Vertex (Buenos Aires, Argentina)最新文献

Introduction: The objective of our study was to estimate the prevalence of prenatal exposure to drugs and the neonatal impact.

Material and methods: Prospective, observational, cross-sectional and analytical study of pregnant women and newborns admitted between March and September 2021. To estimate the prevalence of consumption, the survey and detection of drugs in maternal urine were used as a detection method.

Results: Alcohol consumption had a prevalence of 46.32%, followed by tobacco with 12.12%, marijuana with 5.62% and cocaine with 4.76%. The weight of newborns with mothers with urine positive for some substance was significantly lower than the weight of newborns with mothers with negative urine (mean ± SE of 2800±184gr vs 3332±41gr and median ± MAD of 2950±380gr vs 3385± 335g p 0.002). Gestational age was also significantly lower in neonates with mothers with positive urine (38.00 vs 39.00 p 0.002). Although the prevalence of intrauterine growth retardation (IUGR), malformations, and prematurity was higher in those cases with positive urine, the difference did not become statistically significant.

Conclusions: The prevalence of substance and alcohol use during pregnancy was high with a statistically significant impact on exposed newborns for both weight and gestational age.

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of antidepressants that have revolutionized the psychopharmacological therapeutic field since their appearance. They are in the first line of recommendation forthe treatment of anxiety disorders and major depressive disorder. And although they are better tolerated and have a better side effect profile than the classic ones, they are not exempt from them. Among the adverse effects of SSRIs little considered by health professionals, are apathy or mental dullness. Restrictions of the range of emotions that are related to normal life, such as the ability to cry or feel pleasure, have been reported. This phenomenon has been called variously in the literature, such as emotional blunting, apathy, emotional indifference, or decreased sensitivity or emotional response.

Objectives: The aim of this review is to analyze the emotional effects of SSRI that are described in the literature.

Methods: A bibliographic review of the literature published in Pubmed from 2006 to 2021 was carried out, with the words Mesh "SSRI" and "Apathy" and "emotional blunting".

Results: Literature reports indicate that the mental dullness produced by SSRIs is generated in at least 50 % of the patients who receive them, with different intensities between them.

Conclusions: Although effects of emotional blunting or apathy have been reported with various groups of antidepressants, all reports agree that it occurs more frequently in patients taking SSRIs than with other antidepressants.

Introduction: The Unified Protocol (UP) is a psychotherapeutic intervention that has proven to be effective for the transdiagnostic treatment of emotional disorders, both in individual and group format. Recently, its virtual application through teletherapy has begun to be studied. In a previous pilot study carried out in Argentina in a sample of 7 subjects, significant decreases were observed in levels of depression, difficulties in emotional regulation, hopelessness and negative affect and a significant increase in quality of life after having applied the PU in virtual and group format to people with emotional disorders.

Method: The present work aims to evaluate the maintenance of the results observed in this study after threemonths.

Results: No statistically significant differences were observed in any of the variables analyzed, which shows that the results achieved have been maintained.

Discussion: The UP is presented as a promising intervention for the treatment of emotional disorders in a virtual and group format, although further research is required in order to generalize the results.

Literature concerning patients with Treatment-Resistant Depression (TRD) treatment response and patient report outcomes (PROs) -such as QoL or disability- in Argentina is scarce. In the scope of the Treatment-Resistant Depression in America Latina (TRAL) study which previous results highlighted the burden of TRD compared to non-TRD patients as well as essential epidemiological data in the region, this paper reports on the outcomes of Standard-of-Care (SOC) over a 1-year follow-up of TRD patients in the subsample for Argentina. From a sample of 220 MDD patients identified in 5sites in Argentina, 72 patients were diagnosed with TRD. Exclusion criteria included patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. MADRS, PHQ-9 and PROs (EQ-5D and SDS) were used as outcomes. Patients’ mean age was 54.7 years and 70.3% of the patients were female. Around 61% of the patients achieved a response (reduction of MADRS score ≥ 50%), but over 33% did not achieve a remission (MADRS total score ≤12). Almost 67% of the patients still feltanxious/depressed at the end of the study (EQ-5D), while disruption affected patients in diverse areas -71% in work/school, 69.7% in social life/leisure and 66.6% in their family life/personal responsibilities. The burden of TRD is significant in Argentina, and more effort should be put in the implementation of treatment protocols with better outcomes.

Psychotic symptoms can manifest at any age, but in the elderly they represent a real diagnostic challenge. Thought disorders, hallucinations (usually visual), mood disorders with delusions, impairment of social interaction and occasionally verbal or physical aggression may be observed (Karon & VandenBos, 1998). Since the first descriptions of classical psychiatry, attempts have been made to define the psychoses observed in the elderly and determine whether they are primary "psychiatric" syndromes or, conversely, whether they can be attributed to other pathologies. Thus, different concepts have emerged, such as Late Onset Psychosis or Late-Onset Schizophrenia, Very Late-Onset Psychosis or Very Late-Onset Schizophrenia-Like Psychosis – VLOSL), Late-Life Psychosis, etc.

Introduction: Although there is an abnormal presentation of Niacin Response Syndrome (ANRS) in schizophrenic patients (SZ) compared to subjects with other psychiatric illnesses and with healthy individuals. However, most of the literature is based on studies that have used tests of niacin topical administration, observing, on the other hand, less scientific production of its oral administration. The objective was to determine the sensitivity of the oral niacin test as a method of detecting ASRN in EZ.

Methods: A non-randomized clinical trial was carried out. Two groups were formed, the experimental or SZ, with 21 patients diagnosed with schizophrenia according to DSM-IV-TR SZ or schizoaffective disorder, and the HC group, made up of 20 healthy controls. Both groups were exposed to an oral niacin test and clinical-semiological tools were applied to evaluate the NRS.

Results: 90.5% of the SZ group presented ANRS. In contrast, no participant in the HC group presented ANRS (0%).

Conclusions: Oral niacin administration was sensitive to the detection of ASRN in schizophrenia. Likewise, ASRN could be a gradual phenomenon and its prevalence could be dose-dependent, being lower the lower the dose of oral niacin used. Further trials with larger and randomized samples will be needed.

This document constitutes the third and last part of the Third Argentine Consensus on the Management of Bipolar Disorders carried out by the Argentine Association of Biological Psychiatry (AAPB). Continuing with the initial objective, this section of the Consensus on the Management of Bipolar Disorders is focused on the management of bipolar disorders in special populations. This section constitutes a comprehensive review and expert consideration of the scientific evidence on: a) the management of bipolar disorders in treatment-resistant patients; b) the management of bipolar disorder in childhood and adolescence; c) the management of bipolar disorders in women during their perinatal period and, d) the management of bipolar disorders in older adults.