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OBJETIVO: La ansiedad y la depresión juegan un papel importante en la enfermedad pulmonar obstructiva crónica aunque son escasos los estudios que han tratado de determinar su asociación con la exacerbación y todavía menos los que han tratado de cuantificar el número de exacerbaciones asociadas. El objetivo del estudio fue estudiar el riesgo de las exacerbaciones asociadas a la de ansiedad y depresión en los pacientes diagnosticados de enfermedad pulmonar obstructiva crónica. MATERIAL Y MÉTODOS: Estudio de cohortes prospectivas que analizó los factores asociados a la exacerbación en 512 enfermos durante 2 años. Las exacerbaciones se definieron como moderadas, aquellas que requirieron antibiótico/s y/o corticoides sistémicos; y graves, las que precisaron de hospitalización. Para cada paciente se registró la ansiedad y depresión (Hospital Anxiety and Depression Scale) y se cuantificaron el número de exacerbaciones durante el periodo de seguimiento. RESULTADOS: La prevalencia de ansiedad/depresión al inicio del estudio fue del 15,6%. Durante los 2 años de seguimiento la media de exacerbaciones fue de 2,21. Los pacientes que además presentaban ansiedad/depresión al inicio del estudio presentaron una media de exacerbaciones mayor, de 2,8 (p = 0,001). La ansiedad/depresión se asociaron con un mayor número de exacerbaciones moderadas-graves en el análisis ajustado (IRRa=1,48). Los otros factores de riesgo asociados a un mayor número de exacerbaciones fueron el antecedente de exacerbación grave previa (IRRa=1,50; la obesidad (IRRa=1,27); el sobrepeso (IRRa=1,23); el FEV1 ≤ 77% (IRRa=0,84); y una mayor disnea (IRRa=1,14). CONCLUSIONES: Los enfermos con ansiedad/depresión presentan un mayor número de exacerbaciones y tienen un 48% más de riesgo de padecer una exacerbación respecto a los enfermedad pulmonar obstructiva crónica sin ansiedad/depresión

OBJECTIVE: Anxiety and depression play an important role in chronic obstructive pulmonary disease, although there are a limited number of studies that have attempted to determine their relationship with exacerbations, and even less have tried to quantify the number of associated exacerbations. The aim of this study was to determine the risk of exacerbations associated with anxiety and depression in patients diagnosed with chronic obstructive pulmonary disease. MATERIAL AND METHODS: A prospective cohort study was conducted that analysed the factors associated with exacerbations in 512 patients over a 2-year period. The exacerbations that required antibiotics and/or systemic corticosteroids were defined as moderate, and those that required hospital admission, as severe. The Hospital Anxiety and Depression Scale was applied to each patient, and the number of exacerbations during follow-up were quantified. RESULTS: The prevalence of anxiety/depression at the beginning of the study was 15.6%. During the 2 years of follow-up, the mean number of exacerbations was 2.21. The patients that also had anxiety/depression at the beginning of the study had a higher mean number of exacerbations (2.8; P=.001). Anxiety/depression was associated with an increased number of moderate-severe exacerbations in the adjusted analysis (IRRa=1.48). The other risk factors associated with a higher mean number of exacerbations were, a history of a previous severe exacerbation (IRRa=1.50; obesity (IRRa=1.27); overweight (IRRa=1.23); FEV1 ≤ 77% (IRRa=0.84); and more dyspnoea (IRRa=1.14). CONCLUSIONS: Patients with anxiety/depression have a greater number of exacerbations, and have a 48% higher risk of suffering an exacerbation compared to those with chronic obstructive pulmonary disease with no anxiety/depression

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OBJECTIVE: Anxiety and depression play an important role in chronic obstructive pulmonary disease, although there are a limited number of studies that have attempted to determine their relationship with exacerbations, and even less have tried to quantify the number of associated exacerbations. The aim of this study was to determine the risk of exacerbations associated with anxiety and depression in patients diagnosed with chronic obstructive pulmonary disease. MATERIAL AND METHODS: A prospective cohort study was conducted that analysed the factors associated with exacerbations in 512 patients over a 2-year period. The exacerbations that required antibiotics and/or systemic corticosteroids were defined as moderate, and those that required hospital admission, as severe. The Hospital Anxiety and Depression Scale was applied to each patient, and the number of exacerbations during follow-up were quantified. RESULTS: The prevalence of anxiety/depression at the beginning of the study was 15.6%. During the 2 years of follow-up, the mean number of exacerbations was 2.21. The patients that also had anxiety/depression at the beginning of the study had a higher mean number of exacerbations (2.8; P=.001). Anxiety/depression was associated with an increased number of moderate-severe exacerbations in the adjusted analysis (IRRa=1.48). The other risk factors associated with a higher mean number of exacerbations were, a history of a previous severe exacerbation (IRRa=1.50; obesity (IRRa=1.27); overweight (IRRa=1.23); FEV1 ≤ 77% (IRRa=0.84); and more dyspnoea (IRRa=1.14). CONCLUSIONS: Patients with anxiety/depression have a greater number of exacerbations, and have a 48% higher risk of suffering an exacerbation compared to those with chronic obstructive pulmonary disease with no anxiety/depression.

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La práctica clínica de calidad no incluye tan solo la mejora de conocimientos en aspectos científicos y técnicos, sino también en la gestión de valores, la sensibilidad ética y las habilidades en la valoración y manejo de los conflictos éticos. La literatura revisada sugiere la existencia de la llamada «erosión ética», según la cual la competencia ética y la empatía disminuyen, o no progresan, durante la formación médica. La finalidad del presente estudio es determinar la relación entre estas variables: ética (razonamiento moral y sensibilidad ética) y empatía en un grupo de estudiantes de medicina, así como determinar la relación con otras variables como el curso académico y el género. Material y método: estudio observacional transversal realizado a 193 estudiantes de medicina de diferentes cursos. Se les administró un cuestionario sociodemográfico, escala de dilemas sociomorales de Rest, viñetas clínicas de medida de sensibilidad ética (Problem Identification Test) y el Test de empatía cognitiva y afectiva.Resultados: se halló una relación directa y significativa entre desarrollo moral, la sensibilidad ética y la mayor empatía. Se detectó un incremento de razonamiento moral y sensibilidad ética entre los alumnos de 1.° y 3.°, sin incremento entre 3.° y cursos superiores. No se encontraron diferencias significativas entre estas variables y el género. Conclusiones: en este estudio se ha hallado una correlación entre razonamiento moral, sensibilidad ética y empatía, así como una falta de progresión de las 2 primeras variables en los últimos cursos del grado de medicina

High-quality clinical practice includes not only improving clinicians' expertise in scientific and technical aspects but also managing values, ethical sensitivity and skills for assessing and dealing with ethical conflicts. The reviewed literature suggests the presence of an "ethical erosion", according to which ethical competence and empathy decrease or do not progress during medical training. The aim of this study was to determine the relationship between ethics (moral reasoning and ethical sensitivity) and empathy in a group of medical students and to determine the relationship with other variables such as academic year and sex. Material and method: a cross-sectional observational study was conducted with 193 medical students from different academic years, who were administered a sociodemographic questionnaire, the Rest sociomoral dilemma test, clinical vignettes to measure ethical sensitivity (Problem Identification Test [PIT]) and a cognitive and emotional empathy test (test de empatía cognitiva y afectiva, TECA). Results: we found a direct and significant relationship between moral development, ethical sensitivity and greater empathy. We detected an increase in moral reasoning and ethical sensitivity among first and third-year students, with no increase between the third year and later academic years. There were no significant differences between these variables and sex. Conclusions: this study found a correlation between moral reasoning, ethical sensitivity and empathy and a lack of progression of the first 2 variables in the last years of the medical degree

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High-quality clinical practice includes not only improving clinicians' expertise in scientific and technical aspects but also managing values, ethical sensitivity and skills for assessing and dealing with ethical conflicts. The reviewed literature suggests the presence of an "ethical erosion", according to which ethical competence and empathy decrease or do not progress during medical training. The aim of this study was to determine the relationship between ethics (moral reasoning and ethical sensitivity) and empathy in a group of medical students and to determine the relationship with other variables such as academic year and sex. MATERIAL AND METHOD: A cross-sectional observational study was conducted with 193 medical students from different academic years, who were administered a sociodemographic questionnaire, the Rest sociomoral dilemma test, clinical vignettes to measure ethical sensitivity (Problem Identification Test [PIT]) and a cognitive and emotional empathy test (test de empatía cognitiva y afectiva, TECA). RESULTS: We found a direct and significant relationship between moral development, ethical sensitivity and greater empathy. We detected an increase in moral reasoning and ethical sensitivity among first and third-year students, with no increase between the third year and later academic years. There were no significant differences between these variables and sex. CONCLUSIONS: This study found a correlation between moral reasoning, ethical sensitivity and empathy and a lack of progression of the first 2 variables in the last years of the medical degree.

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INTRODUCTION. Recent studies have shown that alterations to the executive cognitive functions may be endophenotypes of eating disorders. AIM. To perform a critical review of the literature on neuropsychological alterations in patients with eating disorders and their first-degree relatives. DEVELOPMENT. We review the papers written in English and in Spanish indexed in Medline and PsycINFO over the last 10 years. We included abstracts of papers that have still not been published and search terms were crossed. Excluding some isolated clinical cases, we obtained 41 studies on patients with anorexia nervosa (n = 17), bulimia nervosa (n = 5), both (n = 13) or a non-specific eating disorder (n = 6). CONCLUSIONS. The studies reviewed display important limitations due to their heterogeneous methodology and small samples, which give rise to contradictory results. Most of them were conducted on anorexia nervosa. Cognitive rigidity seems to be more frequent in patients with anorexia and their relatives, and alterations in decision-making or central coherence is more often found in bulimia nervosa. There is evidence suggesting that the neuropsychological alterations found in eating disorders are endophenotypes of the disease.

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BACKGROUND: Raised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences. OBJECTIVE: To compare exposure to antipsychotic medications in immigrant and native-born populations in Spain. METHOD: Descriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64years, in a Spanish Health Region during 2008. RESULTS: 1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant. CONCLUSIONS: All immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.

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OBJECTIVE: To investigate the cognitive impairment of a sample of euthymic bipolar patients treated with lithium monotherapy at baseline in a 2-year longitudinal study. METHOD: Fifteen DSM-IV-TR bipolar out-patients and 15 healthy-matched controls were cognitively assessed twice over a 2-year follow-up. All patients underwent lithium monotherapy on the first evaluation, and they were euthymic in both evaluations. Cognitive assessment was performed by means of a neuropsychological test battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory). RESULTS: Repeated measures multivariate analysis of variance showed that the bipolar disorder group was cognitively impaired in the executive domain, attention and processing speed, and such deficits were maintained over time. CONCLUSION: Our results showed that executive dysfunction is the main long-term neuropsychological deficit of bipolar disorder. Also, the persistence of these deficits did not seem to be influenced by any clinical or pharmacological variables.

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BACKGROUND: The objective of this study was to examine the long-term course of obsessive-compulsive disorder (OCD) in patients treated with serotonin reuptake inhibitors (SRIs) and behavioral therapy and to identify predictors of clinical outcome. METHOD: Sixty outpatients meeting DSM-II-R or DSM-IV criteria for OCD were followed up for 1 to 5 years (mean = 2.5 years). All of them received prolonged pharmacologic therapy with an SRI. RESULTS: Thirty-seven patients (61.7%) completed an adequate behavioral treatment. At long-term assessment, 22 patients (36.7%) exhibited a global Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score greater than 16 or a final reduction in Y-BOCS global score of less than 35% and were considered nonresponders. Patients who completed behavioral therapy showed a significant decrease in Y-BOCS compulsions subscale score (p = .01), whereas no significant differences in either Y-BOCS global or obsessions subscale scores between those who did and those who did not undergo behavioral therapy were detected. Obsessions of sexual/religious content were the unique factor related to a poorer long-term outcome. CONCLUSION: A substantial number of OCD patients showed persistent disabling symptoms at the long-term follow-up in spite of combined pharmacologic and behavioral treatment. Major benefits from behavioral therapy appeared to be the improvement of ritualistic behaviors. Sexual/religious obsessions predicted poorer long-term outcome, whereas short-term response to SRI treatment failed to achieve predictive value in the long-term course of OCD.

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OBJETIVOS: Estudiar si existen diferencias en la percepción del estilo educativo recibido en la infancia entre un grupo de pacientes con trastorno obsesivo-compulsivo y un grupo de controles sanos, y determinar si puede establecerse alguna relación entre las dimensiones del estilo educativo y el desarrollo de las distintas temáticas obsesivo-compulsivas. MÉTODO: Cuarenta pacientes con diagnóstico de TOC según criterios DSM-IV y 40 controles sanos completaron el EMBU, un cuestionario autoadministrable que valora la percepción del estilo educativo recibido en la infancia. Se compararon las puntuaciones obtenidas por ambos grupos en las diversas dimensiones educativas y se emplearon regresiones logísticas binarias para analizar si la percepción del estilo educativo permitía predecir el desarrollo de síntomas obsesivos específicos. RESULTADOS: Los pacientes obsesivos percibían mayor rechazo en ambos progenitores y menor calidez emocional en sus padres durante la infancia que el grupo control, sin constatarse diferencias en la percepción de sobreprotección parental entre ambos grupos. La presencia de conductas de acumulación se asociaba débilmente a la percepción de una escasa calidez emocional paterna. Ninguna de las dimensiones educativas permitía predecir el desarrollo de otros síntomas obsesivos. CONCLUSIONES: Próximos estudios deben profundizar en el papel que las variables sociales y culturales, como el estilo educativo recibido en la infancia, pueden desempeñar en el desarrollo del trastorno obsesivo-compulsivo, en interacción con factores biológicos y genéticos (AU)

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Objetivos: Estudiar el pronóstico a largo plazo de una muestra de pacientes con trastorno obsesivo-compulsivo (TOC) tratados mediante inhibidores de la recaptación de serotonina (IRS) y terapia cognitivo-conductual (CBT) e identificar predictores de evolución en el TOC. Método: Sesenta pacientes (n = 60) con criterios diagnóstico DSM-IV para TOC recibieron tratamiento estandarizado durante un período de uno a 5 años (media, 2,5 años). Todos ellos siguieron tratamiento farmacológico con IRS y un 61,7 por ciento completó un protocolo adecuado de terapia cognitivo-conductual. Resultados: Veintidós pacientes (36,7 por ciento) presentaban en la valoración a largo plazo una reducción del Y-BOCS inferior al 35 por ciento o puntuaciones globales del Y-BOCS superiores a 16 y podían ser considerados no respondedores. Los pacientes que completaron la CBT presentaron una reducción significativa de las compulsiones, sin constatarse cambios significativos respecto a las obsesiones. La presencia de obsesiones sexuales/religiosas fue el único factor clínico asociado a un peor pronóstico a largo plazo del TOC. Conclusiones: Un porcentaje importante de pacientes con TOC presenta síntomas incapacitantes a largo plazo pese a tratamiento combinado farmacológico y cognitivo-conductual. El principal beneficio aportado por la terapia cognitivo-conductual es la reducción de las conductas ritualísticas. La presencia de obsesiones de contenido sexual/religioso se asocia a una peor evolución del TOC, mientras que la respuesta inicial al abordaje farmacológico carece de valor pronóstico (AU)

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Objetivo: Determinar la existencia de posibles diferencias en los potenciales evocados cognitivos (PPEE) entre pacientes obsesivos, melancólicos y controles. Investigar la influencia de la sintomatología depresiva comórbida sobre los PPEE en los pacientes con trastorno obsesivo-compulsivo (TOC). Métodos: Se estudian las latencias N100, N200, P300, N400 y la amplitud P300, utilizando un oddball-paradigm auditivo, en 47 obsesivos, 80 depresivos melancólicos y 88 controles. Resultados: La amplitud media de la P300 fue significativamente menor entre los melancólicos (-X = 9,6, DE = 4,2) respecto los obsesivos (-X = 14,3, DE = 6,3) y controles (-X = 17,3, DE = 4,8), manteniéndose las diferencias al controlar la edad como covariante. Al controlar la edad, los melancólicos presentaron una mayor latencia de las ondas N100, N200 y P300 respecto a obsesivos y controles. Los pacientes con TOC presentaron valores intermedios, obteniendo significaciones sólo para una mayor latencia N100 y una menor amplitud P300 respecto a los controles. Entre los obsesivos, los que presentaron puntuaciones más patológicas (y más cercanas a los melancólicos) fueron los que tenían puntuaciones más altas en el test de Hamilton de depresión, siendo este hecho independiente de la edad y del subtipo de TOC. En cambio, entre los melancólicos, la gravedad de la depresión no se relacionaba con el grado de alteración en los PPEE. Conclusiones: Este estudio apoyaría la hipótesis de que las alteraciones en los PPEE en pacientes con TOC son secundarias al nivel de depresión comórbido y no a la sintomatología obsesiva primaria. Sin embargo, estas alteraciones parecen ser cualitativamente diferentes entre pacientes obsesivos respecto a los melancólicos (AU)

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BACKGROUND: Functional imaging studies have demonstrated abnormal patterns of brain activity in obsessive-compulsive disorder, which consistently suggest the alteration of frontal lobe functioning. We performed a brain activation study in obsessive-compulsive disorder using a cognitive task involving the frontal lobes. METHODS: Twenty patients and 20 healthy control subjects were assessed with functional magnetic resonance imaging during a phonologically guided word generation task. The study analysis was based on the comparison of group average time-course functional changes occurring at the site of largest frontal cortex activation during alternating rest and task periods. RESULTS: In terms of relative signal changes, patients showed a significantly greater activation during word generation and a defective suppression of this activation during the following rest period. Both abnormal imaging findings significantly correlated with the severity of the clinical process assessed by the Yale-Brown Obsessive-Compulsive Scale. CONCLUSIONS: The results indicate that functional magnetic resonance imaging during cognitive challenge may be useful to reveal distinctive features of latent brain dysfunction in obsessive-compulsive disorder.

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