Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Órgãos dos Sentidos/fisiopatologia , Transtornos Somatoformes/diagnóstico , Sintomas Inexplicáveis , Sinais e Sintomas , Transtornos Somatoformes/prevenção & controle , Inquéritos e Questionários/estatística & dados numéricos , Estudos Retrospectivos , Diagnóstico Duplo (Psiquiatria)/psicologia , Pessoas Mentalmente Doentes/psicologiaAssuntos
Humanos , Masculino , Feminino , Diagnóstico Duplo (Psiquiatria)/efeitos adversos , Diagnóstico Duplo (Psiquiatria)/psicologia , Transtornos Neurocognitivos/complicações , Alcoolismo/complicações , Alcoolismo/prevenção & controle , Diagnóstico Duplo (Psiquiatria)/métodos , Pesquisa Qualitativa , Alcoolismo/psicologiaRESUMO
El dolor torácico no cardiogénico se define como episodios recurrentes de dolor subesternal en pacientes que no poseen una causa cardiológica luego de un estudio acabado. Representa un dilema clínico dado que el dolor frecuentemente es indistinguible de un dolor de origen coronario llevando a extensas y costosas evaluaciones. Diversos mecanismos han sido implicados en su origen, entre ellos el reflujo gastroesofágico, alteraciones de la motilidad, hipersensibilidad visceral y comorbilidad psicológica. Junto a ello, diversos test diagnósticos están disponibles en la práctica clínica para identificar el origen del dolor, incluyendo la pH metría de 24 horas, estudios de motilidad esofágica, endoscopía digestiva alta, test de probación y tratamientos de prueba. Su tratamiento idealmente debiera estar enfocado a corregir el mecanismo subyacente y aliviar los síntomas. Inhibidores de la bomba de protones, antidepresivos, relajantes de la musculatura lisa y terapia cognitiva conductual aparecen como medidas terapéuticas de utilidad.
Noncardiac chest pain is defined by recurrent episodes of subesternal chest pain in patients lacking a cardiac cause after a comprehensive evaluation. It is a diagnostic dilemma, chest pain is often indistinguishable from cardiac cause leading to extensive and expensive evaluations. Pathophysiologically, gastroesophageal reflux disease, esophageal dismotility, esophageal hypersensitivity, and psychological comorbidities have been implicated. A variety of diagnostic tests are available in the clinical practice to identify the origin of pain, including ambulatory pH testing, esophageal motility, upper endoscopy, provocative testing and even therapeutic trails. Ideally treatment should be aimed at correcting the underlying mechanism and relieving symptoms. Proton pumps inhibitors, antidepressants, smooth muscle relaxants and cognitive behavorial therapy appear to be useful for the treatment of these patients.
Assuntos
Humanos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Transtornos da Motilidade Esofágica/complicações , Transtornos da Motilidade Esofágica/terapia , Refluxo Gastroesofágico/complicações , Endoscopia do Sistema Digestório , Diagnóstico Duplo (Psiquiatria)/psicologia , Inibidores da Bomba de Prótons , Concentração de Íons de Hidrogênio , ManometriaRESUMO
La patología dual es una problemática en la que se observa la coexistencia de un trastorno psiquiátrico y el consumo de sustancias psicoactivas, simultáneamente. Es de difícil diagnóstico y tratamiento. Se observa en los estados depresivos, los trastornos de ansiedad, la esquizofrenia, el trastorno bipolar y los trastornos de conducta. El abordaje debe ser integral e incluir tratamiento psicofarmacológico, psicoterapéutico cognitivo-conductual, psicoterapia grupal y orientación a la familia, asimismo, lograr un compromiso del paciente, los familiares y los amigos en el cumplimiento estricto del tratamiento. El tratamiento puede realizarse en forma ambulatoria, en hospital de día, con internación breve para la desintoxicación o en comunidades terapéuticas, la elección dependerá del tipo de patología psiquiátrica y del nivel bajo, medio o alto de consumo de sustancias concomitante.
Dual pathology is a problem in which a psychiatric disorder and the consumption of psychoactive substances coexist at the same time. It is difficult to diagnose and to treat. This pathology is observed in depressive states, anxiety disorders, shizophrenia, bipolar disorder and behavior disorders. Its approach should be integral and include psychopharmacological, psychotherapeutic, cognitive-behavioral treatment, group psychotherapy and family guidance, and it should achieve commitment on the part of the patient, relatives and friends, in the strict compliance of such treatment. Treatment can be performed externally, at a day hospital, through brief hospitalization for desintoxication or in therapeutic communities, the choice will depend on the type of psychiatric pathology and on the low, medium or high concomitant level of consumption of substances.
Assuntos
Humanos , Transtornos Relacionados ao Uso de Cocaína , Comorbidade , Comportamento Aditivo/patologia , Comportamento Aditivo/terapia , Depressão/patologia , Diagnóstico Duplo (Psiquiatria)/psicologia , Esquizofrenia/patologia , Aceitação pelo Paciente de Cuidados de Saúde , Transtorno Bipolar/patologiaRESUMO
Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment.
Assuntos
Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Pacientes Internados/psicologia , Transtornos Mentais/epidemiologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos de Coortes , Comorbidade , Diagnóstico Duplo (Psiquiatria)/psicologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Transtornos Psicóticos/epidemiologia , Estudos Retrospectivos , Esquizofrenia/epidemiologia , Fatores Sexuais , Espanha/epidemiologiaRESUMO
This study compared baseline demographics, clinical characteristics and patterns of substance use of 99 substance misusing women seeking treatment in a Brazilian hospital who had been diagnosed with drug dependence (alcohol dependence, if present, was not the most important) against 162 women diagnosed with alcohol dependence. Most of the drug-dependent women in this study were dependent on cocaine (73.7%). It was found that drug-dependent women, at entry, were younger, with a higher educational level, single or lived alone, and had a job outside home more often than alcoholics; they also had less alcohol-use related problems in the family and more relatives with problems with other drugs. They sought treatment mainly by self-initiative and reported more past suicide attempts than their alcoholic counterparts. In addition, they began drug use at the same age but increased drug use, as well as seeking treatment, significantly earlier. Alcoholics had more psychiatric comorbidity. The findings point out heterogeneity among chemically-dependent Brazilian women.