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Depression is a prevalent and incapacitating condition with a significant impact on global morbidity and mortality. Although the immune system's role in its pathogenesis is increasingly recognized, there is a lack of comprehensive understanding regarding the involvement of innate and adaptive immune cells. To address this gap, we conducted a multicenter case-control study involving 121 participants matched for sex and age. These participants had either an active (or current) major depressive episode (MDE) (39 cases) or a remitted MDE (40 cases), including individuals with major depressive disorder or bipolar disorder. We compared these 79 patients to 42 healthy controls (HC), analyzing their immunological profiles. In blood samples, we determined the complete cell count and the monocyte subtypes and lymphocyte T-cell populations using flow cytometry. Additionally, we measured a panel of cytokines, chemokines, and neurotrophic factors in the plasma. Compared with HC, people endorsing a current MDE showed monocytosis (p = 0.001), increased high-sensitivity C-reactive protein (p = 0.002), and erythrocyte sedimentation rate (p = 0.003), and an altered proportion of specific monocyte subsets. CD4 lymphocytes presented increased median percentages of activation markers CD69+ (p = 0.007) and exhaustion markers PD1+ (p = 0.013) and LAG3+ (p = 0.014), as well as a higher frequency of CD4+CD25+FOXP3+ regulatory T cells (p = 0.003). Additionally, patients showed increased plasma levels of sTREM2 (p = 0.0089). These changes are more likely state markers, indicating the presence of an ongoing inflammatory response during an active MDE. The Random Forest model achieved remarkable classification accuracies of 83.8% for MDE vs. HC and 70% for differentiating active and remitted MDE. Interestingly, the cluster analysis identified three distinct immunological profiles among MDE patients. Cluster 1 has the highest number of leukocytes, mainly given by the increment in lymphocyte count and the lowest proinflammatory cytokine levels. Cluster 3 displayed the most robust inflammatory pattern, with high levels of TNFα, CX3CL1, IL-12p70, IL-17A, IL-23, and IL-33, associated with the highest level of IL-10, as well as ß-NGF and the lowest level for BDNF. This profile is also associated with the highest absolute number and percentage of circulating monocytes and the lowest absolute number and percentage of circulating lymphocytes, denoting an active inflammatory process. Cluster 2 has some cardinal signs of more acute inflammation, such as elevated levels of CCL2 and increased levels of proinflammatory cytokines such as IL-1ß, IFNγ, and CXCL8. Similarly, the absolute number of monocytes is closer to a HC value, as well as the percentage of lymphocytes, suggesting a possible initiation of the inflammatory process. The study provides new insights into the immune system's role in MDE, paving the ground for replication prospective studies targeting the development of diagnostic and prognostic tools and new therapeutic targets.
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Citocinas , Transtorno Depressivo Maior , Imunofenotipagem , Monócitos , Humanos , Feminino , Masculino , Estudos de Casos e Controles , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Maior/sangue , Adulto , Pessoa de Meia-Idade , Citocinas/sangue , Citocinas/imunologia , Monócitos/imunologia , Transtorno Bipolar/imunologia , Transtorno Bipolar/sangue , Inflamação/imunologia , Inflamação/sangue , Antígenos CD/sangue , Antígenos CD/imunologia , Citometria de FluxoRESUMO
Lithium is an alkaline metal, used for more than 60 years in psychiatry, and currently considered the gold standard in the treatment of bipolar disorder (BD). According to recent evidence, this active ingredient is useful for the treatment of a wide spectrum of clinical varieties of affective disorders. In addition, it is estimated that lithium reduces the risk of suicide and suicidal behavior in people with mood disorders. On the other hand, some novel studies have shown that the cation has a potential efficacy for the treatment of other neuropsychiatric processes, such as the likelihood of reducing the risk of dementia and slowing down the development of neurodegenerative diseases. Despite the enormous evidence in favor of the use of lithium, it is known that, in Argentina, medications containing it are prescribed less than expected. In view of all this, the Asociación Argentina de Psiquiatría Biológica (Argentine Association of Biological Psychiatry) (AAPB or AABP) convened a group of experts to review the available scientific literature and prepare an updated document on the management and use of lithium in neuropsychiatry. In addition to the use of the ion in daily clinical practice, the scope of this review includes other contents that have been considered of interest for the psychiatrist, such as certain pharmacological and pharmacogenetic aspects, possible clinical predictors of response to treatment with lithium, management of ion during perinatal period, management of lithium in child and adolescent population, management of adverse effects linked to cation and interactions with drugs and other substances.
El litio es un metal alcalino, usado hace más de 60 años en psiquiatría, y actualmente es considerado el estándar de oro en el tratamiento del trastorno bipolar (TB). De acuerdo con la evidencia reciente, este principio activo es útil para el tratamiento de un amplio espectro de variedades clínicas de los trastornos afectivos. Además, se estima que desde hace tiempo el litio reduce el riesgo de suicidio y de comportamiento suicida en personas con trastornos del estado de ánimo. Por otro lado, algunos estudios novedosos han demostrado que el catión posee una potencial eficacia para el tratamiento de otros procesos neuropsiquiátricos, tales como la probabilidad de disminuir el riesgo de demencia y la de ralentizar el desarrollo de enfermedades neurodegenerativas. A pesar de la enorme evidencia a favor de la utilización del litio, se sabe que, en la Argentina, las especialidades medicinales que lo contienen se prescriben menos de lo esperado. En virtud de todo lo mencionado, la Asociación Argentina de Psiquiatría Biológica (AAPB) convocó a un grupo de expertos para revisar la literatura científica disponible y elaborar un documento actualizado sobre el manejo y el uso del litio en neuropsiquiatría. Además de la utilización del ion en la práctica clínica diaria, el alcance de esta revisión incluye otros contenidos que se han considerado de interés para el médico psiquiatra, tales como ciertos aspectos farmacológicos y farmacogenéticos, posibles predictores clínicos de la respuesta al tratamiento con litio, el manejo del ion durante el período perinatal, el manejo de litio en la población infantojuvenil, el manejo de los efectos adversos vinculados con el catión y las interacciones con medicamentos y otras sustancias.
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This document constitutes the third and last part of the Third Argentine Consensus on the Management of Bipolar Disorders carried out by the Argentine Association of Biological Psychiatry (AAPB). Continuing with the initial objective, this section of the Consensus on the Management of Bipolar Disorders is focused on the management of bipolar disorders in special populations. This section constitutes a comprehensive review and expert consideration of the scientific evidence on: a) the management of bipolar disorders in treatment-resistant patients; b) the management of bipolar disorder in childhood and adolescence; c) the management of bipolar disorders in women during their perinatal period and, d) the management of bipolar disorders in older adults.
Este documento constituye la tercera y última parte del Tercer Consenso Argentino sobre el Manejo de los Trastornos Bipolares llevada a cabo por la Asociación Argentina de Psiquiatría Biológica (AAPB). Siguiendo con el objetivo propuesto por el comité de expertos, en la actual versión del Consenso sobre el manejo de los trastornos bipolares, esta sección está enfocada al abordaje de los Trastornos Bipolares en situaciones especiales. Esto configura una revisión exhaustiva de la evidencia científica sobre: a) el manejo de los trastornos bipolares en pacientes resistentes al tratamiento, b) el manejo de los trastornos bipolares en la mujer en el período perinatal, c) el manejo del trastorno bipolar en la etapa infantojuvenil y d) el manejo de los trastornos bipolares en los adultos mayores.
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Transtorno Bipolar , Gravidez , Feminino , Humanos , Consenso , Argentina , Estudos RetrospectivosRESUMO
This document constitutes the second section B of the Third Argentine Consensus on the Management of Bipolar Disorders, focused on synthesizing the most updated evidence on therapeutic approaches for adult patients. The scope of this section is to provide therapeutic recommendations for managing bipolar disorders in adults, (i) acute mania (ii) bipolar depression (iii) mixed stated (iv) suicidality and (vi) psychological interventions. In addition, the current manuscript outlines the assessment and management of side effects of pharmacotherapeutic treatments.
Este documento constituye la segunda parte B del Tercer Consenso Argentino sobre el Manejo de los Trastornos Bipolares llevada a cabo por la Asociación Argentina de Psiquiatría Biológica (AAPB). Siguiendo con el direccionamiento iniciado en el parte 2A sobre el tratamiento integral de los trastornos bipolares, esta sección se ha enfocado en sintetizar la evidencia más actualizada sobre abordajes terapéuticos para pacientes adultos. El alcance de esta sección es proporcionar recomendaciones terapéuticas para el manejo de los trastornos bipolares en adultos, (i) manía aguda, (ii) depresión bipolar, (iii) estado mixto, (iv) el suicidio en el trastorno bipolar, (v) intervenciones psicológicas. Además, el presente manuscrito aborda la evaluación y el manejo de los efectos secundarios de los tratamientos farmacoterapéuticos.
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Transtorno Bipolar , Humanos , Consenso , Argentina , Estudos RetrospectivosRESUMO
RESUMEN Objetivos. Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. Materiales y métodos. Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. Resultados. Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). Conclusiones. Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.
ABSTRACT Objectives. To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. Materials and methods. A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. Results. A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). Conclusions. There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.
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Humanos , Masculino , Feminino , COVID-19 , PandemiasRESUMO
This document constitutes the second section A of the Third Argentine Consensus on the Management of Bipolar Disorders, focused on synthesizing the most updated evidence on therapeutic approaches for adult patients. The aim of this section (2A) is to provide therapeutic recommendations for managing bipolar disorders in adults. In addition, the scope of this current manuscript outlines recommendations on the use of treatment guidelines, levels of evidence available to support these recommendations, general considerations for the treatment of bipolar disorders, the so-called pseudoresistance and adherence to treatment, general considerations on psychological therapies, as well as long term treatment of bipolar disorders.
Este documento corresponde a la segunda parte del Tercer Consenso Argentino sobre el manejo de los trastornos bipolares, enfocada en sintetizar la evidencia actualizada sobre los abordajes terapéuticos de esta patología en los pacientes adultos. Siguiendo la metodología descripta en la primera parte del Consenso, el panel de expertos realizó una exhaustiva revisión de la bibliografía y, como consecuencia de un posterior debate sobre la información disponible, se generó esta sección A del segundo documento que abarca el tratamiento integral de las personas adultas que padecen este trastorno. Durante la etapa de debate y discusión de estas guías, se decidió incorporar algunos puntos que estimamos serán de gran utilidad para el equipo interdisciplinario encargado del manejo de pacientes con trastornos bipolares. En tal sentido, en la sección A de la segunda parte de este documento, se podrán encontrar las recomendaciones generales para el uso de las guías de tratamiento, los niveles de evidencia disponibles para sustentar las recomendaciones, las consideraciones generales del tratamiento de los trastornos bipolares, el fenómeno de pseudorresistencia y adherencia al tratamiento, las consideraciones generales sobre el abordaje psicológico, así como el tratamiento a largo plazo de los trastornos bipolares.
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Antipsicóticos , Transtorno Bipolar , Adulto , Humanos , Transtorno Bipolar/tratamento farmacológico , Antipsicóticos/uso terapêuticoRESUMO
OBJECTIVES.: Motivation for the study. The COVID-19 pandemic has caused profound repercussions at different socio-environmental levels. Its impact on violence against healthcare team workers in Argentina has not been well documented. Main findings. The present study evidenced high rates of aggression, particularly verbal aggression. In addition, almost half of the participants reported having suffered these events on a weekly basis. All participants who experienced violence reported having experienced post-event symptoms, and up to one-third reported having considered changing their profession after these acts. Implications. It is imperative to take action to prevent acts of violence against health personnel, or to mitigate its impact on the victims. . To explore the frequency and impact of violence against healthcare workers in Argentina and to compare it with the rest of their Latin American peers during the COVID-19 pandemic. MATERIALS AND METHODS.: A cross-sectional study was conducted by applying an electronic survey on Latin American medical and non-medical personnel who carried out health care tasks since March 2020. We used Poisson regression to estimate crude (PR) and adjusted (aPR) Prevalence Ratios with their respective 95% confidence intervals. RESULTS.: A total of 3544 participants from 19 countries answered the survey; 1992 (56.0%) resided in Argentina. Of these, 62.9% experienced at least one act of violence; 97.7% reported verbal violence and 11.8% physical violence. Of those who were assaulted, 41.5% experienced violence at least once a week. Health personnel from Argentina experienced violence more frequently than those from other countries (62.9% vs. 54.6%, p<0.001), and these events were more frequent and stressful (p<0.05). In addition, Argentinean health personnel reported having considered changing their healthcare tasks and/or desired to leave their profession more frequently (p<0.001). In the Poisson regression, we found that participants from Argentina had a higher prevalence of violence than health workers from the region (14.6%; p<0.001). CONCLUSIONS.: There was a high prevalence of violence against health personnel in Argentina during the COVID-19 pandemic. These events had a strong negative impact on those who suffered them. Our data suggest that violence against health personnel may have been more frequent in Argentina than in other regions of the continent.
OBJETIVOS.: Explorar la frecuencia e impacto de la violencia contra los trabajadores de salud de Argentina y compararlo con el resto de sus pares de Latinoamérica en el contexto de la pandemia por COVID-19. MATERIALES Y MÉTODOS.: Estudio de corte transversal a través de una encuesta electrónica al personal médico y no médico de Latinoamérica que desempeño tareas asistenciales desde marzo de 2020. Se utilizó una regresión de Poisson para estimar las Razones de Prevalencia crudas (RP) y ajustadas (RPa) con sus respectivos intervalos de confianza al 95%. RESULTADOS.: Un total de 3544 participantes de 19 países respondieron la encuesta; 1992 (56,0%) residían en Argentina. Entre los mismos, el 62,9% padeció al menos un hecho de violencia: 97,7% refirió violencia verbal y 11,8% violencia física. El 41,5% de los agredidos padecieron situaciones de violencia al menos una vez por semana. El personal de salud de Argentina vivenció más frecuentemente violencia que los de otros países (62,9% vs. 54,6%, p<0,001), siendo estos eventos más habituales y estresantes (p<0,05). Además, refirieron más frecuentemente haber considerado cambiar sus tareas asistenciales y/o deseos de abandonar su profesión (p<0,001). En la regresión de Poisson, los participantes de Argentina tuvieron una prevalencia de violencia mayor que los trabajadores de salud de la región (14,6%; p<0,001). CONCLUSIONES.: Existió una elevada prevalencia de violencia contra el personal de salud de Argentina durante la pandemia por COVID-19. Estos hechos tuvieron un alto impacto negativo entre quienes los padecieron. Nuestros datos sugieren que, esto podría haber sido más frecuente en Argentina respecto de otras regiones del continente.
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Agressão , COVID-19 , Humanos , América Latina/epidemiologia , Estudos Transversais , Argentina/epidemiologia , Pandemias , COVID-19/epidemiologia , Violência , Pessoal de SaúdeRESUMO
Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS: The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.
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This paper employs network theory, mining data and bibliometric analysis when mapping the scientific contribution of Nobel Prize candidate; Manuel Sandoval Vallarta, the first and most renowned Mexican physicist and important figure in Latin American science. Vallarta died in 1977, and the existing literature is about his life and contributions to science but not about how those are still valuable today. This paper is the first to highlight, with mapping tools, that his contributions are relevant to the international community of cosmic rays (as he was pioneer and leader), quantum mechanics and relativity. These tools delivered three findings: Identify how he built his own field of study, same as universal knowledge. Unveil that the backward and forward Vallarta citations follow a scale-free network distribution. Determine social factors that benefited or affected his scientific activities-such as World War II interrupting Vallarta's successful productivity at Massachusetts Institute of Technology. Furthermore, this study confirmed the interdisciplinary nature of the mapping studies of the scientist's contributions using scientometric tools. As a result, several interesting questions arose throughout our research, some of which were answered from the history and philosophy of science. However, others need to be analyzed by experts in the fields of Vallarta. Mapping research sends an invitation to interdisciplinary dialogue/research between experts in different areas of study to better understand the process of knowledge production both, individual and collective.
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The COVID-19 pandemic has had tremendous consequences globally. Notably, increasing complaints of verbal and physical violence against health care providers have been reported. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022 to delineate the violent behavior against front-line health professionals in Latin America. A total of 3544 participants from 19 countries were included. There were 58.5% women, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members. About 54.8% reported acts of abuse: 95.6% verbal abuse, 11.1% physical abuse, and 19.9% other types. Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, 56.2% considered changing their care tasks, and 33.6% considered quitting their profession. In a logistic regression model, nurses (odds ratio (OR) 1.90, P < 0.001), doctors (OR 2.11, P < 0.001), and administrative staff (OR 3.53, Pâ¯=â¯0.005) experienced more abuse than other health workers. Women more frequently reported abuse (OR 1.56, P < 0.001), as well as those who worked directly with COVID-19 patients (OR 3.66, P < 0.001). A lower probability of abuse was observed at older ages (OR 0.95, P < 0.001). There has been a high prevalence of abuse against health personnel in Latin America during the COVID-19 pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be at elevated risk. It is imperative to develop strategies to mitigate these acts and their repercussions on the patient-provider relationship and outcomes.
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COVID-19 , Agressão , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , América Latina , Masculino , Pandemias , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Bipolar Disorders (BD) are a mood disorders group charactered by recurrent manic or hypomanic episodes, alternating with depressive episodes. Its prevalence is 4%, and several studies have shown that they generate disability. There are effective therapeutic options for acute episodes. However, the ultimate goal is to achieve functional recovery and adequate well-being. MATERIAL AND METHODS: There was done in Buenos Aires, Argentina a cross-sectional study comparing psychosocial functioning, with the Functioning Assessment Short Test (FAST) and subjective well-being with the Five Well-Being Index (WHO-5), among a sample of stabilized BD patients undergoing treatment at the Center of Medical Education and Clinical Research (Centro de Educación Médica e Investigaciones Clínicas) and the Bipolar Foundation (Fundación Bipolares de Argentina), with a control group. RESULTS: A total of 102 BD patients and 52 controls where included. The FAST mean for patients and controls was 20.71 and 9.73 respectively (P=0.0000). The WHO-5 mean for patients was 59.11 and 69.76 for controls (P=0.0011). More than 70% of the patients presented functional alteration (FAST ≥12), and almost 35% presented inadequate subjective well-being (WHO-5 ≤52). Depressive symptoms conditioned worse scores on both scales. FAST scores were better among those who participated in mutual aid groups (P=0.026). While patients who underwent psychoeducation and those who received anticonvulsant drugs, presented better WHO-5 scores (P = 0.028 and P=0.048 respectively). CONCLUSIONS: Patients with BD showed poor Functionality and poor Well-being despite being stabilized. There is direct relationship between both conditions. Depressive symptoms generated worst scores on the scales.
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Transtorno Bipolar , Argentina , Transtorno Bipolar/diagnóstico , Estudos Transversais , Humanos , Organização Mundial da SaúdeRESUMO
The Third Argentine Consensus on the management of bipolar disorders (TB) is an initiative of the Argentine Association of Biological Psychiatry (AAPB). As a reference document, this consensus pursues two main objectives: on the one hand, to summarize and systematize the best available evidence on the comprehensive management of this pathology; on the other, to provide a useful, up-to-date instrument for psychiatrists, multidisciplinary teams dedicated to mental health, and government agencies. During a period of approximately six months of work -that is, from May to October 2022- a committee of experts made up of 18 professionals and representatives of the three most important Psychiatry and Mental Health associations in Argentina (that is, the AAPB, the Argentine Association of Psychiatrists, AAP, and the Association of Argentine Psychiatrists, APSA) have focused on updating the information regarding TB. Finally, this document was prepared as a result of an exhaustive review of the bibliography published to date, which was strategically divided into three parts: the first deals with the generalities of TB; the second deals with the comprehensive treatment of the pathology; finally, the third analyzes TB in the context of special situations.
El Tercer Consenso Argentino sobre el manejo de los Trastornos Bipolares (TB) es una iniciativa de la Asociación Argentina de Psiquiatría Biológica (AAPB). Como documento de referencia, este consenso persigue dos objetivos principales: por un lado, resumir y sistematizar la mejor evidencia disponible sobre el manejo integral de esta patología; por el otro, proporcionar un instrumento útil y actualizado a psiquiatras, a equipos multidisciplinarios abocados a la salud mental y a organismos gubernamentales. Durante un período de aproximadamente seis meses de trabajo -desde mayo a octubre de 2022- un comité de expertos integrado por 18 profesionales y por representantes de las tres asociaciones de Psiquiatría y Salud Mental más importantes de la Argentina: la AAPB, la Asociación Argentina de Psiquiatras, (AAP) y la Asociación de Psiquiatras Argentinos (APSA), se abocaron a actualizar la información respecto de los TB. Finalmente, y como resultado de una exhaustiva revisión de la bibliográfica publicada hasta la actualidad, se confeccionó este documento que fue dividido estratégicamente en tres partes: la primera versa acerca de las generalidades del TB; la segunda aborda el tratamiento integral de la patología; y, por último, la tercera analiza los TB en el contexto de situaciones especiales.
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Antipsicóticos , Transtorno Bipolar , Humanos , Transtorno Bipolar/tratamento farmacológico , Antipsicóticos/uso terapêutico , Consenso , ArgentinaRESUMO
BACKGROUND: An early and prolonged lockdown was adopted in Argentina during the first wave of COVID-19. Early reports evidenced elevated psychological symptoms. AIMS: To explore if the prolonged lockdown was associated with elevated anxiety and depressive symptoms; if mental fatigue was associated with lockdown adherence (a phenomenon called 'behavioural fatigue'); and if financial concerns were associated with lockdown adherence and emotional symptoms. METHOD: The survey included standardised questionnaires to assess depressive (PHQ-9) and anxious (GAD-7) symptoms, mental fatigue, risk perception, lockdown adherence, financial concerns, daily stress, loneliness, intolerance to uncertainty, negative repetitive thinking and cognitive problems. LASSO regression analyses were carried out to predict depression, anxiety and lockdown adherence. RESULTS: The survey reached 3617 adults (85.2% female) from all provinces of Argentina after 72 days of lockdown. Data were collected between 21 May 2020 and 4 June 2020. In that period, Argentina had an Oxford stringency index of 85/100. Of those surveyed, 45.6% and 27% met the cut-offs for depression and anxiety, respectively. Mental fatigue, cognitive failures and financial concerns were correlated with psychological symptoms, but not with adherence to lockdown. In regression models, mental fatigue, cognitive failures and loneliness were the most important variables to predict depression, intolerance to uncertainty and lockdown difficulty were the most important for anxiety, and perceived threat was the most important for predicting lockdown adherence. CONCLUSIONS: During the extended lockdown, psychological symptoms increased, being enhanced by mental fatigue, cognitive difficulties and financial concerns. We found no evidence of behavioural fatigue. Thus, feeling mentally fatigued is not the same as being behaviourally fatigued.
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BACKGROUND: Missing data is a common issue in different fields, such as electronics, image processing, medical records and genomics. They can limit or even bias the posterior analysis. The data collection process can lead to different distribution, frequency, and structure of missing data points. They can be classified into four categories: Structurally Missing Data (SMD), Missing Completely At Random (MCAR), Missing At Random (MAR) and Missing Not At Random (MNAR). For the three later, and in the context of genomic data (especially non-coding data), we will discuss six imputation approaches using 31,245 variants collected from ClinVar and annotated with 13 genome-wide features. RESULTS: Random Forest and kNN algorithms showed the best performance in the evaluated dataset. Additionally, some features show robust imputation regardless of the algorithm (e.g. conservation scores phyloP7 and phyloP20), while other features show poor imputation across algorithms (e.g. PhasCons). We also developed an R package that helps to test which imputation method is the best for a particular data set. CONCLUSIONS: We found that Random Forest and kNN are the best imputation method for genomics data, including non-coding variants. Since Random Forest is computationally more challenging, kNN remains a more realistic approach. Future work on variant prioritization thru genomic screening tests could largely profit from this methodology.
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INTRODUCTION: Identifying affective temperaments could be useful both for understanding the normal behavioral variations in the general population and to establish if there is a clinical predisposition to certain disorders. Five affective temperaments have been proposed: depressive, cyclothymic, hyperthymic, irritable and anxious. Original instrument for measuring them (TEMPS-A) is a 110-item scale but many short versions in different languages have been validated. The aim of this study was to obtain a short self-administered Spanish version of TEMPS-A with good psychometric properties. MATERIALS AND METHODS: A sample of 550 students who answered the argentinean version of TEMPS-A was included, after psychometric analysis a comparison between inpatients with major depression and their matched controls by sex and age who answered the brief version was performed to get an external validation. RESULTS: The sample was composed by 298 (54.2%) women. The mean age was 23.3 year (SD=6.2). A forced five factor analysis was performed. The 7 items with the highest factorial load (more than 0.350) for each subscale were included in the brief version. The Cronbach alpha's ranged from 0.690 to .800. The most prevalent temperament was hyperthymic followed by cyclothymic for students sample. Similarities between students and controls sample were observed, but not with patients with major depression. CONCLUSIONS: This brief Spanish version of TEMPS-A (35 items) has good psychometric properties and can be used in general and clinical population.
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BACKGROUND: The COVID-19 pandemic's mental health consequences remain unknown. AIM: To assess the mental health status of ambulatory cardiometabolic patients during COVID-19 pandemic lockdown in Spanish speaking Latin American countries. METHODS: Cardiometabolic patients without COVID-19 evidence in 13 Latin American countries answered a survey between June 15th and July 15th, 2020. The Diagnosis Manual of Mental Disorders fifth edition was used to identify the presence of major depressive symptoms. RESULTS: The sample included 4216 patients, 1590 (37.71%; IC95% 36.24-39.19) were considered suffering major depression. Female gender, consuming ≥5 medications day, physical activity <100 minutes weekly, low fruits and vegetables intake, poor treatment adherence, reduced food consumption were independently associated to the presence of major depressive symptoms. CONCLUSIONS: The CorCOVID Latam Psy study showed that one-third of the Latin American Spanish speaking population is suffering from major depressive symptoms during the COVID-19 outbreak.
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COVID-19 , Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Diabetes Mellitus/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus/psicologia , Dieta/estatística & dados numéricos , Dislipidemias/epidemiologia , Dislipidemias/psicologia , Ingestão de Alimentos , Exercício Físico/psicologia , Feminino , Frutas , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , América Latina/epidemiologia , Masculino , Saúde Mental , Síndrome Metabólica/psicologia , Pessoa de Meia-Idade , SARS-CoV-2 , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , VerdurasRESUMO
Ketogenic diet (KD) is comprised of a distinct macronutrient combination: i.e. 90% fat, 8% of protein and 2% of carbohydrates, typically characterized as a high-fat low-carbohydrate diet. KD's efficacy was largely established for treatment resistant epilepsy in children, but its mental, emotional and behavioral effects remain largely unknown. Nevertheless, the efficacious effects of KD in childhood epilepsy provide rationale for repurposing this approach for other brain-based disorders. Consequently, clinicians and researchers should be aware of the evidence regarding efficacy, as well as the benefits and risks of adopting this diet. Results from animals and humans studies provide equivocal evidence across multiple domains of psychopathology. Conceptually, KD shows promise to serve as an efficacious treatment for mental disorders.
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Comportamento , Dieta Cetogênica , Emoções , Transtornos Mentais/dietoterapia , Transtornos Mentais/psicologia , Química Encefálica , Dieta Cetogênica/efeitos adversos , Humanos , Resultado do TratamentoRESUMO
The feature selection (FS) process is a key step in the Quantitative Structure-Property Relationship (QSPR) modeling of physicochemical properties in cheminformatics. In particular, the inference of QSPR models for polymeric material properties constitutes a complex problem because of the uncertainty introduced by the polydispersity of these materials. The main challenge is how to capture the polydispersity information from the molecular weight distribution (MWD) curve to achieve a more effective computational representation of polymeric materials. To date, most of the existing QSPR techniques use only a single molecule to represent each of these materials, but polydispersity is not considered. Consequently, QSPR models obtained by these approaches are being oversimplified. For this reason, we introduced in a previous work a new FS algorithm called Feature Selection for Random Variables with Discrete Distribution (FS4RVDD), which allows dealing with polydisperse data. In the present paper, we evaluate both the scalability and the robustness of the FS4RVDD algorithm. In this sense, we generated synthetic data by varying and combining different parameters: the size of the database, the cardinality of the selected feature subsets, the presence of noise in the data, and the type of correlation (linear and nonlinear). Moreover, the performances obtained by FS4RVDD were contrasted with traditional FS techniques applied to different simplified representations of polymeric materials. The obtained results show that the FS4RVDD algorithm outperformed the traditional FS methods in all proposed scenarios, which suggest the need of an algorithm such as FS4RVDD to deal with the uncertainty that polydispersity introduces in human-made polymers.
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Algoritmos , Polímeros/química , Modelos Moleculares , Conformação Molecular , Peso Molecular , Relação Quantitativa Estrutura-AtividadeRESUMO
Alzheimer's disease is one of the most common neurodegenerative disorders in elder population. The ß-site amyloid cleavage enzyme 1 (BACE1) is the major constituent of amyloid plaques and plays a central role in this brain pathogenesis, thus it constitutes an auspicious pharmacological target for its treatment. In this paper, a QSAR model for identification of potential inhibitors of BACE1 protein is designed by using classification methods. For building this model, a database with 215 molecules collected from different sources has been assembled. This dataset contains diverse compounds with different scaffolds and physical-chemical properties, covering a wide chemical space in the drug-like range. The most distinctive aspect of the applied QSAR strategy is the combination of hybridization with backward elimination of models, which contributes to improve the quality of the final QSAR model. Another relevant step is the visual analysis of the molecular descriptors that allows guaranteeing the absence of information redundancy in the model. The QSAR model performances have been assessed by traditional metrics, and the final proposed model has low cardinality, and reaches a high percentage of chemical compounds correctly classified.
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Doença de Alzheimer/tratamento farmacológico , Secretases da Proteína Precursora do Amiloide/antagonistas & inibidores , Inibidores de Proteases/química , Inibidores de Proteases/farmacologia , Relação Quantitativa Estrutura-Atividade , Doença de Alzheimer/enzimologia , Simulação por Computador , Aprendizado de Máquina , Inibidores de Proteases/uso terapêuticoRESUMO
From the ancient Greeks (V to III centuries BC), through Hippocrates to the Roman physician Aulo Cornelius Celso (I century), the term paranoia has been used as a manifestation of mental illness. After many centuries, Robert Burton in 1621 introduces the concept with a more modern meaning. Only with Heinroth (1818) the syndrome enters into the psychiatric nosology as a disorder of thought with unaltered perceptions. French and German psychiatry agree on the concept of paranoia as a partial psychosis with a maintained level of functioning and absence of deterioration. With this meaning the term is introduced in the modern psychiatry in Kahlbaum's work (1863). Jasper contributes with the introduction of paranoid development that can be influenced by the environment or previous experiences (1910). But to Kraepelin (1921) is owed the most precise description in a specifc essay based on his clinical experience. The German psychiatrist speaks of both a psychogenic and a more biological component. In modern psychiatric classifcations gradually the syndrome has disappeared and encompassed in the generic delusional disorder, clearly distinct from schizophrenia, and only if the delusions are understandable. The consequences of the absence of a diagnostic recognition implies that there is no specific research on this syndrome with difficulties in developing psychotherapeutic and pharmacological treatments.