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BACKGROUND: Bipolar disorder (BD) is higher in developing countries. Childhood trauma exposure is a common environmental risk factor in Colombia and might be associated with a more severe course of bipolar disorder in Low-Middle Income-Countries. We carried out the first case-control study in Colombia using a structural clinical interview and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to describe the prevalence and association between trauma exposure during childhood with a severe course of illness (early age onset, rapid cycling, ideation or suicide attempt, or ≥ 3 hospitalization) in a sample of BD patients. RESULTS: A total of 114 cases and 191 controls evaluated showed the following results. Cases included 61.4% BD type I and 38.6% BD type II. The median age was 31.5 years (IQR, 75-24) for BD patients and 31 years old (IQR, 38-24) for healthy controls. A higher prevalence of childhood trauma was evidenced in cases compared to controls. Emotional abuse, physical abuse, sexual abuse, physical neglect and emotional neglect evidenced a strong association with severe bipolar disorder (OR = 3.42, p < .001; OR = 4.68, p < .001; OR = 4.30, p = .003; OR = 5.10, p < .001; OR = 5.64, p < .001, respectively). CONCLUSIONS: This is the first association study between childhood trauma exposure as a higher risk for a severe course of illness in BD patients in Colombian. Our findings highlight the higher prevalence of childhood trauma in bipolar patients and the strong association of childhood trauma with severe bipolar disorder. These findings are relevant for screening and evaluating childhood trauma exposure during the course of BD patients.

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Background: Mental health outcomes in Healthcare Workers (HCWs) has been few evaluated during COVID-19 pandemic in low-and middle-income countries. Our aim was carry-out a study to identify the prevalence of stress, anxiety, depressive symptoms in HCWs and associated factors to severe illness in a northern region in Colombia. Method: A cross-sectional, hospital-based survey was conducted to assess mental health outcomes in 1,149 HCWs in Colombia. The study used Perceived Stress Scale (PSS-10), 7-item Generalized Anxiety Disorder (GAD-7), and 9-item Patient Health Questionnaire (PHQ-9) to evaluate stress, anxiety, and depression symptoms, respectively. Results: 682 HCWs completed the questionnaire. The 58,21% (397/682) were nurses, 31,23% were physicians (213/682), and 10,56% (72/682) were other health professionals. The proportion of HCWs with stress, anxiety, and depressive symptoms were 59,97%, 44,87%, and 23,02%, respectively. HCWs in emergency room and Intensive Care Units (ICU) have 2-3-fold increase risk to have severe symptoms of stress. Staff in ICU have 64% more likely to have severe anxiety symptoms, and 97% more likely to have severe depression symptoms. Limitations: Including HCWs only in the northern region in Colombia; a non-probabilistic sample, and a cross-sectional design to identify causality. Conclusion: A higher proportion on mental health outcomes has been reported in HCWs in Colombia. There are work areas related with severe mental symptoms such as ICU and emergency room. Hospitals and patient-care institutions in Latin-America needs consider the mental and physical health of HCWs during outbreaks and identify health staff at-risk to implementing support strategies to mitigate adverse mental outcomes.

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Background: Mental health outcomes in healthcare workers (HCWs) in low- and middle-income countries (LMICs) have been poorly explored during COVID-19 pandemic. Our aim was to carry out a cross-sectional study of the prevalence of mental health symptoms in HCWs in Colombia. Methods: A cross-sectional web-survey study was performed during the COVID-19 pandemic mid-2021 including HCWs in two hospitals in Colombia. The PCL-5, GAD-7, and PHQ-9 scales were used to assess the prevalence of symptoms and severity of PTSD, anxiety, and depression in Colombia. Results: From 257 surveyed respondents, 44.36% were nurses, 36.58% physicians and 19.07% other health professionals. The prevalence of PTSD, anxiety, and depressive symptoms were 18.68%, 43.19%, and 26.85%, amongst HCWs. The regression model evidence a strong risk of PTSD, anxiety, and depressive symptoms in HCWs in Colombia during the second wave of COVID-19 in the middle of 2021. Conclusions: The prevalence for several mental health symptoms in HCWs in Colombia were higher compared with the general population. HCWs are at-risk population to develop chronic symptoms and mental disorders during and after outbreaks. These results will be helpful to tailor strategies to support the physical and mental health of the HCWs in LMICs.

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Introducción: Los esfuerzos para avanzar en el tratamiento de patologías duales buscan integrar las intervenciones terapéuticas que permitan mejorar sus tasas de remisión y recuperación. A pesar de la contundente evidencia epidemiológica que asocia el consumo de sustancias con las patologías psiquiátricas mayores, las pautas de tratamiento están basadas en combinaciones que carecen sustento clínico. Objetivos: Describir de forma concisa los estudios clínicos más relevantes sobre intervenciones psicofarmacológicas y psicoterapéuticas en estos pacientes, para desarrollar guías clínicas de manejo dinámicas y flexibles que ayuden en las estrategias usadas en el Eje Cafetero, en Colombia. Método: Búsqueda en la literatura biomédica en Medline, OVID, Proquest, Scielo y EMBASE, cruzando la expresión MeSH diagnóstico dual con tratamiento y pronóstico, delimitando los resultados a los estudios clínicos, revisiones sistemáticas y/o metanálisis en español o inglés en los últimos 25 años en la población farmacodependiente adulta. Resultados: De los 246 artículos arrojados por nuestra búsqueda, se seleccionaron 126, considerados de relevancia clínica por calidad metodológica y resultados en términos de seguridad, eficacia y efectividad. Conclusiones: Se describen los resultados de los estudios clínicos sobre los cuales se basan los nueve protocolos de intervención para pacientes con diagnóstico dual que consultan al Instituto Especializado en Salud Mental Clínica El Prado.

Introduction: In an effort to treat dually diagnosed patients, multiple therapeutic interventions that have shown efficacy for inpatients with major psychiatric disorders or substance abuse have been used in combination. In spite of the vast evidence of the association between drug abuse and major psychiatric disorders, most guidelines for the treatment of dually diagnosed patients are based on combinations that lack enough evidence, thus limiting their success. To date, no treatment has shown promise of long-term effectiveness. Objective: To describe briefl y the available evidence for relevant psychotherapeutic and psychopharmacological strategies in the treatment of dually diagnosed patients. At the same time, we hope to develop dynamic and fl exible algorithms to be included in the Clinical Guidelines for the Treatment of Dually Diagnosed Patients admitted to El Prado Psychiatric Institute in Armenia, Colombia. Method: We searched the Biomedical Literature on Medline, OVID, Proquest, Scielo, and EMBASE for articles matching the MeSH, dual diagnosis with treatment and prognosis, limiting results to clinical trials, systematic reviews, meta-analysis and clinical guidelines published in the last 25 years in adult population. Results: 246 articles were downloaded, of which 146 were selected after carefully reviewing all abstracts that met our established inclusion criteria in terms of methodology, safety, efficacy and effectiveness of the interventions. Conclusion: The clinical evidence available supports the nine protocols designed for the treatment of dually diagnosed patients in the addiction program of El Prado Psychiatric Institute in Armenia, Colombia.

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Introducción: La coexistencia de trastornos psiquiátricos con abuso/dependencia al tabaco, alcohol y sustancias ilícitas es un problema de salud pública en el mundo. Esto ha generado grandes retos diagnósticos en situaciones clínicas donde tienden a sobreponerse ambas condiciones psicopatológicas y que oscurecen el panorama de intervención terapéutica. Objetivos: Fomentar e implementar un adecuado diagnóstico de la patología dual en Colombia, a fin de encaminar al paciente por el tratamiento correcto en su proceso de rehabilitación. Método: Se buscó la literatura biomédica en los servidores de Medline, OVID, Proquest, Scielo y EMBASE, cruzando la expresión del MeSH diagnóstico dual con trastornos relacionados con el consumo de sustancias, tabacco y epidemiología, delimitando los resultados a los estudios clínicos, revisiones sistemáticas o metanálisis publicados en español o inglés en los últimos 25 años en la población farmacodependiente adulta. Resultados: Se encontraron 209 estudios que cumplían con los criterios de inclusión, de los cuales, de acuerdo con su resumen, se seleccionaron los 100 más relevantes. Conclusiones: La implementación rigurosa de estas guías diagnósticas debe encaminar al especialista en contacto con la población farmacodependiente a realizar el diagnóstico dual de forma más frecuente y certera, para que los pacientes obtengan mejores resultados y benefi cios a largo plazo...

Introduction: Dually Diagnosed Patients with major psychiatric disorders are considered an important public health issue worldwide. Objective: Our main goal was to establish practical guidelines for psychiatrists in charge of the treatment of dually diagnosed patients. Method: We searched the Biomedical Literature in Medline, OVID, Proquest, Scielo, and EMBASE for articles matching the Medical Subjects headings (MeSH) ¨Dual Diagnosis¨ with ¨Substance Related Disorders¨, ¨Tobacco¨, and ¨Epidemiology¨, limiting the results only to clinical trials, systematic reviews and metaanalysis published in the last 25 years in the adult addicted population. Results: We found 209 articles that met the initial inclusion criteria for the development of our clinical guidelines for dually diagnosed patients. All abstracts were carefully revised, and only 100 of the 209 articles were selected to be included in the main framework, based on their methodology and clinical significance of their results. Conclusions: Making a precise and accurate diagnosis of dual pathology in psychiatry should be the main goal of everyone involved in the care of patients with tobacco, substance and alcoholrelated disorders. Due to the complexity of dual diagnosis, every patient with substance abuse and alcohol-related problems should received an adequate and structured screening during his initial clinical evaluation...

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Introducción: la enfermedad cerebro-vascular (ECV) es un importante problema de salud pública, causa común de manifestaciones neuropsiquiátricas en personas médicamente afectadas. Las lesiones vasculares del sistema nervioso central generalmente se acompañan de secuelas neurocognitivas que producen importantes manifestaciones psicopatológicas, que infl uyen en el curso de la enfermedad. Objetivo: describir las manifestaciones neuropsiquiátricas de los pacientes con ECV diferentes a la depresión post-ECV. Método: revisión de la literatura médica existente sobre el tema. Conclusión: a pesar del extenso estudio de la neurobiología de los trastornos mentales a partir de modelos vasculares, no existe hasta el momento en los ensayos clínicos disponibles ninguna correlación sólida entre las lesiones estructurales, sus repercusiones funcionales y los trastornos neuropsiquiátricos específi cos. Los mecanismos implícitos en esta convergencia de manifestaciones clínicas tanto médicas como psiquiátricas siguen siendo pobremente comprendidos por gran parte de la comunidad médica. La gran mayoría de estudios consistentes en reportes y series de casos se limitan a describir poblaciones con ECV grave e incapacitante, y dejan por fuera otros enfermos con ECV menores, en quienes es bien reconocido un mayor riesgo para el desarrollo de trastornos neuropsiquiátricos como el Parkinson, los procesos demenciales y el delírium.

Introduction: Cerebrovascular disease is a major public health problem and common cause of neuropsychiatric disorders in the medically ill. Vascular lesions in the Central Nervous System cause signifi cant morbidity, usually followed by severe cognitive dysfunctions which become an important risk factor for developing psychopathology during the course of cerebrovascular disorders. Objective: To describe neuropsychiatric disorders affecting people with stroke other than post-stroke depression, as this will be reviewed extensively elsewhere. Method: Review of medical literature. Conclusions: Research on the neurobiology of mental disorders based on vascular theories to explain the etiology and physiopathology of some mental disorders has not come up with consistent results linking structural and functional studies with clinical correlates of neuropsychiatric syndromes. Implicit mechanisms responsible for the blend between systemic disease, neurological disorders and psychiatry are still poorly understood by the scientifi c community responsible for the treatment of cerebrovascular patients. Most studies are limited to case reports and series in severely ill patients leaving out those patients with mild to moderate stroke. These subjects are known to be at risk for neuropsychiatric disorders involving movement and cognitive symptoms such as Parkinson's, dementia and delirium.