Uso de Antidepresivos y Suicidio en el Trastorno Bipolar

[spa] Introducción. El trastorno bipolar (TB) tiene un gran impacto en las personas que lo padecen y una mortalidad por suicidio hasta 20 veces mayor que el resto de la población. La depresión bipolar es uno de los principales factores de riesgo de suicidio, sin embargo existe escasa evidencia en relación a su tratamiento. Uno de los temas más controversiales es el uso de antidepresivos, que a pesar de ser el tratamiento más utilizado, su eficacia y seguridad han sido puestos en duda. Hipótesis. Los pacientes expuestos a AD vs los no expuestos tienen características clínicas y un curso de enfermedad diferente, presentando un mayor número de complicaciones, entre ellas, una mayor incidencia de suicidabilidad. Objetivos. Caracterizar los factores demográficos y clínicos asociados al uso de antidepresivos en pacientes con depresión bipolar, así como los factores asociados a ideación o actos suicidas. Valorar la asociación entre uso de antidepresivos y conductas suicidas e identificar los factores predictores de riesgo suicida en el trastorno bipolar. Método. Estudio naturalístico de cohorte. Se reclutaron pacientes adultos en seguimiento en la Unidad de Trastorno Bipolar de nuestro hospital. Se recogieron variables clínicas basados en entrevistas semiestructuradas y escalas. Asimismo, se realizó un seguimiento bisemanal de un episodio depresivo index durante 12 semanas y se recogieron variables clínicas, de respuesta al tratamiento y de suicidabilidad. Para el tercer estudio, se reclutaron pacientes con trastorno bipolar en seguimiento sistemático, provenientes de 5 centros en distintos países. Análisis de resultados. Se realizaron análisis bivariados para buscar asociaciones entre factores demográficos y clínicos y uso de antidepresivos. Con los resultados de este análisis preliminar, se realizó un modelo de regresión logística múltiple con uso de AD como variable dependiente. Se utilizó el mismo procedimiento para valorar factores asociados a suicidabilidad y establecer un modelo predictivo de suicidabilidad en depresión bipolar. Resultados/Conclusiones. La prevalencia de uso de antidepresivos para el tratamiento de la depresión bipolar aguda es muy alta (cercana al 80%), incluso en un centro especializado como el nuestro, y está asociado a una historia de depresión más severa. Los virajes fueron 7 veces más altos en el grupo expuesto a antidepresivos, incluso con tratamiento coadyuvante con estabilizadores del ánimo. Los factores de riesgo asociados a la ideación y los actos suicidas en el trastorno bipolar tienen que ver con una mayor severidad de la enfermedad y con la presencia de síntomas mixtos y polaridad predominante depresiva, así como el sexo femenino y la mayor latencia en el diagnóstico. Asimismo, observamos que el riesgo de ideación y conductas suicidas en el trastorno bipolar tipo II es tan alto como en el tipo I, lo que sugiere que éste subtipo no es una variante más leve de la enfermedad, sino clínicamente diferente. La clasificación por polaridad predominante es un buen diferenciador del curso clínico y pronóstico de los pacientes con trastorno bipolar. Destaca la asociación entre polaridad predominante depresiva y el debut de enfermedad con episodios depresivos o mixtos, la presencia de mas episodios mixtos durante la evolución y el aumento del riesgo de actos suicidas. Asimismo, sumar los episodios mixtos a la polaridad predominante depresiva, aumenta significativamente su asociación con los actos suicidas y la capacidad predictiva de morbilidad a largo plazo de los primeros episodios. Por último, esta clasificación permite planificar las intervenciones terapéuticas según las características clínicas de los pacientes, además de abrir la posibilidad de buscar marcadores biológicos a partir de subgrupos con comportamiento clínico diferente. Limitaciones. Los estudios observacionales no permiten establecer relaciones causales. El hecho de haberse realizado en un centro académico especializado podría limitar la generalización de los resultados.[eng] Introduction. Suicide accounts for 15-20% of bipolar patients overall mortality. Depression is one of the most important risk factors and its treatment is a matter of controversy, especially regarding antidepressant use. Objective. To characterize clinical and demographic factors associated to suicidality and antidepressant use. In addition, to evaluate the association between antidepressant use and suicidal behaviour. Methods. Naturalistic cohort study. We recruited 290 systematically followed-up bipolar patients from our program at Hospital Clínic (Barcelona, Spain). We assessed them through semistructured clinical interviews and scales during a depressive index episode and followed them for 12 weeks. For the third study, we recruited 928 bipolar I patients from five academic centers in different countries and tested the replicability and usefulness of the predominant polarity concept and its association with suicide. Results/Conclusions. Despite the scarce evidence available, the proportion of patients receiving antidepressants for the treatment of bipolar depression is strikingly high and its use is associated with more severe depressive morbidity. Regarding acute complications associated with treatment, the risk of treatment associated manic switch in the antidepressant group was seven times higher. In addition, risk for suicidal thoughts/behaviour and rapid cycling was two times higher in the antidepressant group, although the difference was not statistically significant. These results suggest that antidepressant use may be related with a higher proportion of adverse outcomes in bipolar depression. Risk factors associated with suicidal thoughts and acts in bipolar disorder, are associated with a more severe illness and depressive morbidity, such as the presence of mixed symptoms, depressive predominant polarity and longer delay between illness onset and the diagnosis of bipolar disorder. Suicidal thoughts and acts in bipolar disorder type II are as prevalent as in type I. This strongly suggests that bipolar type II is not a milder form of disorder, but clinically different. Finally, predominant polarity is a relevant and useful way of classifying bipolar disorder patients, with different clinical course and prognosis. Depressive predominant polarity is associated with a depressive or mixed episode at onset, the presence of more mixed episodes during the clinical course of the disorder and a two-fold increase in suicidal risk, when compared to manic/hypomanic predominant polarity. Including mixed-states with predominant depressions markedly increased association with suicidal risk (two-fold), which confirms mixed symptoms as an important risk factor. Limitations. Causal relationships cannot be established properly through observational studies. Nevertheless, such naturalistic experiences may serve as useful representations of current clinical practices and results. Sampling at a prominent university referral center may not generalize to other sites

Brain germinoma presenting as a first psychotic episode in an adolescent male

International audienc

La autonomía de la producción de conocimiento como política de la universidad

Contrary to the managerial perspective that characterizes the university and its production as a profit-generating enterprise, we propose to protect the exceptional and asymmetric autonomy that, historically, has characterized the university. Traditionally, universities have allowed to be determined by the legality that governs the processes of knowledge production. Where the social, political or economic usefulness does not count as an operator which determines its outcome. Recognizing the specificity of knowledge production is a fundamental analytical requirement for its proper management. The guiding question for research policies in universities is not how to maximize the usefulness of knowledge, but how to ensure the autonomy of its production processes.Contra el punto de vista que caracteriza la universidad y el conocimiento que ella produce como emprendimientos generadores de utilidades, se propone defender la autonomía que ha caracterizado históricamente la investigación en la universidad. Tradicionalmente, la universidad ha sabido dejarse determinar por la legalidad que gobierna los procesos de producción de conocimiento, donde la utilidad social, política o económica no cuenta como operador determinante de sus resultados. Reconocer la especificidad de los procesos de producción de conocimiento es un requerimiento analítico básico para su gestión adecuada. La pregunta rectora para la gestión del conocimiento en la universidad no es cómo maximizar su utilidad, sino cómo asegurar la autonomía de los procesos que lo producen

El hospital de Antezana (Alcalá de Henares, Madrid): estudio arqueométrico y análisis arquitectónico de ladrillos y morteros

Se presentan los resultados de un estudio combinado que ha comprendido la caracterización arqueométrica y el análisis arquitectónico del Hospital de Antezana, que es uno de los pocos ejemplos de casa urbana aristocrática que se conservan en la ciudad de Alcalá de Henares (Madrid). El objetivo principal fue la identificación de las técnicas de construcción y la caracterización de los materiales utilizados en la casa original, antes de que esta se convirtiera en hospital. A partir del análisis arquitectónico y aprovechando las obras de rehabilitación, se seleccionó un conjunto representativo de ladrillos y sus correspondientes morteros asociados. Para caracterizar las fábricas de estos materiales se emplearon técnicas químico-físicas convencionales, como lupa binocular, microscopía petrográfica con luz polarizada, espectrometría de fluorescencia de rayos X (FRX), difracción de rayos X (DRX) y análisis térmico diferencial y termo-gravimétrico (ATD-TG). Los resultados han permitido identificar los materiales utilizados en la casa original del siglo XV y diferenciarlos de los empleados en las intervenciones del siglo XVII, lo que pone de manifiesto que un trabajo de estas características puede ser una vía eficaz para el estudio y conservación del Patrimonio Construido

Bricks and mortars from the “Patio de Santo Tomás”, Alcalá University (Madrid, Spain): a combined study of fabric characterization and building morphology

A combined study of fabric characterization and building geometry and morphology has been undertaken at the “Patio de Santo Tomás, Colegio Mayor de San Ildefonso” from the Alcalá University (Madrid, Spain). A set of bricks and their associated mortars from differ-ent chronology and locations has been selected to carry out fabric characterization, which were accomplished by using observation and analytical conventional techniques, such as thin section polarized light microscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), en-ergy dispersive X-ray spectrometry (EDS), and thermogravimetric-differential thermal analysis (TG-DTA). Resulting data have enabled the recognition of three groups of bricks with their as-sociated mortars in the five constructive phases of the building. Each group showed composi-tional and technological differences which can be correlated with their chronology and location in the building. This combined study has provided outstanding data which can be useful for fu-ture conservation and restoration strategie

Bricks and mortars from the “Patio de Santo Tomás”, Alcalá University (Madrid, Spain): a combined study of fabric characterization and building morphology

A combined study of fabric characterization and building geometry and morphology has been undertaken at the “Patio de Santo Tomás, Colegio Mayor de San Ildefonso” from the Alcalá University (Madrid, Spain). A set of bricks and their associated mortars from differ-ent chronology and locations has been selected to carry out fabric characterization, which were accomplished by using observation and analytical conventional techniques, such as thin section polarized light microscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), en-ergy dispersive X-ray spectrometry (EDS), and thermogravimetric-differential thermal analysis (TG-DTA). Resulting data have enabled the recognition of three groups of bricks with their as-sociated mortars in the five constructive phases of the building. Each group showed composi-tional and technological differences which can be correlated with their chronology and location in the building. This combined study has provided outstanding data which can be useful for fu-ture conservation and restoration strategie

Brick masonry identification in complex historic buildings

This study is part of the Program “Geomateriales. Durabilidad y conservación de geomateriales del patrimonio construido” (S2009/MAT-1629) funded by the Comunidad de Madrid. The authors acknowledge the 13 professional support from Techno-Heritage (Network on Science and Technology for the Conservation of Cultural Heritage).The aim of the study is to define a reliable interdisciplinary procedure for brick masonry identification in complex historic buildings, in order to enhance documentation, conservation and restoration issues, thereby putting into value the architectural heritage. The methodology integrates experimental data obtained through on site measuring and sampling with historical information. Direct measurements were obtained through photogrammetry and brick and mortar characterization tests and were used to relate stratigraphic units, fabric morphology and materials. The differences identified through morphological analysis and experimental results are double-checked with historical data, allowing a scientific interpretation, supported by experimental results and contrasted to historical information. This approach was used for the study of the brick masonry walls of the first College of the University of Alcalá (Madrid, Spain), founded in 1495 and declared World Heritage Site by the UNESCO in 1998. Different brick masonry typologies with the same morphology but different constitutive materials and vice versa were found. An integrated constructive analysis based upon available historical data allowed to identify six brick masonry types based on their period of construction, fabric morphology and building material

Prevalence of Depressive Disorder in the Adult population of Latin America: a systematic review and meta-analysis

Background: Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR). Methods: We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI’s critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054). Findings: Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%–14.16%); 5.30% (4.55–6.06%), and 3.12% (2.22–4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR. Interpretation We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region