，我们是什么，我们要去哪里？

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2024.07.005

引用次数: 0

Assessing skills in psychiatry. Experience and implementation of OSCE for medical students 评估精神病学技能。医科学生 OSCE 的经验和实施。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2024.07.001

Ángela Rocío Acero González , Álvaro Enrique Romero Tapia , Yahira Rossini Guzmán Sabogal , Sandra Milena Toro Herrera , Lina María Ruiz Moreno , Raúl Andrés Araujo Tabares

Introduction

Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE’s introduction in 2015.

Methods

An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described.

Results

The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0–5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups.

Conclusions

The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

导言：医学教育一直在发生变化，其评估策略不仅涉及理论知识，还涉及临床技能。在心理健康领域，这些技能发挥着核心作用。客观结构化临床考试（OSCE）是可以评估临床技能的评价方法之一。本文介绍了自2015年引入OSCE以来，对本科生进行评估的实施情况和表现：方法：对实施情况进行了说明，并利用这些年的期末实践考试数据库，描述了对心理健康专业第二学期本科医学生进行的OSCE。此外，还介绍了心理健康教师的看法：2015-2学年实施的心理健康OSCE是在该校的模拟医院中开发的，有五个站点（访谈、心理检查、诊断、治疗和向家属提供信息以及伦理）。在 2016-2 学年至 2019-2 学年期间，共有 486 名学生参加了 OSCE，平均得分 3.85（0-5 分）。据观察，评估焦虑障碍时获得的分数低于平均水平，情感障碍的分数高于平均水平，而精神病障碍的分数在平均水平之内。教授们强调了OSCE的多功能性、对实践和理论方面的全面客观评价，以及在不同组别之间进行比较的可能性：OSCE考试为评估医科学生的精神病学能力提供了可能，并能确定教学过程中需要改进的方面。

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引用次数: 0

Telerehabilitation of subjects with neurodevelopmental disorders during confinement due to COVID-19 在因 COVID-19 而被禁闭期间，对患有神经发育障碍的受试者进行远程康复治疗。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.03.002

Esteban Vaucheret Paz, Mariana Giacchino, Mariana Leist, Claudia Chirila, Luciana Petracca, Guillermos Agosta

Introduction

Social distancing measures due to the COVID-19 pandemic prevented many children with neurodevelopmental disorders from accessing face-to-face treatments. Telerehabilitation grew at this time as an alternative therapeutic tool. In this study we analysed remote cognitive rehabilitation in neurodevelopmental disorders.

Methods

This was a prospective, quasi-experimental (before-after) study that included 22 patients (mean age 9.41 years) with neurodevelopmental disorders who had telerehabilitation for over six months.

Results

After six months of telerehabilitation, a statistically significant improvement was found with a large effect size in these areas: attention (sustained, selective and divided), executive functions (verbal and visual working memory, categorisation, processing speed), visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia) and language (comprehensive and expressive). On the Weiss Functional Impairment Scale, all areas (family, learning and school, self-concept, activities of daily living, risk activities) improved with statistical significance. We found a positive correlation between the number of sessions and the improvement observed in executive functions (visual working memory, processing speed), attention (sustained attention, divided attention) and visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia). We did not find statistical significance between the family structure and the number of sessions carried out. A high degree of perception of improvement and satisfaction was observed in the parents.

Conclusions

Telerehabilitation is a safe alternative tool which, although it does not replace face-to-face therapy, can achieve significant cognitive and functional improvements in children with neurodevelopmental disorders.

简介：由于 COVID-19 大流行，许多患有神经发育障碍的儿童无法获得面对面的治疗。此时，远程康复作为一种替代治疗工具得到了发展。在这项研究中，我们对神经发育障碍的远程认知康复进行了分析：这是一项前瞻性准实验（前后对比）研究，包括 22 名接受远程康复治疗超过 6 个月的神经发育障碍患者（平均年龄 9.41 岁）：经过 6 个月的远程康复治疗后，患者在以下方面的能力得到了显著改善，且效果显著：注意力（持续性、选择性和分裂性）、执行功能（语言和视觉工作记忆、分类、处理速度）、视觉空间技能（空间定位、知觉整合、感知、同时性失认症）和语言（综合能力和表达能力）。在韦氏功能障碍量表中，所有方面（家庭、学习和学校、自我概念、日常生活活动、风险活动）的改善都具有统计学意义。我们发现，疗程次数与执行功能（视觉工作记忆、处理速度）、注意力（持续注意力、分散注意力）和视觉空间技能（空间定向、知觉整合、知觉、同时失认症）的改善呈正相关。我们没有发现家庭结构与治疗次数之间存在统计学意义。结论：远程康复是一种安全的替代疗法：远程康复是一种安全的替代工具，虽然它不能取代面对面的治疗，但可以显著改善神经发育障碍儿童的认知和功能。

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引用次数: 0

Problematic Internet Use and Personality Traits: Results in Working Age Adults 有问题的互联网使用与人格特质：工作年龄成年人的研究结果

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2024.08.001

Sofia A. Cárdenas Garza , Reinhard Janssen Aguilar , Ángel Alberto Ruíz Chow

Introduction

Problematic Internet use has become a growing problem worldwide; several factors, including personality, play an essential role in understanding this disorder. The Big Five personality traits and their association with problematic Internet use were examined in a large and diverse population.

Methods

A survey was applied to a total of 1,109 adults of working age. Each answered the Big Five Inventory and the Internet Addiction Test.

Results

Problematic Internet use was found in 10.6% of them (n = 112). The personality traits extraversion and openness to experience were significantly associated with those with the disorder. With adjustment models, a positive association was found between these traits and being single and higher education.

Conclusions

This study represents the largest of its kind in the Spanish-speaking population, highlighting the importance of recognising the factors involved in problematic Internet use.

导言有问题地使用互联网已成为全球范围内一个日益严重的问题；包括人格在内的几个因素在理解这种障碍方面起着至关重要的作用。本研究对大量不同人群的大五人格特质及其与问题性上网的关系进行了研究。方法对 1109 名工作年龄的成年人进行了调查，每个人都回答了大五人格问卷和网络成瘾测试。每个人都回答了大五人格量表和网瘾测试。结果发现其中 10.6%（n = 112）的人有使用互联网的问题。人格特质中的外向性和经验开放性与上网成瘾者有明显的相关性。通过调整模型，发现这些特质与单身和高学历之间存在正相关。结论这项研究是在西班牙语人群中开展的规模最大的同类研究，强调了认识到问题性网络使用所涉及的因素的重要性。

引用次数: 0

Adherence to psychopharmacological treatment in patients with severe and persistent mental disorders: A systematic review 严重持续性精神障碍患者坚持精神药物治疗的情况：系统综述。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.01.004

María José Alvear Velásquez, Iván Patricio Sandoval Carrión

Introduction

It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society.

Objective

To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders.

Methods

A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015–2020) on specialised databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor >0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomised design were included. Once the articles were identified, they were analysed, extracting the information necessary to answer the research questions.

Results

Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight.

Conclusions

Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.

导言：众所周知，不坚持精神药物治疗会给患者和社会带来有害后果：收集有关严重和顽固性精神障碍患者不坚持精神药物治疗的发生率以及影响患者坚持精神药物治疗的因素和原因的信息：系统回顾过去五年（2015-2020 年）在 PubMed、Scopus、Scielo 和 BioMed 等专业数据库中发表的有关成年患者（17 岁以上）的科学文章。收录的原创文章来自影响因子大于 0.5 的索引期刊，以英语或西班牙语撰写，采用分析性、前瞻性、回顾性、横断面和随机设计。确定文章后，对其进行分析，提取回答研究问题所需的信息：结果：共纳入 15 篇文章。其中，40%（6 篇）发表于 2020 年，20%（3 篇）发表于中国，53.3%（8 篇）采用观察性设计。共纳入 5837 名患者，其中 50.6% 为男性（n = 2955），10 项研究报告了中度依从性（n = 10；66.7%）。非依从性从 7.7% 到 60.6% 不等。影响依从性的因素与患者（年龄和性别）、家庭支持网络以及疾病或治疗有关。不坚持治疗的主要原因是缺乏洞察力：结论：坚持精神药物治疗是多因素的。应改善精神健康服务的可及性，重视对患者的教育和提供更多有关精神疾病的知识。采取干预措施，促进教育和与精神科医生的互动，可能会有所裨益。

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引用次数: 0

Association between cognitive impairment and socioeconomic and sociodemographic factors in Colombian older adults 哥伦比亚老年人认知障碍与社会经济和社会人口因素之间的关系。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.02.005

Andrés Felipe Sarmiento Buitrago , Daniela Cerón Perdomo , Mayra Alejandra Mayorga Bogota

Introduction

Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults.

Methods

The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables.

Results

19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43−3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28−0.32), differentially according to gender.

Conclusions

An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.

导言：在世界范围内，由于人口结构的转型，老年人的比例有所增加，这反映在重大神经认知障碍（MND）发病率的增加上。这一现象在哥伦比亚等中低收入国家尤为重要，因为它带来了高昂的经济和社会成本。本研究旨在分析哥伦比亚老年人的社会经济变量与认知障碍之间的关系：在 2015 年哥伦比亚 SABE 调查中，对 23694 名 60 岁以上的成年人进行了记录调查，该调查按企业集团进行分层抽样，对 60 岁以上的成年人具有代表性。该工具使用简略版认知功能障碍测试（AMMSE）评估认知功能障碍，并收集了多个社会经济变量的信息：结果显示：19.7%的参与调查的老年人被检查出患有认知障碍，并给出了评分结论：哥伦比亚老年人的社会经济和社会人口因素与认知障碍之间存在关联。尽管如此，性别因素对认知障碍的影响仍有所不同。

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引用次数: 0

Successful treatment for serious depression with suicidal risk in a heart transplant patient 成功治疗一名有自杀风险的心脏移植患者的严重抑郁症。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.03.001

María del Mar Arango-Posada, Ana Isabel Prada-Escobar, Carolina Marín-Hernández, Veronica Monsalve-Franco, Diana Restrepo-Bernal

Introduction

Major depressive disorder is related to unfavourable outcomes in patients with severe comorbidities. In transplant patients, major depression is associated with worse clinical outcomes.

Case report

We present the case of a 55-year-old man with a heart transplant due to heart failure of ischaemic origin. Six months after the transplant he developed depressed mood, anhedonia and suicidal ideation with a score of 20/27 on the PHQ-9 depression screening scale. After receiving mirtazapine 30 mg/night for a week and persisting with a high suicide risk, it was decided to administer ketamine infusion for 24 h, with which a significant improvement in mood was observed, and the disappearance of suicidal ideation 24 h after the infusion.

Discussion

Depression in transplant patients is a factor associated with graft loss and post-transplant mortality, in addition to favouring other negative outcomes such as deep vein thrombosis.

Conclusions

Ketamine infusion was shown to be an effective and safe option to treat major depression with suicidal risk in a heart transplant patient.

简介重度抑郁症与患有严重并发症的患者的不良预后有关。在移植患者中，重度抑郁症与较差的临床预后有关：本病例是一名 55 岁男子因缺血性心力衰竭而接受心脏移植手术的病例。移植术后六个月，他出现了情绪低落、厌世和自杀倾向，PHQ-9 抑郁症筛查量表评分为 20/27。在接受了每晚30毫克的米氮平治疗一周后，自杀风险仍然很高，于是决定输注氯胺酮24小时，观察到情绪明显好转，输注24小时后自杀念头消失：讨论：移植患者的抑郁症是导致移植物丢失和移植后死亡率的一个因素，此外还可能导致其他不良后果，如深静脉血栓形成：结论：氯胺酮输注被证明是治疗心脏移植患者有自杀风险的重度抑郁症的一种有效而安全的选择。

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引用次数: 0

Medical conditions, symptoms of anxiety, and depression during the COVID-19 pandemic in a population sample of Lima, Peru 在 COVID-19 大流行期间，秘鲁利马人口样本中的医疗状况、焦虑症状和抑郁症状。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.04.004

Hever Krüger-Malpartida , Martin Arevalo-Flores , Victor Anculle-Arauco , Mauricio Dancuart-Mendoza , Bruno Pedraz-Petrozzi

Introduction

This study aims to determine differences between the number of underlying medical conditions, depression, and anxiety, when controlling for the covariates of age, sex, and completed education.

Methods

Participants (n = 484) indicated the number of medical conditions present during the survey, also including the PHQ-9 and GAD-7, to assess depression and anxiety, respectively.

Results

Differences were found between groups of medical conditions and the combined values of PHQ-9 and GAD-7 after controlling for the covariates mentioned above (F_4,954 = 5.78; Wilks’ Λ = 0.95; P < 0.0005). The univariate tests showed differences for PHQ-9 (F_2,478 = 8.70; P < 0.0005) and GAD-7 (F_2,478 = 11.16; P < 0.0005) between the 3 groups. Finally, post-hoc analysis showed differences between participants with one medical condition and with no medical condition (PHQ-9: M_D = 1.82; 95%CI, 0.25–3.40; GAD-7: M_D = 1.73; 95%CI, 0.55–2.91), and between participants with more than one medical condition and participants with no medical condition (PHQ-9: M_D = 3.10; 95%CI, 1.11–5.10; GAD-7: M_D = 2.46; 95%CI, 0.97–3.95).

Conclusions

Our results suggest that people who had a medical condition during the COVID-19 pandemic were more prone to developing severe symptoms of anxiety and depression.

导言：本研究旨在确定在控制年龄、性别和完成教育程度等协变因素的情况下，潜在疾病数量、抑郁和焦虑之间的差异：本研究旨在确定在控制年龄、性别和完成教育程度等协变量的情况下，潜在病症数量、抑郁和焦虑之间的差异：方法：参与者（n = 484）在调查过程中填写了所患疾病的数量，还包括 PHQ-9 和 GAD-7，分别用于评估抑郁和焦虑：在控制了上述协变量后，发现各组医疗状况与 PHQ-9 和 GAD-7 的综合值之间存在差异（F4,954 = 5.78；Wilks' Λ = 0.95；P 2,478 = 8.70；P 2,478 = 11.16；P D = 1.82；95%CI，0.25-3.40；GAD-7：MD = 1.73；95%CI，0.55-2.91），以及在患有一种以上疾病的参与者和没有任何疾病的参与者之间（PHQ-9：MD = 3.10；95%CI，1.11-5.10；GAD-7：MD = 2.46；95%CI，0.97-3.95）：我们的研究结果表明，在 COVID-19 大流行期间患有疾病的人更容易出现严重的焦虑和抑郁症状。

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引用次数: 0

The structure of depressive symptoms using CES-D and ZDS in outpatients in a general hospital in Lima, Peru 使用 CES-D 和 ZDS 分析秘鲁利马一家综合医院门诊患者的抑郁症状结构。

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2022.02.004

Jair R. Jara-Fernández, Nieves Gutiérrez-Kolotvina, Jhoselyn Milagros Flores-Egocheaga, Paulo Ruíz-Grosso, Johann M. Vega-Dienstmaier

Background

Depression represents one of the leading causes of disability due to illness worldwide. Previous studies have demonstrated the significant heterogeneity of the diagnosis of depression, making it necessary to develop new diagnostic approaches. Network analysis is a perspective that considers symptoms as constituents of the psychiatric disorder itself. The objective was to determine the structure of depressive symptoms using the CES-D and ZDS depression scales.

Methods

Cross-sectional study of secondary analysis of 194 patients using the CES-D and ZDS scales. Correlation matrices and regularised partial correlation networks were constructed from the database. Centrality measures were estimated, and a network stability analysis was performed.

Results

On the CES-D scale, the most central item was “Sad”; while on the ZDS scale, the most central items were “Sad” and “Live”. On the CES-D scale, the connection between “Enjoy” and “Happy” was the strongest. On the ZDS scale, the strongest connection was between the items “Live” with “Useful”. The item “Morning” was the least connected on the ZDS.

Conclusions

The most central symptom from the CES-D scale was sadness, while from the ZDS scale, was sadness and anhedonia.

背景：抑郁症是全球因病致残的主要原因之一。以往的研究表明，抑郁症的诊断具有显著的异质性，因此有必要开发新的诊断方法。网络分析从一个角度将症状视为精神障碍本身的组成部分。本研究旨在使用 CES-D 和 ZDS 抑郁量表确定抑郁症状的结构：使用 CES-D 和 ZDS 量表对 194 名患者进行二次分析的横断面研究。从数据库中构建了相关矩阵和正则化部分相关网络。对中心度进行了估算，并进行了网络稳定性分析：在 CES-D 量表中，最中心的项目是 "悲伤"；而在 ZDS 量表中，最中心的项目是 "悲伤 "和 "生活"。在 CES-D 量表中，"享受 "和 "快乐 "之间的联系最强。在 ZDS 量表中，"生活 "与 "有用 "之间的联系最强。结论：结论：CES-D 量表中最主要的症状是悲伤，而 ZDS 量表中最主要的症状是悲伤和失乐症。

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引用次数: 0

Psychopharmacology of Intellectual Disability—Defamed, Debased or Debated? 智障的精神药理学--诋毁、贬低还是辩论？

Revista Colombiana de psiquiatria (English ed.)

Pub Date : 2024-04-01 DOI: 10.1016/j.rcpeng.2024.07.003

Ahmed Naguy

引用次数: 0