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Introduction: Adjustment disorder (AD) is a diagnosis that must be differentiated from major depressive episode (MDE) because of the therapeutic implications. The aim of this study is to understand the experience of patients who in their lifetime have been diagnosed with AD as well as MDE to establish the characteristics of each disorder. Methods: A descriptive phenomenological approach was used with in-depth interviews to four patients and the method proposed by Colaizzi to understand the experiences and reach the description of both disorders. Results: Three women and one man, with advanced schooling were interviewed. The participants emphasized the existence of differences that were grouped in: the attribution made by the individual, the theme of cognitions, the variability in the course, the possibility of mood modulation, the syndrome severity, the presence of hopelessness and the perceived course. Conclusion: Phenomenological differences were found in the subjective experience of MDE and AD. The MDE would be described as an intense state of generalized shutdown of the subject's own life, with little response to events, and the AD, as a dynamic reaction attributed to a stressful event, with high variability in the course of symptoms due to the dependence on such event, with the preserved hope that it will end.

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ABSTRACT Background: Delusion of control, including thought insertion, occurs in 20% of patients with schizophrenia. However little is known of its psychopathology, and studies involving patients are scarce. Aims: To explore the subjective experience of patients with delusion of control and to propose a psychopathological explanation based on empirical evidence. Methods: Qualitative exploratory study of 7 patients (6 with schizophrenia and 1 with schizophreniform disorder). A phenomenologically-oriented semi-structured interview was used. Results: Delusion of control is not an isolated and pure symptom; it is always immersed in the context of a persecutory delusion and other psychiatric symptoms. The patient experiences partial control, i.e. the control is never complete. In all cases, it is possible to trace the history of the narrative formation of delusion of control from its origins in persecutory delusions and other concomitant symptoms. Conclusions: The delusion of control is a narrative resulting from the joint presence of a persecutory delusion and other psychiatric symptoms. For the patient, the delusion of control is the narrative of the elaborate expression of the meaning of the anomalous experience. Delusion of control is a narrative variety of persecutory delusion.

resumen Introducción: El delirio de control, incluida la inserción de pensamientos, se presenta en el 20% de los pacientes con esquizofrenia. Sin embargo, se conoce poco de su psicopatología y los estudios que implican a pacientes son escasos. Objetivo: A partir de una serie de casos clínicos, explorar la experiencia subjetiva de pacientes con delirio de control y proponer una explicación psicopatológica con base en elementos empíricos. Métodos: Estudio exploratorio de tipo cualitativo con 7 pacientes (6 con esquizofrenia y 1 con trastorno esquizofreniforme). Se utilizó una entrevista semi estructurada de orientación fenomenológica. Resultados: El delirio de control no se presenta como síntoma aislado y puro, siempre está inmerso en el contexto de un delirio persecutorio y otros síntomas psiquiátricos. El control vivido por el paciente es parcial, nunca total. En todos los casos fue posible rastrear la historia de la constitución narrativa del delirio de control a partir del delirio persecutorio y los otros síntomas concomitantes. El delirio de control es la narrativa que expresa de manera más elaborada el sentido que la experiencia tiene para el paciente. Conclusiones: El delirio de control es una narrativa derivada de la concomitancia de un delirio persecutorio y otros síntomas psiquiátricos. Es la narrativa que expresa de manera más elaborada el sentido que tiene la experiencia anómala para el paciente. El delirio de control es una variedad narrativa del delirio persecutorio.

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INTRODUCTION: It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. OBJECTIVES: Find differences in subjective experience (first person) between unipolar and bipolar depression. METHODS: Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). RESULTS: The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. CONCLUSIONS: Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.

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Introducción: Es importante distinguir la depresión unipolar de la bipolar, pues hay diferencias en el tratamiento y el pronóstico. Dado que el diagnóstico de las dos condiciones es netamente clínico, encontrar diferencias sintomáticas puede ser de gran utilidad. Objetivos: Buscar diferencias en la experiencia subjetiva (de primera persona) entre depresión unipolar y bipolar. Métodos: Estudio exploratorio de tipo cualitativo, de orientación fenomenológica, con 12 pacientes (7 con depresión bipolar y 5 con depresión unipolar; 3 varones y 9 mujeres). Se utilizó una entrevista semiestructurada basada en el Examen de la Experiencia Anómala del Self (EASE). Resultados: Estado de ánimo predominante: en la depresión bipolar es el apagamiento emocional; en la unipolar, la tristeza. Experiencia del cuerpo: en la bipolar, el cuerpo se siente pesado, francamente cansado y como un obstáculo para el movimiento. En la unipolar, la experiencia del cuerpo se parece a la pereza cotidiana. Cognición y flujo de conciencia: en la depresión bipolar, en comparación con la unipolar, el pensamiento se vive lentificado, como si tuviera que vencer obstáculos en su curso; hay mayor dificultad para comprender lo que se escucha o se lee. Perspectiva del futuro: en la depresión bipolar, la desesperanza es más intensa y de mayor alcance que en la unipolar, como si se perdiera la posibilidad misma de la esperanza. Conclusiones: Se encontraron diferencias cualitativas en el estado de ánimo predominante, la experiencia corporal, la cognición y la perspectiva del futuro entre la depresión unipolar y la bipolar.

Introduction: It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. Objectives: Find differences in subjective experience (first person) between unipolar and bipolar depression. Methods: Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). Results: The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. Conclusions: Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.

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Introducción: La ciencia cognitiva se ha constituido en el paradigma acerca de lo mental más influyente de finales del siglo XX y comienzos del XXI. Sus conceptos, el planteamiento de los problemas y las soluciones a estos han sufrido modificaciones significativas en pocos años. Método: Se presentan y se discuten los conceptos fundamentales de la ciencia cognitiva, dividiéndola en cuatro etapas de desarrollo: los inicios, el cognitivismo clásico, el conexionismo y la corporalización-enacción. También se explora el ámbito clínico, sobre todo lo atinente a la psicoterapia cognitiva. Desarrollo y Conclusiones: En la etapa de corporalización-enacción se destaca el papel del cuerpo, que con su conjunto evolutivamente determinado de movimientos da lugar a una manera de navegar el mundo y a un estilo de pensar. La realización de las tareas cognitivas es vista como un proceso que utiliza recursos del entorno capaces de amplificar las habilidades mentales y desplegarlas más allá del ámbito interno del cerebro. Por otra parte, se encuentra al cuerpo y la mente embebidos en el mundo, creando la cognición al interactuar con él, proceso denominado enacción. Desde esta perspectiva, se considera que hay una íntima conexión entre la percepción y la acción, de ahí el interés enlas interacciones con el mundo en tiempo real más que en el razonamiento abstracto. En cuanto al ámbito clínico, específicamente la terapia cognitiva, hay poca discusión conceptual, debido quizá a que los buenos resultados en la práctica llevan a pensar que los fundamentos teóricos son firmes y poco problemáticos…

Introduction: Cognitive science has become the most influential paradigm on mental health in the late 20th and the early 21st centuries. In few years, the concepts, problem approaches and solutions proper to this science have significantly changed. Method: Introduction and discussion of the fundamental concepts of cognitive science divided in four stages: Start, Classic Cognitivism, Connectionism, and Embodying / Enacting. The 2nd Part of the paper discusses the above mentioned fourth stage and explores the clinical setting, especially in terms of cognitive psychotherapy. Development and Conclusions: The embodying/ enacting stage highlights the role of the body including a set of determined evolutionary movements which provide a way of thinking and exploring the world. The performance of cognitive tasks is considered as a process that uses environmental resources that enhances mental skills and deploys them beyond the domestic sphere of the brain. On the other hand, body and mind are embedded in the world, thus giving rise to cognition when interacting, a process known as enacting. There is a close connection between perception and action, hence the interest in real-time interactions with the world rather than abstract reasoning. Regarding clinics, specifically the cognitive therapy, there is little conceptual discussion maybe due to good results from practice that may led us to consider that theoretical foundations are firm and not problem-raising…AU)

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INTRODUCTION: Cognitive science has become the most influential paradigm on mental health in the late 20(th) and the early 21(st) centuries. In few years, the concepts, problem approaches and solutions proper to this science have significantly changed. METHOD: Introduction and discussion of the fundamental concepts of cognitive science divided in four stages: Start, Classic Cognitivism, Connectionism, and Embodying / Enacting. The 2(nd) Part of the paper discusses the above mentioned fourth stage and explores the clinical setting, especially in terms of cognitive psychotherapy. DEVELOPMENT AND CONCLUSIONS: The embodying/enacting stage highlights the role of the body including a set of determined evolutionary movements which provide a way of thinking and exploring the world. The performance of cognitive tasks is considered as a process that uses environmental resources that enhances mental skills and deploys them beyond the domestic sphere of the brain. On the other hand, body and mind are embedded in the world, thus giving rise to cognition when interacting, a process known as enacting. There is a close connection between perception and action, hence the interest in real-time interactions with the world rather than abstract reasoning. Regarding clinics, specifically the cognitive therapy, there is little conceptual discussion maybe due to good results from practice that may led us to consider that theoretical foundations are firm and not problem-raising.

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Finales del siglo XX y comienzos del XXI. Sus conceptos, el planteamiento de los problemas y las soluciones a estos han sufrido modificaciones significativas en el curso de pocos años. Método: Presentación y discusión de los fundamentos de la ciencia cognitiva en cuatro etapas: los inicios, el cognitivismo clásico, el conexionismo y la corporalización-en acción. Desarrollo y conclusión: Los inicios están marcados por la construcción de las computadoras modernas y la aparición de la teoría de la información. El cognitivismo clásico comenzó en 1956 con la noción de que todos los sistemas procesadores de información, incluido el cerebro humano, comparten los mismos principios. A partir de la analogía entre la computadora y el cerebro, se consideró apropiado estudiar la mente como si se tratara de un software. El conexionismo, también llamado procesamiento distribuido en paralelo o de redes neuronales, permite explicar la rapidez con que se realizan los procesos cognitivos y su resistencia a los daños. No trabaja con símbolos, sino con patrones de activación y desactivación de las unidades componentes y de transmisión de señales entre ellas. En percepción y memoria se encuentran los casos típicos de tareas realizadas por redes neuronales, por ejemplo, reconocimiento de patrones (rostros, palabras a partir de letras, etc.).

Introduction: Cognitive science has become the most influential mental paradigm of the late twentieth and early twenty-first centuries. Its concepts and approach to problems and solutions have changed significantly in the course of a few years. Method: The fundamental concepts of cognitive science are presented and discussed, divided into four stages: The beginnings, classical cognitivism, connectionism, and embodiment-enaction. Development and Conclusion: The beginnings are marked by the construction of modern computers and the advent of information theory. Classical cognitivism began in 1956 with the notion that all information processing systems, including the human brain, share the same principles. From the analogy between computer and brain, it was considered appropriate to study the mind as if it were software. Connectionism, also called parallel distributed processing or neural networks get these names because of their underlying computational architecture. It helps explain the speed with which cognitive processes are performed and resistance to damage, being closer to biology. It does not work with representations, but with patterns of activation and deactivation of the component units and transmission of signals between them. Typical cases of tasks performed by neural networks are found in perception and memory, for example, pattern recognition (faces, words from letters, etc).

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Introducción: Este artículo busca determinar la prevalencia y los factores asociados a la no adherencia en el tratamiento de mantenimiento de pacientes adultos con diagnóstico de trastorno afectivo bipolar. Métodos: Estudio de corte transversal con 124 pacientes ambulatorios. Se evaluó la adherencia al tratamiento de mantenimiento con el cuestionario de Morisky-Green. Se usó, además, la escala de impresión clínica global modificada para el trastorno bipolar (CGI-BPM) y el test de Apgar familiar. Resultados: La prevalencia de la no adherencia al tratamiento farmacológico de mantenimiento fue del 29,8%, y fue mayor para las mujeres (64,9%) que para los hombres (35,1%), si bien la diferencia no fue estadísticamente significativa (p=0,17). Los factores que de manera estadísticamente significativa se asociaron a la no adherencia fueron: mayor gravedad de la enfermedad (OR 1,9), antecedente de no adherencia (39%, p=0,001), menor insight (87%, RP 4,65), haberse sentido estigmatizado por padecer la enfermedad (50%, RP 6,2), el hábito de fumar (47,6%, p=0,048), mayor disfunción familiar, no contar con familiares que ayuden al paciente en la toma del medicamento (73%, p=0,001) y percepción negativa del médico tratante (100%, p=0,001). Conclusiones: La prevalencia estuvo dentro del rango de otros estudios publicados. Los factores asociados a la no adherencia fueron: mayor gravedad de la enfermedad, sentirse estigmatizado, antecedentes de falta de adherencia, pobre insight, el hábito de fumar, disfunción familiar, no tener familiares que ayuden a tomar el medicamento y la percepción negativa del médico tratante...

Introduction: This study aims to determine the prevalence and factors associated with non-adherence in maintenance treatment of adult patients diagnosed with bipolar disorder. Methods: Cross sectional study with 124 patients. Adherence to treatment was evaluated by the Morisky-Green Test. A structured questionnaire was applied. It included variables associated with demographics factors and factors related to the patient, illness, treatment, family, therapeutic relationship, and health system. The Global Impression Scale Modified for Bipolar Disorder (CGIBPM) and Family Apgar were used as well. Results: The prevalence of non-adherence to maintenance drug treatment was 29.8%. It was greater in women (64.9%) than men (35.1%), although this difference was not statistically significant (p = 0.17). The factors statistically significant associated with nonadherence factors were: Increased severity of the disease (OR 1.9), history of non-adherence (39% P=0,001), negative perception of the psychiatrist (100%, P=0.001), less insight (87%, RP4.65), greater stigma (50%, RP 6.2), having no family member to remind taking the drug (73%, P=0.001). Conclusions: The prevalence was inside the range found in other studies. The statistically significant factors associated with non-adherence were: Severity of disease, history of non-compliance, stigma, no family support, poor insight, smoking habit, and negative perception of the psychiatrist...

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OBJECTIVES: To report trends in mortality from suicide in Colombia from 1985 to 2002 by sex, age group, and method, and determine the number of Years of Potential Life Lost (YPLL) to suicide during this period. METHODS: Age- and sex-specific and age-adjusted crude mortality rates were calculated based on mortality and population information available from the official database of the Department of National Statistics Administration, Colombia. YPLL were estimated and adjusted for societal impact, age, and poor quality of mortality records. The results were tabulated according to codes X600-X849 and Y870 from the International Statistical Classification of Disease and Related Health Problems, 10th revision (ICD-10), and codes E950-E959 from the 9th revision (ICD-9). RESULTS: Suicide rates have been climbing in Colombia since 1998, particularly among young adults and males. The highest rates among males were in the age groups 20-29 years of age and over 70 years of age, and rates increased over time. Among females, the highest rates were recorded for the group 10-19 years of age. The YPLL rose in proportion with the increase in suicides, from 0.81% in 1981 to 2.20% in 2002. Among males, the most common methods used were firearms and explosives, hanging, and poison, with a relative increase in hanging; whereas among females, poison was most common. CONCLUSIONS: A rising trend in suicide rates in Colombia was confirmed, especially among the productive segment of the population, which has resulted in a marked increase in YPLL.

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OBJETIVOS: Describir las tendencias de la mortalidad por suicidios en Colombia en el período de 1985 a 2002, analizar su comportamiento según el sexo, el grupo de edad y el mecanismo de lesión y calcular los años de vida potencial perdidos (AVPP) por suicidios en ese período. MÉTODOS: Se calcularon las tasas de mortalidad crudas, específicas por edad y sexo y ajustadas por la edad, a partir de la información de mortalidad y población de las bases de datos oficiales del Departamento Administrativo Nacional de Estadística de Colombia. Se estimaron los AVPP, corregidos por el impacto social, la edad y la mala calidad de los registros de muertes. La tabulación de los resultados se realizó según los códigos X600-X849 y Y870 de la décima revisión de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud (CIE-10) y los códigos E950-E959 de la novena revisión (CIE-9). RESULTADOS: Se observó un aumento considerable en las tasas de suicidios en Colombia a partir de 1998, particularmente en la población de adultos jóvenes y en hombres. Las tasas más altas en los hombres se observaron en los grupos de 20 a 29 años y de mayores de 70, con un incremento en el tiempo. En las mujeres, las tasas más altas se registraron en el grupo de 10 a 19 años. La proporción de AVPP por suicidios aumentó de 0,81 por ciento en 1981 a 2,20 por ciento en 2002. En los hombres, los principales mecanismos de lesión fueron las heridas por armas de fuego y explosivos, el ahorcamiento y el envenenamiento, con un aumento relativo del ahorcamiento, mientras que en las mujeres fue el envenenamiento. CONCLUSIONES: Se confirmó la tendencia ascendente en la tasa de suicidios en Colombia, especialmente en el segmento de la población laboralmente activa, lo que conlleva un drástico incremento en los AVPP.

OBJECTIVES: To report trends in mortality from suicide in Colombia from 1985 to 2002 by sex, age group, and method, and determine the number of Years of Potential Life Lost (YPLL) to suicide during this period. METHODS: Age- and sex-specific and age-adjusted crude mortality rates were calculated based on mortality and population information available from the official database of the Department of National Statistics Administration, Colombia. YPLL were estimated and adjusted for societal impact, age, and poor quality of mortality records. The results were tabulated according to codes X600-X849 and Y870 from the International Statistical Classification of Disease and Related Health Problems, 10th revision (ICD-10), and codes E950-E959 from the 9th revision (ICD-9). RESULTS: Suicide rates have been climbing in Colombia since 1998, particularly among young adults and males. The highest rates among males were in the age groups 20-29 years of age and over 70 years of age, and rates increased over time. Among females, the highest rates were recorded for the group 10-19 years of age. The YPLL rose in proportion with the increase in suicides, from 0.81 percent in 1981 to 2.20 percent in 2002. Among males, the most common methods used were firearms and explosives, hanging, and poison, with a relative increase in hanging; whereas among females, poison was most common. CONCLUSIONS: A rising trend in suicide rates in Colombia was confirmed, especially among the productive segment of the population, which has resulted in a marked increase in YPLL.

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Objetivo: Presentar la historia un hombre joven que desde la infancia ha mostrado rasgos de trastorno de personalidad depresiva. Método: Reporte de caso. Resultados y conclusión: Si bien el trastorno de personalidad depresiva tan sólo figura en el anexo del DSM-IV, ha sido ampliamente discutido en diversas publicaciones. En el presente caso clínico, a partir de la narración en primera persona, se emplea una aproximación de tipo fenomenológico que destaca el ámbito de las vivencias predominantes de alguien con este trastorno de personalidad; las principales son el sinsentido de la vida, el aburrimiento y la sensación de vacío.

Objective: To present the story of a young man who has shown depressive personality traits since infancy. Methods: Case report. Results and conclusion: Even though depressive personality disorder is described only in the annex of DSM-IV, it has been widely discussed in various publications. In this clinical case with a first person narration, a phenomenological approach is used that highlights the environment of the predominant experiences of someone with this personality disorder; namely the senselessness of life, boredom and a sensation of emptiness…

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La estimulación magnética transcraneana (EMT) es una técnica neurofisiológica nueva que permite inducir una corriente eléctrica en el interior del cerebro mediante un campo magnético que atraviesa el cuero cabelludo y el cráneo sin causar dolor. Debido a esto no se requiere anestesia alguna. Existen dos tipos de aplicación: EMT simple y EMT repetitiva (EMTr). La primera hace referencia a la aplicación de estímulos únicos. La EMTr es la aplicación de estímulos repetidos con regularidad a una misma zona de la corteza cerebral. La EMT es segura y no tiene efectos colaterales la mayoría de las veces. No obstante, los más frecuentes son la presencia de cefalea o dolor en el cuello, leves en intensidad y ceden fácilmente con Aspirina o acetaminofén. Las contraindicaciones absolutas incluyen a las personas que tengan algún objeto metálico en la cabeza, con excepción de las prótesis dentales. También quienes tienen implantado marcapasos, bombas de infusión y aumento de la presión endocraneana. En personas con antecedentes personales o familiares de epilepsia debe guardarse especial precaución, debido al riesgo de convulsiones. La EMT se está estudiando corno un tratamiento potencial para la depresión y otros trastornos neurológicos y psiquiátricos. Algunos estudios sugieren su utilidad en lugar de la terapia electroconvulsiva en pacientes con depresión resistente al tratamiento con antidepresivos

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