Vertex (Buenos Aires, Argentina)最新文献

Delivering the diagnosis of Alzheimer’s disease to the patient can cause situations that do not meet the necessary ethical professional standards. We present two cases in which the rash way such a diagnosis was delivered did not respect the principle of nonmaleficence. In both cases the revelation worsened the situation prior to the consultation, causing unfortunate distress to the patient and family. The blunt use of the term “Alzheimer”, together with the insufficient information on the characteristics of the affection, seems to have been the main factor that produced a negative emotional impact, revealing an arrogant professional attitude of ‘absolute’ and unquestionable knowledge, without the necessary equity. A diagnosis of Alzheimer´s should be not only truthful but delivered with caution, above all things avoiding a further damage than that already brought about by the disease.

Book review of: Ten days in a Mad-House, by Nellie Bly. Alquimia Ediciones, 2021.

Several authors have taken up the challenge of demonstrating the influence of the social environment on mental health and questioning the hegemonic, individual and organicist psychiatric gaze, with the intention of constructing critical models of professional practice in which the subject is prime. This work proposes to study, on the one hand, the fundamental concepts of the sociologist Erving Goffman and, on the other, in the light of them, to expose the current operation of a psychiatric inpatient ward in a general hospital.

Approved drug treatments for Alzheimer´s disease (AD) are symptomatic and don´t modify the disease course. These include acetylcholinesterase inhibitors (AchI) and N-methyl-D-aspartate receptor antagonist, memantine. Around 20 years ago, these drugs were approved for Alzheimer type Dementia. This wasbased on clinical trials which inclusion criteria were focused on a clinical amnestic AD presentation. At that time, subjects with an atypical AD clinical presentation or biomarkers were not included in the pharmacological trials. New biomarkers that detect amyloid and neurodegeneration have allowed us to evaluate pathological changes compatible with AD. These new advances from aclinical and biomarkers perspective allowed a diagnostic criteria update; going from an exclusively clinical criteria to one that is hybrid: clinical presentation and biomarkers based criteria.New biomarkers facilitate the early diagnosis of AD and other dementias.However, they also generate new challenges and questions regarding the adequate pharmacological treatment.There is a need for clinical trials that evaluate anti-dementia drug’s efficacy based on current diagnostic criteria (clinical profile and biomarkers) and new practice guidelines. In addition, regulatory authorities should update ACHI and memantine indications.This will help doctors to prescribe the best possible treatment for this specific population without increasing risks.

The prevalence of autism spectrum conditions has been increasing in recent decades. However, this has not been reflected in an increase in clinical research, so there is insufficient evidence on the supports and adaptations that psychological treatments require for this population. Evidence-based psychological therapies are frequently goal-focused, usually short-term, such as cognitive behavioral therapy, which integrates cognitive and behavioral modalities. Due to the high rates of comorbidity in people with autism, various psychological therapies are in the process of adapting their delivery. This review explores research-suggested adaptations to implement psychological therapies in adults with autism without intellectual disability. Both formal and intervention techniques adaptations are required. Adaptations at each stage of psychological therapies are important to support the differences, needs, and preferences of the adult with autism. Professional training aimed at working with this particular population, and research on how to optimizethe access of this population to mental health services are essential for its correct implementation.

Objective: The purpose of this study was to asess the efficacy of an intensive outpatient treatment (IOT) for substance use disorder (SUD) using a multidimensional approach.

Methods: All the patients consecutively admitted to a private institution between May 2019 and May 2020 were invited to participate in the study. The program consisted in a 12-month set of psychosocial, medical and recreative interventions requiring an attendance of at least 9 hours per week. Efficacy was evaluated at admission and every three months by the Addiction Severity Index (ASI). Quality of life was evaluated at admission and at the end of the treatment by the WHOQOL-Bref questionnaire. A comparison of parameters obtained at admission between the group that completed and the one that abandonned the treatment was also performed to detect potential predictors of early dropout. Six months after the end of the treatment, the participants were contacted in order to repeat an evaluation through the ASI and the WHOQOL-Bref scales.

Results: 41 participants (73% male, age 42.8 ± 16 years) were included. 14 participants dropped out at a median time of88 days. Among those who completed the treatment improvements were observed in different clinical dimensions: in alcohol and drug consumption (3 months), in medical problems (6 months), in family/social relationships (9 months), in psychological scores (12 months) and in the four dimensions of WHOQOL-Bref. No changes were observed in legal problems and in the employment status. Only legal problems and family/social relationships at admission were significantly different among patients who completed versus those who dropped-out. Six months after discharge, no differences in WHOQOL-Bref scores were observed in the 15 participants who could be located and accepted the assessment. A little but statistically significant worsening was observed in the psychological problems dimension of the ASI in post-discharge follow-up. The rest of the ASI dimensions remained unchanged 6 months after concluding the treatment.

Conclusion: This is one of the few studies performed in a latinamerican setting assessing the efficacy of a long-term IOT for SUD. It confirms previous works from developed countries, showing the potential benefits of IOTs implementation in our region.

Addictions are one of the most important health problems worldwide. Within these disorders, cannabis is one of the psychoactive substances with more burden of morbidity and mortality worldwide. The actual knowledge about the effectiveness of treatments for cannabis use disorders is unsatisfactory. This review aims to explore the evidence on cannabidiol for the treatment of cannabis use disorder. There are several clinical pharmacotherapy trials researching cannabis use disorders with limited evidence. A smaller number of trials in animal models and humans on the use of cannabinoids, especially Cannabidiol and Tetrahydrocannabinol to treat cannabis dependence show evidence of reduction in days of use, withdrawal symptoms and craving. New trials are under development, and there is an urgent need for trials with larger numbers of patients and longer treatment periods to support possible indications in the near future.

Objective: To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder ina regional hospital; to explore factors related to the patient’s referrer upon admission and prolonged stay.

Materials and methods: Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%.

Results: 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and ¼ of those admitted had self-excluded themselves from specialized supervision for more than a year.

Conclusions: The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

The pandemic caused by COVID-19 in the world, in its different periods, produced many changes in sleep and in various areas of mental health. Objectives: To evaluate and to compare sleep quality and aspects of mental health during two different periods of the COVID-19 pandemic, as well as to analyze some changes in habits/behaviors. Subjects and methods: A cross-sectional study was carried out, through an anonymous survey. Demographic information, sleep quality, depressive and anxiety symptoms were analyzed. Of the total, 998 surveys were selected. The survey focused on 2 time periods, from March to July 2020 and from March to July 2021. Results: When sleep quality was compared during the 2020 versus 2021 periods, the percentage of poor sleepers went from 51% to 59% in the second period. Regarding depressive symptoms, it went from 21.1 to 16.3% and the percentage of anxiety symptoms went from 59.5 to 47.6%. Poor sleep quality affected more people in 2021 compared to 2020. The percentage of participants with symptoms of anxiety and depression decreased in 2021. People changed some habits/behaviors, such as: changing routine schedules, acquiring pets, sharing their dreams more, and remembering them more frequently. This article contributes to knowing various aspects of sleep, mood swings and changes in habits/behaviors that occurred during the pandemic in Argentina.