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No disponible
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Humanos , Femenino , Anciano , Trastornos del Movimiento/diagnóstico , Monitorización Neurofisiológica/métodos , ElectromiografíaRESUMEN
BACKGROUND AND AIMS: The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. METHODS: This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. RESULTS: A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn's disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37-45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6-3.7], depression [OR = 2.4, 95% CI = 1.4-3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1-2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4-5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3-14.2], anxiety [RC = 25.8, 95% CI = 20.0-31.5], depression [RC = 30.6, 95% CI = 24.3-37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3-20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. CONCLUSIONS: The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.
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Fatiga , Glucocorticoides , Enfermedades Inflamatorias del Intestino , Calidad de Vida , Adulto , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/fisiopatología , Depresión/diagnóstico , Depresión/epidemiología , Depresión/fisiopatología , Fatiga/diagnóstico , Fatiga/epidemiología , Fatiga/etiología , Fatiga/psicología , Femenino , Glucocorticoides/efectos adversos , Glucocorticoides/uso terapéutico , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/psicología , Enfermedades Inflamatorias del Intestino/terapia , Masculino , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/fisiopatología , España/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Researchers have previously found that persistent subthreshold symptoms increase the risk and shorten the time until an affective relapse in bipolar disorder (BD) patients. Research has mainly focused on patients from tertiary Care Centers in USA. We tested the hypothesis that even in a different setting, BD outpatients with subsyndromal affective symptoms would re.turn to a subsequent major affective episode significantly faster than completely asymptomatic at baseline. Secondarily, we analysed other variables related to time and risk to relapse. METHODS: A community cohort of BD outpatients from Madrid (Spain) followed-up in a systematic prospective follow-up protocol for up to five years were evaluated. Patients in clinical euthymia at baseline were included and evaluated quarterly. RESULTS: Initially, 225 patients were included in the survival analysis. Of them, according to predefined psychometric criteria, 163 were in euthymia (72.4%) and 62 (27.6%) suffered subsyndromal symptoms. Median follow-up was 157.6 weeks (95% CI, 78.14 to 111); 57.3% of patients experienced at least one affective episode during their follow-up. Median survival time to first affective episode was 109 weeks for patients in euthymia at baseline, versus 35 weeks for those with subsyndromal symptoms (p<0.0001). Psychosocial stress (p=0.003; HR 2.20; 95% CI 1.31-3.68) and the affective mood baseline state, subsyndromal vs. euthymic (p=0.046; HR 1.74; 95%CI 1.009-3.020), were related to time to first affective episode. LIMITATIONS: Naturalistic study, some of the data collected were necessarily retrospective. CONCLUSIONS: In Spanish non-tertiary psychiatric outpatients, subsyndromal BD symptoms and psychosocial stress at baseline predict earlier episode relapse/recurrence.
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Trastorno Bipolar/psicología , Trastorno Bipolar/diagnóstico , Enfermedad Crónica , Trastorno Ciclotímico/psicología , Supervivencia sin Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Estudios Prospectivos , Psicometría , Recurrencia , Estudios Retrospectivos , España , Factores de TiempoRESUMEN
BACKGROUND: Subsyndromal symptoms have been recognized as relevant in the course and outcome of bipolar disorder (BD) patients. Nevertheless, their definition and cutoff points on current depression and mania scales are uncertain. The recently defined International Society for Bipolar Disorders (ISBD) operational criteria for the assessment of the course and outcome of bipolar illness have never been tested until now. METHODS: A naturalistic longitudinal follow-up study of up to 5 years included a cohort of 317 DSM-IV-TR BD outpatients. For the first time, we assessed the proportion of visits in different affective states using the ISBD criteria. Secondarily, we compared the results with those obtained applying other cutoff points. RESULTS: Patients were symptomatic in 39.1% (95% CI 35.3-42.9) of the visits. Subsyndromal symptoms, primarily subsyndromal depression, were present in 15.9% of patients (95% CI 13.4-18.4). No significant differences were found between bipolar I patients and bipolar II patients. There were differences in the total percentage of visits in euthymia depending on the cutoff points (p < 0.05). CONCLUSIONS: Applying ISBD criteria, bipolar patients have significant clinical morbidity and are often symptomatic, both with threshold symptoms and with subthreshold symptoms, especially with depression. The chosen cutoff points modify the apparent results. LIMITATIONS: The cutoff points used have not been validated. Psychopharmacologic treatments were naturalistic.
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Trastorno Bipolar/diagnóstico , Trastorno Bipolar/epidemiología , Progresión de la Enfermedad , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Psicometría , Índice de Severidad de la EnfermedadRESUMEN
No disponible
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Humanos , Femenino , Anciano , Catatonia/etiología , Trastorno Bipolar/complicaciones , Diagnóstico DiferencialRESUMEN
Introducción. El propósito de este estudio transversal es obtener un perfil de las características sociodemográficas, clínicas, de funcionamiento psicosocial y pautas terapéuticas de los pacientes con trastorno bipolar atendidos de forma ambulatoria en la Comunidad de Madrid. Metodología. Un total de 115 pacientes fueron incluidos en el estudio de forma consecutiva por 10 psiquiatras. Resultados. Desde el inicio de los síntomas hasta recibir un diagnóstico correcto de trastorno bipolar habían transcurrido una media de 7,6 años. La depresión fue la forma de inicio de la enfermedad en la mayoría de los pacientes, independientemente del subtipo. El 47% de los pacientes presentaba alguna sintomatología clínica sindrómica o subsindrómica, siendo depresiva la más predominante (33,1%). Una percepción subjetiva reducida de la calidad de vida se asoció a la presencia de síntomas depresivos y a una peor evolución el año previo. Más de la mitad del total de los pacientes (58,2%) se encontraban en una situación de sobrepeso u obesidad. El litio fue el estabilizador del humor más utilizado (71,3%), aunque el 41% de los pacientes recibía al menos tres psicofármacos. Conclusiones. Los resultados obtenidos en este estudio confirman en gran medida buena parte de los datos conocidos en la actualidad sobre el trastorno bipolar. Destaca la disminución en la calidad de vida de los pacientes bipolares relacionada con la presencia de síntomas depresivos. Se hace necesario optimizar los tratamientos en el trastorno bipolar para mejorar así su pronóstico (AU)
Introduction. The purpose of this cross-sectional study is to obtain a sociodemographic, clinical, psycho-social functioning and therapeutic profile of bipolar outpatients in the Madrid Community. Methods. A total of 115 outpatients were consecutively recruited by 10 psychiatrists. Results. Mean time between initial symptoms and an accurate bipolar diagnosis was of 7.6 years. A depressive episode was the onset of the illness in most patients independently of clinical subtype. Syndromal or subsyndromal symptoms were present in 47% of the patient population, dominating the depressive polarity (33.1 %). A subjectively reduced perception of quality of life was associated to the presence of depressive symptoms and a worse clinical outcome last year. More than half of the patients (58.2%) were overweight or obese. Lithium was the most frequently used mood stabilizer (71.3%), whereas41 % of the patients were taking at least three psychotropic drugs. Conclusions. Results of this study widely confirm previous data on bipolar disorder. Reduction in quality of life of bipolar patients associated to depressive symptoms must be highlighted. It is necessary to optimize treatments in bipolar disorder in order to improve prognosis (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Atención Ambulatoria/psicología , Pacientes Ambulatorios/psicología , Calidad de Vida/psicología , Depresión/epidemiología , Litio/uso terapéutico , Protocolos Clínicos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Antipsicóticos/uso terapéutico , Trastorno Bipolar/epidemiología , Pacientes Ambulatorios/estadística & datos numéricos , Estudios Transversales , Apoyo Social , España/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Signos y Síntomas , Modelos Logísticos , Hábitos , Ácido Valproico/uso terapéuticoRESUMEN
INTRODUCTION: The purpose of this cross-sectional study is to obtain a sociodemographic, clinical, psychosocial functioning and therapeutic profile of bipolar outpatients in the Madrid Community. METHODS: A total of 115 outpatients were consecutively recruited by 10 psychiatrists. RESULTS: Mean time between initial symptoms and an accurate bipolar diagnosis was of 7.6 years. A depressive episode was the onset of the illness in most patients independently of clinical subtype. Syndromal or subsyndromal symptoms were present in 47% of the patient population, dominating the depressive polarity (33.1%). A subjectively reduced perception of quality of life was associated to the presence of depressive symptoms and a worse clinical outcome last year. More than half of the patients (58.2%) were overweight or obese. Lithium was the most frequently used mood stabilizer (71.3%), whereas 41% of the patients were taking at least three psychotropic drugs. CONCLUSIONS: Results of this study widely confirm previous data on bipolar disorder. Reduction in quality of life of bipolar patients associated to depressive symptoms must be highlighted. It is necessary to optimize treatments in bipolar disorder in order to improve prognosis.
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Trastorno Bipolar/diagnóstico , Trastorno Bipolar/terapia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , España , Población UrbanaRESUMEN
FUNDAMENTO: Se investigan la prevalencia y los factores de riesgo del hipotiroidismo clínico y subclínico en pacientes tratados con litio. PACIENTES Y MÉTODO: Se estudiaron todos los pacientes que recibían litioterapia de al menos 2 años de duración. RESULTADOS: La prevalencia de hipotiroidismo clínico y subclínico fue del 10,5 por ciento. La edad elevada al inicio del tratamiento y el sexo femenino se asociaron significativamente con la presencia de hipotiroidismo clínico. CONCLUSIONES: Los factores de riesgo de hipotiroidismo en pacientes tratados con litio son similares a los de la población general (AU)
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Adulto , Femenino , Masculino , Persona de Mediana Edad , Humanos , Trastornos Psicóticos Afectivos/tratamiento farmacológico , Glándula Tiroides , Hipotiroidismo/inducido químicamente , Carbonato de Litio/efectos adversos , Factores de Riesgo , Enfermedades de la Tiroides/epidemiologíaRESUMEN
INTRODUCTION: In spite of the frequent prophylactic use of lithium salts in affective disorders, few papers have been published about clinical outcome predictors in long-term follow-up. OBJECTIVE: To identify clinical predictors of long-term outcome in a sample of bipolar outpatients on lithium treatment. METHODS: An intervention study was conducted in a case series of all patients treated, at least for two years, at two Affective Disorders ambulatory Units. It was examined the association between two dependent outcome variables (presence vs absence of relapses and number of relapses/person/year) and the rest of clinical variables. RESULTS: 139 outpatients diagnosed of bipolar disorder were included in the sample. In each case, therapeutic lithium dosages were administered. Delay time to start treatment since the disorder has begun was the only variable useful to predict weakly outcome. The time spent without treatment and the association with other mood stabilizers or neuroleptics correlates with bad outcome. CONCLUSION: Whichever clinical characteristics of the sample may be, patients should be treated as soon as possible with lithium to get better outcome.
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Trastorno Bipolar/tratamiento farmacológico , Litio/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sales (Química) , Factores de TiempoRESUMEN
Introducción: A pesar de la amplia utilización de las sales de litio en el tratamiento profiláctico de los trastornos afectivos, existen pocos trabajos publicados sobre las variables predictivas de respuesta al tratamiento en seguimientos a largo plazo. Objetivo: Identificar las variables predictoras de evolución en una muestra amplia de pacientes bipolares en tratamiento ambulatorio con sales de litio. Metodología: Diseño: estudio de intervención, con evaluación pre-post en una serie de casos. Muestra: todos los pacientes en tratamiento durante al menos dos años, en dos unidades de trastornos afectivos. Se estudia la posible asociación de las variables dependientes, presencia o ausencia de recaídas y número de fases por persona y año antes, y durante el tratamiento con litio, con el resto de variables clínicas recogidas. Resultados: La muestra la componen 139 pacientes diagnosticados de trastorno bipolar en tratamiento ambulatorio con sales de litio. La única variable que predice de forma débil la respuesta al litio es el tiempo de demora entre el inicio de la enfermedad y el tratamiento. Los meses de abandono del tratamiento, así como la asociación de otros estabilizadores o de neurolépticos, también correlacionan con peor respuesta, aunque estas últimas variables no son conocidas al inicio del tratamiento. Conclusiones: Independientemente de las características clínicas de una muestra habría que iniciar, lo antes posible, el tratamiento con sales de litio para mejorar la respuesta al mismo (AU)
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Persona de Mediana Edad , Masculino , Femenino , Humanos , Comercio , Factores de Tiempo , Trastorno Bipolar , Litio , Estudios de SeguimientoRESUMEN
UNLABELLED: Lithium effectiveness in manic depressive illness is still controversial. Recent naturalistic trials on lithium effectiveness as a mood stabilizer offer poorer results than previous controlled studies. These previous studies have methodological deficiencies. OBJECTIVE: To determine the effectiveness of lithium treatment as a mood stabilizer under real clinical conditions. METHODOLOGY: An intervention study in a case series of all patients treated at least for two years at two Affective Disorders ambulatory Units was conducted to evaluate the incidence of episodes by year, before and during lithium therapy. RESULTS: 152 patients were included. (91% were bipolar patients). Most of them were in monotherapy. The average time of illness before lithium treatment was 13 years, and cases were followed up a media of 8 years. Only 33% of the sample had no relapses during lithium therapy. An average of 1.38 (+/- 2.89) episodes/person year was estimated previous to lithium therapy and was decreased to 0.35 (+/- 0.47) phases/person year during lithium therapy. CONCLUSIONS: Although the total absence of relapses is not attained in most of the patients, our results support the lithium effectiveness to reduce the relapses in bipolar patients.
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Antimaníacos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Litio/uso terapéutico , Trastornos del Humor/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Prevención Secundaria , Resultado del TratamientoRESUMEN
Introducción: En la actualidad existe todavía controversia sobre la efectividad del litio como profiláctico, dado que en los estudios observacionales más recientes se obtienen muy pobres resultados, en comparación con los ensayos controlados iniciales, los cuales a su vez presentaban serios problemas metodológicos. Objetivo: Valorar la efectividad del litio como estabilizador del ánimo en condiciones clínicas habituales. Metodología: Diseño: estudio de intervención, con evaluación pre-post en una serie de casos. Muestra: Todos los pacientes en tratamiento durante al menos dos años, en dos Unidades de trastornos afectivos. Se comparó la incidencia de recaídas (por unidad de tiempo) antes y durante el tratamiento con litio. Resultados: Se incluyeron 152 pacientes (91 por ciento bipolares). El tiempo medio de enfermedad antes del tratamiento con litio era de 13 años y durante el tratamiento con litio fue de ocho años. Sólo el 33 por ciento no tuvo ninguna recaída, pero globalmente se alcanzó una disminución significativa de la incidencia de recaídas maníacas y depresivas, pasando de 1,38 (ñ 2,89) antes del litio hasta 0,35 (ñ 0,47) durante la litioterapia. Es decir, se obtuvo una reducción del riesgo de recaídas totales de una fase/persona año1. Conclusiones: Si bien no se obtiene una ausencia total de recaídas en la mayoría de los pacientes, nuestros resultados apoyan la efectividad del litio en la reducción del número de recaídas de los pacientes bipolares. (AU)
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Persona de Mediana Edad , Masculino , Femenino , Humanos , Incidencia , Resultado del Tratamiento , Antimaníacos , Recurrencia , Trastornos del Humor , Trastorno Bipolar , Litio , Estudios de SeguimientoRESUMEN
This study examined the relationship between clinical and psychosocial variables and unipolar major depression outcome. Ninety ambulatory patients, with an index phase duration of less than 6 months, were followed-up for 12 months. Two measures of outcome were used: persistence of severe or partial symptomatology. Sixty percent of the patients were asymptomatic (HDRS < 8), 24% improved but not totally and 17% persisted with severe symptomatology (HDRS> 18). Personality disorder, recurrent depression, low self-esteem and low satisfaction with social support were associated to non-full remission. Personality disorder and low satisfaction with social support were associated to non-improvement. This work underlines the need during treatment to take into account personality and social variables.
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Trastorno Depresivo Mayor/diagnóstico , Adulto , Trastorno Depresivo Mayor/psicología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Satisfacción del Paciente , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Pronóstico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Autoimagen , Índice de Severidad de la Enfermedad , Apoyo SocialRESUMEN
A number of authors have indicated in recent years that the course of depression is not as favourable as previously expected. Research conducted in order to identify predictors of recovery has shown widely different results. In this paper a sample of 90 consecutive patients with non-chronic major depressive disorders (index episode < 6 months) attending four mental health centres in Madrid were followed up prospectively for 6 months, and clinical social and cognitive variables were studied. The patients were treated pharmacologically and controlled. The rate of recovery was measured according to the Hamilton Rating Scale for Depression (HAM-D). Other tools used were: Life Events and Chronic Difficulties, Global Assessment Functioning in the 6 months prior to the onset of episode, Brown Rating Scale for Self-Esteem and Mannheim Interview of Social Support. The results showed that 41 cases recovered (HAM-D score < 8), 29 cases achieved a partial remission, and major depressive disorder persisted in 17 cases (HAM-D score > or = 18). The presence of personality disorders, having suffered a previous episode, GAF score and some aspects of social support were the variables most associated with non full remission in the logistic regression analysis. Personality disorders and the initial HAM-D score were related to non-improvement. Some clinical and cognitive variables maintain a weak relation to outcome and are rejected in logistic regression. This study emphasizes the relationship of personality, and social variables such as social support and previous global functioning, with incomplete recovery in major depression.
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Trastorno Depresivo/terapia , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Trastorno Depresivo/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Trastornos de la Personalidad/complicaciones , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Prevención Secundaria , Apoyo Social , Resultado del TratamientoRESUMEN
We studied the relationship between 2 types of psychosocial factors, life events and chronic stress, and the numerical order of the depressive episodes. The population studied consisted of 97 subjects suffering from major depressive disorder and 65 controls. Life events occurred with the first 2 depressive episodes with significantly higher frequency than with later episodes or with the control group. Patients in the third or later episode had no more life events than controls. No significant differences were apparent in the incidence of chronic stress in the different depressive episodes of the patient group or in the comparison of this group with controls. No second order interaction between life events and chronic stress was found.