To look for structural and/or functional deviations of the salience network in depressive patients that might help to identify individuals with ideation of suicide. In 2 matched groups of patients with major depression and with and without ideation of suicide and in a healthy control group, structural and functional magnetic resonance imaging was performed during resting state and activation by a moral decision paradigm. Data were evaluated using voxel based morphometry, statistical parametric mapping, independent component analysis and network-based statistics (NBS) and related to the Clinical Analysis Questionnaire score of suicidality. Functional connectivity was reduced significantly (p<0.05, NBS corrected) within the salient network during resting state in patients with suicide ideation. Application of a moral paradigm activated nearly identical areas, and both anterior parts of the insulae correlated negatively to the score of suicidality. Because the cerebral areas activated during a moral decision paradigm are nearly identical to the salience network seen in our study and because selected areas within this network, mainly the anterior parts of the insula, correlate negatively to suicidality, a special training using moral tasks or possibly also religious reinforcement might help to reduce suicidality in depressive patients.
Depression is a frequent psychological problem in the general population. There are no single conclusive causes for its development; on the contrary, it arises from the interaction of other emotional disorders. Determining risk factors is a primary objective to identify vulnerable individuals and optimize prevention. To analyze risk factors of the depression through network analysis in Peruvian adults from the general population. Cross-sectional study with a quantitative approach. A total of 567 Peruvian adults who answered several instruments assessing depressive symptoms, insomnia, suicidal ideation and anxiety participated. An undirected network model with all psychological variables and a predictive path diagram was estimated to identify risk factors for depression. Measures of centrality, precision and stability were also analyzed. The network structure showed that depression, insomnia, suicidal ideation, and anxiety were mutually associated. In terms of expected influence and predictability, depression obtained the highest value, followed by anxiety. In the prediction plot, all psychological variables were directly connected with depression, with anxiety having the highest connection. The tests of accuracy and stability (CS = 0,75), were robust. The results of the study suggest that problems with insomnia, suicidal ideation, and anxiety, are considerable risk factors for depression. Identifying and intervening early on those risk factors in adults in the general population could help to prevent the development of depressive symptoms.
To analyze factors associated with more severe outcomes of suicide attempt due to toxicological events in adolescents. A cross-sectional study involving adolescents between 10 and 19 years of age treated due to attempted suicide from 2017 to 2020. The dependent variable was the final severity, divided into two categories: asymptomatic or mild and moderate, severe or fatal, and the independent variables were those related to patients, exposure, and clinical conditions. For association analyses, logistic regression was used, with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI). A total of 1462 suicide attempts in adolescents were evaluated, and 21.1% (N=306) were classified moderate, severe or fatal outcome. Suicide attempts due to toxicological events in adolescents showed a higher prevalence of the moderate, severe or fatal outcome in males (OR 1.52; 95% CI 1.11-2.07), in the summer months (OR 1.81; 95% CI 1.31-2.48) and in cases whose time until attendance was equal to or greater than 300min (OR 1.72; 95% CI 1.29-2.29), with evidence of increasing severity of cases over the years (2019: OR 1.87; 95% CI 1.21-2.98; 2020: OR 2.80; 95% CI 1.31-2.48). Since adolescents need a more rigorous psychosocial follow-up due to the adversities inherent to the age group, there is a clear need for better identification of striking prodromal signs of suicide attempts in order to develop therapeutic interventions and preventive strategies.
Suicidal behaviors are one of the top ten causes of death worldwide. It is recommended to prioritize the surveillance of suicide attempts, as this is a useful risk factor in the short-term prediction of suicide. In Colombia, its surveillance was implemented in 2016. The study evaluated the performance of the suicide attempt surveillance system in Cali, Colombia, in the period 2016-2019. The attributes of timeliness, data quality and representativeness were evaluated according to the CDC Guidelines for Violence and Injury Surveillance, in addition to describing patterns of occurrence through time series. The median timeliness of notification was 0 days (RIQ=3). The variables exposure to violence (73.5%), depressive disorder (49.6%) and personality disorder (44.1%) had the highest percentages of missing data. The system identifies priority populations similar to other sources of information, such as young people between 15 and 24 years of age (28.1%), women (64.8%), students (35.5%) and the single population (69.6%); triggering factors such as relationship problems (35.6%), economic problems (13.7%) and serious illness (7%); and mechanisms used such as intoxication (61.6%), short stabbing weapon (27.6%) and hanging (5.3%). The system predicts 22 cases (95% CI=21.6-22.3) per week of attempted suicide in the short term. The system meets the attributes of quality, timeliness and representativeness. It also allows the identification of an expected threshold of cases that needs to be validated to detect outbreak situations. This study contributes to the knowledge and prevention of the suicidal phenomenon.
Selective serotonin reuptake inhibitors (SSRIs) are medications used in child and adolescent psychiatry mainly for the treatment of depression, anxiety and obsessive compulsive disorder. In general, these medications are safe and well tolerated. However, they can cause adverse effects such as activation syndrome, which if not identified can negatively affect adherence and response to treatment. Activation syndrome has received little attention and can be difficult to recognise due to the lack of a clear definition and objective diagnostic measures, and also because it can be confused with a worsening of the psychiatric disorder or mania triggered by the antidepressants. For all the above, it is important that professionals who prescribe antidepressants in the paediatric population are able to identify and manage activation syndrome when it occurs. Our aim was to carry out a narrative review of activation syndrome in children and adolescents treated with SSRIs in terms of definition, prevalence, pathophysiology, associated factors, relationship with suicide risk, management strategies and recommendations for reducing the risk of suicidal behaviours when using antidepressants in this population. We performed a non-systematic narrative review of activation syndrome in children and adolescents which involved finding information in PubMed, Ovid, EBSCO, ProQuest and Embase. Review articles, prospective and retrospective investigations, systematic reviews, meta-analyses and other articles related to activation syndrome in children and adolescents were selected. The search was limited to studies published in English and Spanish that involved children and adolescents and no limits were applied to the publication date or study design. A total of 62 articles were included, 61 of them in English. The results were grouped into the following topics: definition; prevalence; pathophysiology; associated factors; relationship with suicide risk; management strategies; and recommendations for reducing the risk of suicidal behaviours when using antidepressants in this population. Activation syndrome refers to a set of symptoms consisting of impulsiveness, restlessness, increased activity, insomnia, irritability, disinhibition and agitation. This syndrome is poorly characterised in terms of its definition, prevalence, risk factors and pathophysiology, a situation that limits its recognition and evaluation. There are many factors that predispose the development of the syndrome such as age, differences in brain development in the paediatric population, the characteristics of the patient or the antidepressant, disorders of neurological development, and the doses and plasma levels of the medications. It has been thought that activation syndrome may be related to suicidal tendencies. However, the evidence in support of this link is inconsistent and further studies are therefore necessary. Activation syndrome with SSRI is a particularly important adverse effect in children and adolescents and, when it occurs, can cause lack of adherence to or discontinuation of treatment. Strict vigilance is therefore recommended during the use of these medications.
To describe the impact of COVID-19 on oncology care providers' self-reported perceived stress, resilience, moral distress, anxiety, and depression in Colombia. During 2020, a cross-sectional survey was carried out among oncology care providers. The Perceived Stress Scale, Connor-Davidson Resilience Scale, Moral Distress Thermometer, and the PHQ-4 were used. Basic socio-demographic and occupational characteristics are described, and bivariate and multivariate analyses were done to investigate their association with a high PHQ-4 score (>6). 148 participants (mean age 43.1 years, 54.6% women, 72.3% medical specialists) were recruited. The major source of stress was not being infected, but spreading COVID-19. A low prevalence of depression/anxiety was found, as well as low resilience and moral distress. Women reported lower resilience and higher depression/anxiety. History of depression and lack of adequate coping strategies were associated with higher levels of depression/anxiety. The impact of the COVID-19 pandemic on the mental health of oncology care providers was mild, probably due to the protection for oncology patients during this period; however, women reported a greater impact. The association of demographic and clinical variables with higher levels of depression/anxiety should inform further preventive measures to reduce the impact of prolonged public health crises on healthcare providers' mental health.
There is scarce evidence of the impact of delirium on the post-ICU outcomes of critically ill patients. This study assessed the effect of delirium on cognitive function, functionality, and quality of life after three months from discharge in critically ill patients. A nested case-control study was realized from April to September 2018. The prevalence of delirium and its association with mortality was assessed, and the alterations in cognition, functionality, and quality of life in survivors of critical illness three months after discharge from the ICU. 81 patients were included and evaluated with the CAM-ICU; 43 were defined as cases. The prevalence of delirium was 26%, and the mortality of patients with and without delirium was 35.4% vs. 10%, respectively. In the follow-up, the delirium group showed lower scores in the MMSE (p<0.01), with a specific decline in the subdomains of orientation, calculation, and language/praxis compared with the control group. The delirium group showed a decreased score in the SF-36, with a significant decline in social function, emotional role, and mental health (p<0.05). There were no differences observed in functionality measured by the PGC-IADL. Education strategies are required to increase delirium awareness in ICU teams. Support from a mental health interdisciplinary team is needed to guide the preventive and rehabilitation interventions for post-ICU patients.
This manuscript reports on the clinical outcomes (response, remission and relapse) in TRD patients in Colombia under Standard-of-Care (SOC), and patient reported outcomes (PROs) - QoL, disability, depression severity - over a 1-year follow-up. From a sample of 162 MDD patients from 4 centres in Colombia, 52 had a formal diagnosis of TRD and were included in the 1-year follow-up. Exclusion criteria were patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. Clinical outcomes were measured with MADRS and PHQ-9, while PROs included EQ-5D (QoL) and Sheehan Disability Scale (SDS - disability). Patients' mean age was 41.88 years, 80.8% of which were female, 37.3% were married or on consensual union and 42.3% had at least 13 years of formal education. Half of the sample achieved clinical response after 1-year of follow-up, while remission was not achieved by 57.9% of the participants (MADRS). Over 60% of the patients had mild to severe depression at the end of study (PHQ-9), while 57.9% reported feeling anxious/depressed (EQ-5D). Over three-quarters of the sample reported disruption in work/school, social life/leisure and family/home responsibilities (SDS). Present results for Colombia underline the burden of TRD in most aspects of daily living. Current SOC fails to deliver the necessary clinical outcomes and patient centric approach, which suggests the need to improve treatment protocols, while increasing access to specialists, foster earlier diagnosis and the implementation on a nationwide programme for mental health.
The main aims of this study were to adapt the COVID-19 peritraumatic distress index (CPDI) to the Peruvian population and to establish a model explaining depression using CPDI values and anxiety symptoms during the COVID-19 lockdown. Finally, we sought predictive values of the obtained CPDI factors for depression and anxiety as a secondary aim. An exploratory factor analysis (n=300) was performed, followed by confirmatory factor analysis in a second phase (n=1135). To explain depression scores during the COVID-19 lockdown, we performed structural equation modeling (SEM). Finally, we performed a hierarchical regression model (HRM) to evaluate the amount of explained variance of the CPDI factors above depression, anxiety, and socio-demographic variables. A 2-factor solution (rumination and stress) for the CPDI (p<0.001; CFI=0.99) was found. Concerning the SEM, our model was able to explain 81% of the depression scores (p<0.001; CFI=0.98). Finally, in the HRM, rumination could explain 17% additional variance in depression (p<0.001) and 28% in anxiety (p<0.001). However, stress showed collinearity with depression and anxiety, not continuing for further HRM analysis. Our results showed a 2-factor solution for the CPDI. Moreover, our SEM model showed that female sex, younger age, and incomplete education (with high COVID-related stress and anxiety) lead to more depression symptoms during the COVID-19 lockdown. Finally, our HRM showed that people who frequently ruminate during the COVID-19 lockdown are more afraid and negatively affected.
Dementias constitute a group of diseases that notoriously affect people who suffer from them, especially in terms of their independence and decision-making, leading the caregiver to assume or make various decisions about the patient. However, in the past this was explained by the fact that there was a theoretical and narrative insufficiency around patients with dementia, which led us to ignore that they still conserved their decision-making capacity as well as their autonomy. This text proposes to defend the existence of autonomy in these patients and a way about how we can take care of it and preserve it in the medical field, through an ethical position based on the care and recognition of vulnerability. An approach focused on the ethics of care and vulnerability by Ronald Dworkin, Emmanuel Levinas and Corine Pelluchon focused on the person with dementia. I introduced a scale that allows assessing autonomy and decision-making in people with dementia. To guarantee the dignity of the person with dementia, it is necessary to understand how they are autonomous, in terms of self-governance and seeking to reduce asymmetries in relationships. In addition, always include caregivers and family members in decision-making. People with dementia are autonomous in an individual or personal sense and deserve respect; Although they are in a state of vulnerability, there are different mechanisms focused on their care.
Neonatal hypoxic-ischemic encephalopathy after perinatal asphyxia causes neurolinguistic disturbances in children without disabilities. Poor academic performance appears as a long-term result. Language intervention is sought to reduce harmful effects on children. The aim of this study is showing the relationship between clinical conditions of hypoxic-ischemic-encephalopathy (HIE) and language disorders in children without disabilities. This cross-sectional study with a neurolinguistic approach was carried out in patients with perinatal asphyxia during childbirth, at the ZH Sikder Women's Medical College Hospital, Bangladesh. Respondents between 4 and 12 years, 76% underwent cranial computed tomography (CT); 82% underwent magnetic resonance imaging (MRI); and 70% underwent electroencephalogram (EEG). Among them were found positive results for neonatal hypoxia ischemic encephalopathy (EHI). These results are related to the following language disorders: reception/perception disorder (64%), sociolinguistic disorders (84%); metalinguistic competence disorder (66%); 86% of children had poor peer relationships and 72% had reading and writing disorders. Concluding, school-age children after perinatal asphyxia who developed Hypoxic-Ischemic Encephalopathy (HIE) had language disorders and poor school performance. There are still challenges to be overcome, as this is the first neurolinguistic approach in Bangladesh. More large-scale studies are needed.
Depressive episodes are frequent in chronic obstructive pulmonary disease (COPD) patients. These episodes are related to a vast number of clinical and psychosocial variables. Nevertheless, the relationship between the number of COPD exacerbations and depression has not been extensively studied in the Colombian Caribbean. The objective was to determine the relationship between COPD exacerbations and depression in a sample of outpatients in Santa Marta, Colombia. A cross-sectional analytical study was designed in which COPD adult patients participated. The number of COPD exacerbations (none versus one or more) and the risk of depression were documented. The crude and adjusted association was established by calculating the odds ratios (OR) and 95% confidence interval (95%CI). The study included 408 patients aged between 40 and 102 years (mean 72.9±10.2), and 58.8% were male. 105 patients (25.9%) reported one or more exacerbations in COPD, and 114 patients (27.9%) were at risk for depression. The crude relationship between exacerbations and depression was statistically significant (OR=1.80; 95%CI, 1.12-2.89) and after adjusting for sex (OR=1.99; 95%CI, 1.23-3.23). The number of COPD exacerbations among outpatients in Santa Marta, Colombia is related to depression. Longitudinal studies are needed in Colombia.
A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.
Suicidal behavior (SB) is nuclear in Borderline Personality Disorder (BPD). It is considered a symptom clinically relevant and with an important prognostic value. The literature describes different variables related to SB in BPD such as impulsivity, aggressiveness or hopelessness. There are not hardly any studies focused on the role of sociodemographic variables and their specific relationship with SB in BPD. The objective of this work is to identify which clinical and sociodemographic parameters could act as markers of suicide risk in BPD. A cross-sectional, observational, and retrospective study was conducted of a sample of 134 patients diagnosed with BPD. The analysis of the association between variables was carried out with a multivariate negative binomial logistic regression model. SB is related to the number of siblings with statistical significance. Likewise, a greater number of suicide attempts is significantly associated with female gender, parenthood, permanent work, sick leaves and the number of previous hospital admissions. Both the presence of SB and a greater number of suicide attempts are significantly related to history of trauma in childhood and to the score in Hamilton Anxiety Rating Scale. These parameters could act as risk factors for SB in BPD. The role of these variables could be the subject of further research projects in order to identify them in clinical practice.
To estimate the prevalence of treatment-resistant depression (TRD) in Colombia, and characterize hospitalized major depressive disorder (MDD) patients for disability, health-related quality of life (HRQoL) and work-impairment. Adult MDD patients (n=162) from 4 centers in Colombia, with a clinical diagnosis of MDD based on DSM-5 and MINI, were consecutively included. Patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial were excluded. Patient reported outcomes and clinical assessment scales were used as outcomes with WPAI:D (work impairment), EQ-5D (QoL) and Sheehan Disability Scale, as well as healthcare resource utilization. Prevalence of TRD in Colombia among patients treated at psychiatric reference sites was 32.1% [24.9%; 39.3%], higher in private institutions. Most patients were females and single. 55% reported having moderate to severe problems with usual activities at the beginning of the study. Mean percent of working time missed due to depression was around 53%, and work impairment was roughly 67%. A mean of 2.85 days in the last seven were marked by lost school/work, with higher losses in TRD patients compared to non-TRD. Overall results for HRQoL were lower in TRD patients, but disability and work impairment were higher in non-TRD. There is a high prevalence of mental disorders in Colombia, including TRD, impacting significantly HRQoL. The burden associated with them may be reduced by a most comprehensive and customized usage of therapies, including the innovations, and implementation of national mental health programs.
Emotion regulation (ER) problems have been shown to mediate the relationship between childhood maltreatment and suicidality. However, evidence is sparse regarding specific types of maltreatment and ER strategies involved. To explore cognitive reappraisal and expressive suppression as potential mediators of the association between three types of child abuse (sexual, physical, and emotional) and suicidal ideation. A cross-sectional design was used. A total of 375 Mexican young adults (77.1% female) responded to an online survey. Measures of child abuse, ER, and suicidal ideation were administered. Three mediation models were tested (one for each type of abuse), each with two mediators (the two ER strategies). The presence of mediation was formally tested through bootstrapping applied to the indirect effects. Expressive suppression significantly mediated the relationship between two types of abuse (physical and emotional) and suicidal ideation. Also, lower use of cognitive reappraisal mediated the association between sexual abuse and suicidal ideation. Studying different types of abuse and ER strategies separately provides a more complete understanding of how suicidal thoughts develop. This could also affect how interventions are tailored for different groups. The present results can be used as a starting point for further, more detailed research.
The beliefs and opinions of the general population are based substantially on mass media, which often equates mental disorders with violence and criminality. These stigmatising depictions contribute to the development and persistence of negative attitudes towards people with psychiatric conditions. The objective was to examine, through popular music, the subcultural representations of crime and violence in the context of mental disorders, focusing on depictions of victims and offenders. Strategy of analysis: Content analysis of Spanish punk lyrics (1981-2010) with references to violent and criminal behaviour associated with mental disorders. 257 Spanish punk bands were identified. The discographies included 7,777 songs, of which 190 were related to aggression, violence, or crime. A predilection for violent crimes and descriptions of the perpetrator as "mentally disturbed" was observed. Although they were present, psychotic symptoms were not the main psychiatric symptoms associated with violent crime, but instead it was substance use, antisocial personality traits and paraphilic behaviour. There was less attention paid to victims than to perpetrators. The relationships between mental disorders and criminality/violence are overemphasised in the analysed subculture. A positive connotation of social deviance and violent content (particularly serial murder) in service to the provocative nature of this type of music was observed.
Bipolar disorder (BD) has been related to various cognitive dysfunctions as well as to a high prevalence of metabolic syndrome (MS), which seems to influence the cognitive performance of patients with BD. Therefore, different hypotheses have been generated to try to explain the pathophysiological relationship between cognitive deficit in BD and MS. The objective was to review the current literature regarding the possible pathophysiological explanation of the relationship between BD and MS and its effect on cognitive performance of patients with BD. A bibliographic search was carried out using MEDLINE, ClinicalKey, EMBASE, Literatura Latino-Americana y del Caribe en Ciencias de la Salud [Latin American and Caribbean Literature in Health Sciences] (LILACS), APA PsycNet, Scopus and Scielo databases, and the Pan-American Medical Electronic Library; using the following search terms: "bipolar disorder"[MeSH Terms] OR "bipolar disorder"[All Fields] OR "mood disorders"[All Fields] AND "cognitive deficit"[MeSH Terms] OR "cognitive deficit"[All Fields] OR "cognitive dysfunction"[All Fields] OR "cognitive impairment"[All Fields] OR "cognitive decline"[All Fields] AND "metabolic syndrome" [MeSH Terms] OR "metabolic abnormalities"[All Fields] OR "metabolic effects"[All Fields] OR "obesity" [All Fields] OR "abdominal obesity" [All Fields] OR "overweight" [All Fields] OR "diabetes" [All Fields] OR "hypertension" [All Fields] AND "antipsychotics" [MeSH Terms] OR "antipsychotics"[All Fields] AND "antidepressants" [MeSH Terms] OR "antidepressants"[All Fields] AND "mood stabilizers" [MeSH Terms] OR "mood stabilizers"[All Fields]. Filters: free full text, full text, from 2001 to 2022. A total of 80 articles in Spanish and English, of any type of design, were selected. Selection and reading were carried out by all the authors. The various pathophysiological hypotheses proposed, inflammatory, endocrine, drug, environmental and social, suggest that a series of changes at the macro and microcellular level are correlated in patients with BD and MS with a negative effect on cognition of patients both globally and in specific domains, mainly executive function, memory, attention, and perceptual motor skills. Research processes should be continued to explore the various hypotheses that support the relationship between BD, MS and cognition.
This study aimed to investigate the association between occupation and depressive/anxiety symptoms, and education levels, among professionals from a Brazilian General Hospital in need of mental health treatment. This is a cross-sectional study, involving professionals from a teaching hospital in São Paulo. Socio-demographic data were collected as well as two standardized scales for depression and anxiety symptoms. Data from 506 employees seeking mental health assistance have been described: mean age was 34.6 years, 46.2% of them worked in the administrative sector, 35.0% were nursing assistants, 7.5% were nursing technicians, 6.7% were nurses, and 4.5% reported other occupations. According to the International Classification of Diseases-10th edition (ICD-10) criteria, the rates of diagnosis of depressive disorders and anxiety disorders were 60.9% and 37%, respectively. Nursing technicians and nursing assistants reported higher somatic cluster Beck Depression Inventory (BDI) scores (P=0.012) than other professionals of technical staff, but they were less inclined to receive a psychiatric diagnosis. Our study demonstrated prevalence rates higher than similar studies in university hospitals, fact that associated with difficulties of the studied population as seeing themselves as sick, and the social discrimination suffered by people with mental disorders can make this problem even worse.
Treatment of mental disorders is carried out through of drugs that are associated with hyposalivation. The study assessed the oral and salivary profiles of mental disorder patients undergoing drug treatment. A cross-sectional study, it involved participants over 18 years with mental disorders. Data collection included demographic, clinical, and oral health assessments, such as salivary flow, pH, and buffering capacity analyses. Of the 50 participants, 68% exhibited salivary alterations, with predominance of women. Schizophrenia was prevalent, with most patients taking three or more medications daily. Comorbidities were more common in the salivary alterations group. Salivary flow at rest was significantly lower in the group with alterations. While plaque index and tongue coating were similar in both groups, stimulated sialometry was lower in the alteration group. Xerostomia complaints were prevalent, indicating salivary dysfunction in psychiatric drug users, impacting oral health parameters like plaque index, tongue coating, pH, and buffering capacity.