RESUMEN
La depresión es una entidad que afecta a una proporción del 15-25% de los pacientes con cáncer. A pesar de su elevada incidencia, es un trastorno habitualmente infradiagnosticado y que no recibe tratamiento adecuado. Este hecho conduce a una mala calidad de vida, una inadecuada adherencia al tratamiento y una menor tasa de supervivencia en esta población médica. Existe evidencia sobre la eficacia de abordajes tanto farmacológicos como psicoterapéuticos en pacientes oncológicos con depresión. El objetivo de este artículo es aportar una visión sobre aquellas intervenciones con demostrada eficacia que permiten a los pacientes con cáncer desarrollar un mejor afrontamiento de su enfermedad y lograr una mejor calidad de vida.
Depression is an entity that concerns about the15-25% of the patients with cancer. In spite of his high incident, it is habitually an under diagnosed disorder and do not receive adequate treatment. This fact drives to a worse quality of life, a worse adherence to the treatment and a minor rate of survival. There is evidence of the efficiency of pharmacological and psychological boardings in the patients with cancer and depression. The aim of this paper is to have a vision on those interventions with demonstrated efficiency. This treatment allows to the patients with cancer to develop a better confrontation of his disease and to achieve a better quality of life.
Asunto(s)
Humanos , Terapéutica , Depresión , Neoplasias , Calidad de Vida , Adaptación Psicológica , Tasa de Supervivencia , Cumplimiento y Adherencia al TratamientoRESUMEN
OBJECTIVE: Neurocognitive impairments observed in psychotic disorder may impact on emotion recognition and theory of mind, resulting in altered understanding of the social world. Early intervention efforts would be served by further elucidation of this mechanism. METHOD: Patients with a psychotic disorder (n=30) and a reference control group (n=310) were asked to offer emotional appraisals of images of social situations (EASS task). The degree to which case-control differences in appraisals were mediated by neurocognitive alterations was analyzed. RESULTS: The EASS task displayed convergent and discriminant validity. Compared to controls, patients displayed blunted emotional appraisal of social situations (B=0.52, 95 percent CI: 0.30, 0.74, P<0.001; adjusted for age, sex and number of years of education: B=0.44, 95 percent CI: 0.20, 0.68, P<0.001), a difference of 0.88 (adjusted: 0.75) standard deviation. After adjustment for neurocognitive variables, the case-control difference was reduced by nearly 75 percent and was non-significant (B=0.12, 95 percent CI: -0.14, 0.39, P=0.37). CONCLUSIONS: Neurocognitive impairments observed in patients with psychotic disorder may underlie misrepresentation of the social world, mediated by altered emotion recognition. A task assessing the social impact of cognitive alterations in clinical practice may be useful in detecting key alterations very early in the course of psychotic illness.
OBJETIVO: Melhoras neurocognitivas observadas no transtorno psicótico podem ter impacto no reconhecimento de emoções e na teoria da mente, resultando numa alteração na compreensão do mundo social. Esforços para uma intervenção precoce poderiam se beneficiar de uma maior elucidação deste mecanismo. MÉTODO: Pacientes com transtornos psicóticos (n=30) e um grupo controle de referência (n=310) foram convidados a realizar avaliações emocionais de imagens de situações sociais (teste AESS). A relação das diferenças entre casos e controles com as alterações neurocognitivas foi analisada. RESULTADOS: O teste AESS apresentou validade convergente e discriminatória. Quando comparados aos controles, os pacientes apresentaram avaliação emocional embotada das situações sociais (B=0,52, 95 por cento CI: 0,30, 0,74, P<0,001; ajustado para a idade, sexo e número de anos de educação: B=0,44, 95 por cento CI: 0,20, 0,68, P<0001), uma diferença de 0,88 (ajustado: 0,75) desvio-padrão. Após o ajuste para as variáveis neurocognitivas, as diferenças no estudo caso-controle foram reduzidas em quase 75 por cento e deixaram de ser significativas (B=0,12, 95 por cento CI: -0,14, 0.39, P=0,37). CONCLUSÕES: Disfunções neurocognitivas observadas em pacientes com transtornos psicóticos podem ser subjacentes a uma distorção do mundo social, mediada pela alteração no reconhecimento de emoções. Um teste que avalie o impacto social de alterações cognitivas na prática clínica pode ser útil para a detecção das principais alterações nos primeiros estágios de transtornos psicóticos.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Cognición/fisiología , Emociones , Expresión Facial , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Reconocimiento en Psicología , Estudios de Casos y Controles , Diagnóstico Precoz , Escolaridad , Relaciones Interpersonales , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Conducta SocialRESUMEN
OBJECTIVE: Neurocognitive impairments observed in psychotic disorder may impact on emotion recognition and theory of mind, resulting in altered understanding of the social world. Early intervention efforts would be served by further elucidation of this mechanism. METHOD: Patients with a psychotic disorder (n=30) and a reference control group (n=310) were asked to offer emotional appraisals of images of social situations (EASS task). The degree to which case-control differences in appraisals were mediated by neurocognitive alterations was analyzed. RESULTS: The EASS task displayed convergent and discriminant validity. Compared to controls, patients displayed blunted emotional appraisal of social situations (B=0.52, 95% CI: 0.30, 0.74, P<0.001; adjusted for age, sex and number of years of education: B=0.44, 95% CI: 0.20, 0.68, P<0.001), a difference of 0.88 (adjusted: 0.75) standard deviation. After adjustment for neurocognitive variables, the case-control difference was reduced by nearly 75% and was non-significant (B=0.12, 95% CI: -0.14, 0.39, P=0.37). CONCLUSIONS: Neurocognitive impairments observed in patients with psychotic disorder may underlie misrepresentation of the social world, mediated by altered emotion recognition. A task assessing the social impact of cognitive alterations in clinical practice may be useful in detecting key alterations very early in the course of psychotic illness.