Efectos No Analgésicos del Clorhidrato de Ketamina. Nuevas Indicaciones.

Ketamine hydrochloride (CKTM) is a dissociative anesthetic agent, with a unique position in the anesthetic practice. It was first described in the literature in 1965 and approved by the Food and Drug Administration (FDA) in 1970, being introduced commercially with the manufacturers description as that of a "general anesthesia non-barbiturate of rapid action.” This drug is considered as the only complete anesthetic, since it provides a real anesthesia that includes hypnosis, analgesia and neuroendocrine protection, in addition to considerable amnesia. In addition, inadequate responses that for a time carried out its minimum use, could be minimized or avoided with the use of adjuvant drugs such as benzodiazepines and butyrophenones.This drug has contributed significantly to the anesthetic-analgesic knowledge, as well as depressive and schizophrenic symptoms. Today, it continues to shed light on the molecular basis of pain, hypnosis and the physiopathology of different neuropsychiatric disorders. Because of its unique pharmacological and clinical properties, as well as its newly discovered indications, CKTM currently has a wide variety of clinical applications. Both the neuroprotective, antiinflammatory and antitumor effects discovered in recent years, as well as the findings on the use of low dose regimens of CKTM, have helped to broaden the profile of clinical application of this drug. The important role it plays today is corroborated by the thousands of bibliographic quotes that continue to appear in the world medical literature.This review presents the main off label indications, excluding those of acute and chronic pain, such as its use in treatment-resistant depression, obsessive-compulsive disorders, posttraumatic stress, suicide, insomnia, electroconvulsive therapy, migraine, Parkinson's disease dyskinesia, bronchial asthma, sedoanalgesia of the critical patient, postoperative cognitive dysfunction, antitumor and traumatic therapy, etc. In summary, its versatility is confirmed, both in the multiple administration routes, as well as in the concepts of brain protector and perioperative analgesia enhancer in preventive analgesia. On the contrary, the presence of tolerance, hepatic enzymatic induction, as well as multiple and diverse adverse events have been reported with its chronic administration.El clorhidrato de ketamina (CKTM) es un agente anestésico disociativo, con un lugar único en la práctica anestésica. Fue descrito por primera vez en la literatura en 1965, y aprobado por la Food and Drug Adminstration (FDA) en 1970, siendo introducido comercialmente con la descripción del fabricante como la de un "anestésico general no barbitúrico de acción rápida". Este fármaco se considera como el único anestésico completo, ya que brinda una anestesia real que incluye hipnosis, analgesia y protección neuroendocrina, además de amnesia considerable. Además, las respuestas inadecuadas que durante un tiempo conllevaron su mínimo uso podían ser minimizadas o abolidas con el uso de fármacos adyuvantes como las benzodiazepinas y las butirofenonas.                Este fármaco ha contribuido de manera notable al conocimiento anestésico-analgésico, así como de los cuadros depresivos y esquizofrénicos. Hoy en día continúa arrojando luz sobre las bases moleculares del dolor, hipnosis y la fisiopatología de los diferentes trastornos neuropsiquiátricos. Por sus propiedades farmacológicas y clínicas únicas, así como por sus nuevas indicaciones descubiertas recientemente, el CKTM actualmente tiene una amplia variedad de aplicaciones clínicas. Tanto los efectos neuroprotectores, antiinflamatorios y antitumorales descubiertos en los últimos años, como los hallazgos sobre la utilidad de los regímenes de dosis bajas de CKTM, han contribuido a ampliar el perfil de aplicación clínica de este medicamento. El importante papel que juega en la actualidad, se corrobora por las miles de citas bibliográficas que continúan apareciendo en la literatura médica mundial.             Esta revisión presenta las principales indicaciones off label, excluyendo aquellas de la esfera del dolor agudo y crónico, como son su empleo en cuadros de depresión resistente a tratamiento, trastornos obsesivos compulsivos, estrés postraumático, suicidio, insomnio, terapia electroconvulsiva, migraña, disquinesia de la enfermedad de Parkinson, asma bronquial, sedoanalgesia del paciente crítico, disfunción cognitiva postoperatoria, terapia antitumoral y traumática, etc. En resumen, se ratifica su versatilidad, tanto en las múltiples vías de administración, como en los conceptos de protector cerebral y potenciador de analgesia perioperatoria en analgesia preventiva. Por el contrario, se ha informado de la presencia de tolerancia, inducción enzimática hepática, así como múltiples y diversos eventos adversos con su administración crónica

Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records

Background There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. Aims This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6). Method A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. Results The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. Conclusions The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings