[Numerical expression of the clinical course of the disease. Data management]

Data management "behind the scenes" refers to collection, cleaning, imputation, and demarcation; and despite of being indispensable processes, they are usually neglected and thus, generate erroneous information. During the collection are errors: omission of covariates, deviation from the objective, and insufficient quality. The omission of covariates distorts the result attributed to the main manoeuvre. Deviation from the primary objective commonly occurs when the outcome is rare, delayed, or subjective and promotes substitution by non-equivalent surrogate variables. Moreover, insufficient quality occurs due to inadequate instruments, omission of the measurement procedure, or measurements out of context, such as attribution at the wrong time or equivalent. Furthermore, cleaning implies identifying erroneous, extreme, and missing values, which may or may not be imputed, depending on the percentage. The values of the manoeuvre or the outcome are never imputed, nor are patients eliminated due to a lack of values. Finally, the demarcation of each variable seeks to give it a clinical meaning about the outcome, for which a hierarchical sequence of criteria is followed: 1) previous clinical study, 2) expert agreement, 3) clinical judgment of the investigator/investigators, and 4) statistics. Acting without quality controls in data management frequently causes involuntary lies and confuses instead of clarifying.

Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population

BACKGROUND

Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs.

METHODS

An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients.

RESULTS

HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R²=0.05).

CONCLUSIONS

HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.

Association between CLOCK gene polymorphisms and ADHD in Mexican teenagers: A comprehensive assessment

This study aimed to evaluate markers of the CLOCK gene rs1801260 and rs4864548 in Mexican adolescents, addressing clinical and biological aspects previously associated with ADHD. 347 Mexican adolescents were assessed for mental disorders, metabolic disruption and related conditions, circadian preference, as well as genotyping for the CLOCK. We found a significant association between ADHD and the AA and AG genotypes of rs1801260. Also, we identified in the ADHD group that the total Triiodothyronine and total Thyroxine values were respectively 10 ng/dl units and 0.58 ug/dl units lower in females than in males. Previously reported common variations of the CLOCK gene have been associated with ADHD like the Rs1801260 polymorphism hereby we could consider it as risk factor, but genetic, biochemical and clinical studies in the Mexican population are entailed.

Looking for factors affecting functioning in euthymic patients with bipolar I disorder: the importance of cognitive complaints and BDNF's Val66Met polymorphism

INTRODUCTION

Functioning in Bipolar Disorder (BD) is affected in a substantial proportion of patients. The impact of demographic, clinical, cognitive, and genetic factors on functioning has been shown individually; however, as a complex phenomenon, a global approach to identify the most relevant as well as possible interactions is needed.

METHODS

102 patients with type I BD in euthymia were invited for evaluation of demographic, clinical, and cognitive characteristics as well as genotype for Val66Met polymorphism of BDNF gene to determine those associated with poor functioning according to the FAST scale cut-off score. Clinical evaluation included assessment of residual affective symptoms and anxiety. Cognitive evaluation included the COBRA scale, verbal memory, and executive functions testing.

RESULTS

Residual depressive symptoms, anxiety, cognitive complaints and being a Met carrier were more frequent in the poor functioning group and were entered in a logistic regression model. Being a Met carrier (OR=4.46, CI=1.19-16.67) and cognitive complaints (OR=1.29, CI= 1.13-1.46) were the most important predictors of poor functioning in type I BD.

LIMITATIONS

Cross-sectional study, with select population limiting generalizability of findings.

CONCLUSIONS

A better understanding of underlying factors affecting cognition, including the possible involvement of BDNF Val66Met polymorphism, its systematic evaluation and a continued search for targeted treatment, along with recognition and attention of residual affective and anxious symptoms might improve psychosocial outcomes such as functioning in this population.

Limited Prosocial Emotions in a Clinical Population of Children and Adolescents: Proposal for Core and Ancillary Characteristics

OBJECTIVE

Limited prosocial emotions (LPE) has been recently incorporated into international classifications as a specifier for conduct disorder in the DSM-5 and for all disruptive behavioural disorders in the ICD-11. The aims of the current work were to determine (a) the accuracy of each of the characteristics used to assess the LPE specifier and (b) whether the manner in which symptoms group together supports the idea of LPE having core characteristics.

METHOD

Trained clinicians conducted interviews and determined LPE characteristics using responses from 74 parent/guardian and child/adolescent participants.

RESULTS

The distribution of LPE characteristics among those participants with LPE (n = 13) was compared to those with only one LPE characteristic (n = 11). The proposal of callous lack of empathy (CLE) and shallow deficient affect (SDA) as core characteristics was supported by strong associations with the presence of the LPE specifier, larger specificity, and sensitivity indices than those for unconcerned about performance and lack of remorse or guilt, as well as by a robust aggregation in a latent class analysis.

CONCLUSIONS

CLE and SDA could be considered as core characteristics of LPE in children and adolescents.

Ten-year course of treated bipolar I disorder: The role of polarity at onset

INTRODUCTION

Early-stage predictors of illness course are needed in bipolar disorder (BD). Differences among patients with a first depressive versus maniac/hypomanic episode have been stated, although in most studies, memory bias and time from onset to start of specialized treatment might interfere. The aim was to compare the first 10 years of illness course according to polarity at onset.

METHODS

49 type I BD patients admitted for treatment for a first-time affective episode and a following 10-year attendance to the institution were included. A retrospective year by year comparison according to polarity at onset (depressive (DPO) or maniac (MPO)) was performed. Cramer's V and Cohen d were computed to determine effect size.

RESULTS

59.2% (n = 29) started with MPO. Both groups were similar in demographic and social outcome characteristics, clinical features, and treatment variables. Patients with DPO reported more depressive episodes than MPO patients (U = 149.0 p < .001, Cohen's d = 0.87); both groups had a similar number of manic episodes. Only during the first year of follow-up, suicide attempts (SA) were more frequent in patients with DPO while the presence of a psychotic episode and psychiatric hospitalizations were more frequent in the MPO group.

CONCLUSION

According to these findings, it can be concluded that illness onset is only indicative of depressive predominant polarity but is not related to other poor prognostic variables after the first year of illness onset, in treated BD. SA in the first year of an affective disorder could represent a marker of BD.

[The relevance and irrelevance of charts in clinical research]

Charts are a visual aid that is used in articles in order to highlight the results of an investigation. They allow illustrating the results with the purpose of making them clearer. Charts, just like statistical tests, are selected based on the objective of the study, the types of variable, and the statistical analyzes to be illustrated. Some of the most commonly used charts in clinical practice are frequency histograms, which illustrate qualitative variables or frequencies; also error charts, that are used for normally distributed quantitative variables; box plots or violin plots are used for distribution-free quantitative variables, and survival curves are for variables that include the person-time variable. The aforementioned charts can be used to illustrate the comparisons between maneuvers and outcome depending on the type of variable that is being analyzed. When two groups are compared and the dependent variable is dichotomous, forest plots are used; for multivariate models, the chart depends on the type of analysis. As for logistic regression and linear regression, tree diagrams are used; and scatter plots are used for linear regression. Survival plots are used for Cox proportional hazards. Although charts can be very useful, if they are misused, they can show differences where there are none, which leads to a misinterpretation of the studies. In this article, we will use examples to complement the topics that were previously addressed in the articles of this series.

Back to the clinic. Methods II. The Architecture of Clinical Research. Subject interaction, maneuvers and disease throughout time

Medicine is characterized by the application of the scientific method through clinical judgment, by correct interpretation and use of the clinical course and/or natural history of the disease; its best description is observed in the architecture of clinical research. Through a temporal sequence, this model explains the phenomenon of causality with three sections: baseline status, maneuver, and outcome. The baseline status assesses who the patient is, where does he come from, his general conditions, the diagnosis, stage and aggressiveness of the pathology, complications, previous therapies, socioeconomic-cultural level, habits, therapeutic indications or contraindications, and the expected evolution is anticipated. In the maneuver, risk or prognostic factors, specific or symptomatic treatment, and general measures can be evaluated. In the outcome, early and late evolution are monitored. The model also allows the causes of follow-up loss to be determined. Anticipating patient evolution by recognizing his condition, disease, and expected effect of medical decisions allows acting in advance, since waiting for the manifestations of the evolutionary process of disease results in detriment to the patient.

The ball search field task in the evaluation of methylphenidate treatment of children with attention deficit / hyperactivity disorder

Assessing behavioral change in psychiatric contexts requires retesting patients where, however, ecologically relevant tasks are rarely used. We employed the Ball Search Field Task (BSFT) to evaluate the performance of attention deficit/hyperactivity disorder (ADHD) outpatients before and after administration of methylphenidate (MPH) and compared their performance with that of non-medicated ADHD outpatients and age-matched controls. The outpatient groups showed poorer performance at initial testing, improved performance at re-test although not to the level of the controls, and no clear effect of MPH treatment. The BSFT is thus sufficiently motivating and discriminating for the behavioral evaluation of treatments in psychiatric contexts.

[List of Ethical Principles for Medical Research Involving Human Subjects]

The ethical principles of a research proposal are not contained only in a paragraph or in the informed consent form; actually, they are an essential part of the whole protocol from the beginning to the end. In a complementary manner to the regulatory and educative documents, our objective in this article is to propose a checklist of questions so researches can ensure they have included the necessary information and precautions to meet the ethical considerations that are required for every research with human beings, which shall be called List of Ethical Principles for Medical Research Involving Human Subjects. We propose questions that researchers must ask themselves when they compose the background, justification, objectives, research question, hypothesis, selection criteria, sample size calculation, sampling, research design, statistical analysis plan, ethical aspects, publication plan, and references.

[Correlation: not all correlation entails causality]

The concept of correlation entails having a couple of observations (X and Y), that is to say, the value that Y acquires for a determined value of X; the correlation makes it possible to examine the trend of two variables to be grouped together. We know that, with increasing age, blood pressure figures also increase, therefore, if we want to answer a research question like "what is the connection between age and blood pressure?" the relevant statistical test is a correlation test. This test makes it possible to quantify the magnitude of the correlation between two variables, but it is also helpful for predicting values. If these variables had a perfect correlation, the value of the variable Y could be deduced by knowing the value of X. Because of these advantages, the correlation is one of the most frequently used tests in the clinical setting since, in addition to measuring the direction and magnitude of the association of two variables, it is one of the foundations for prediction models, such as linear regression model, logistic regression model and Cox proportional hazards model.

De vuelta a la clínica. Métodos I. Diseños de investigación. Mayor calidad de información, mayor certeza a la respuesta

Research designs refer to the way information is obtained and are limited by ethical, economic and temporal viability. Research designs are standardized strategies to reduce biases, which in the architectural model of research are identified in the baseline state, the maneuver and the outcome; hence, there are no specific designs for each question. The design with the lowest probability of bias is the clinical trial, followed by cohort and case-control studies and, finally, by cross-sectional surveys. Among the main characteristics that give merit to research designs are the following: population inquiry, which refers to the situation of the population in relation to the clinical course/natural history of the disease; the maneuver, or action that is expected to modify the baseline state, which can be observational or experimental; follow-up, or documented monitoring that is given to each subject, which can be longitudinal or cross-sectional; and directionality, which can prolective or retrolective and refers to the timing of data collection for research purposes. It will always be better having a valuable question, even when answered with a design with higher risk of bias, than a question that is irrelevant or has no applicability.

De vuelta a la clínica: sin justificación no existe pregunta de investigación que valga

A clinical research question requires the concurrence of clinical experience and knowledge on methodology and statistics in that who formulates it. Initially, a research question should have a structure that clearly establishes what is that which is being sought (consequence or outcome), in whom (baseline status), and by action of what (maneuver). Subsequently, its reasoning must explore four aspects: feasibility and reasonableness of the questioning, lack of a prior answer, relevance of the answer to be obtained, and applicability. Once these aspects are satisfactorily covered, the question can be regarded as being "clinically relevant", which is different from being statistically significant, which refers to the probability of the result being driven by chance, which does not reflect the relevance of the question or the outcome. One should never forget that every maneuver entails adverse events that, when serious, discredit good results. It is imperative to have the possible answer estimated from within the structure of the question. The function of clinical research is to corroborate or reject a hypothesis, rather than to empirically test to find out what the outcome is.

Comparison of clinical and cognitive characteristics of a Mexican adult clinical population with and without ADHD

Introduction. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of the world population, with symptoms that may persist into adulthood. Despite the findings on the clinical course of this disorder, information regarding comorbidity patterns, psychosocial and executive functioning in adult life in those with and without ADHD in Latin American samples is scarce. Objective. The aim of this study is to compare the comorbidity pattern, psychosocial, and executive functioning of adults with and without ADHD from a clinical sample. Method. One hundred and fifty-one patients between 20 and 45 years, with screened positively on ASRS-V1.1, were invited to continue an evaluation process as part of clinical research program (PROMETEO): 1) K-SADS-PL Mx interview, 2) MINI-Plus interview, ASRS-V1-1 18 item version, BRIEF self-reported questionnaire, SCQA-ADHD, and 3) Individual case review by clinical expert in ADHD. Results. Individuals in the ADHD group had a higher average of comorbid disorders (2.5 SD 1.1 vs. 1.3 SD 1.0 respectively, F = .439; t = -6.621; df = 149; p < .001), more likelihood of procrastinating (OR = 6.5; 95% CI[2.6, 16.2]; z = 4.0) and were more likely to present difficulties in both the behavior regulation index (OR = 104.9; 95% CI[31.8, 345.7]; z = 7.65) and the metacognitive index (OR = 94.79; 95% CI[29.10, 308.76]; z = 7.56) compared to the non-ADHD group, regardless of gender. Discussion and conclusions. Our results indicate that the ADHD adult group presented with more comorbidity, and worse psychosocial and executive functioning than non-ADHD adults.

Construct validity and parent-child agreement of the six new or modified disorders included in the Spanish version of the Kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5)

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

A novel experimental paradigm to evaluate children and adolescents diagnosed with attention-deficit/hyperactivity disorder: Comparison with two standard neuropsychological methods

INTRODUCTION

In this study we evaluated a recently developed test, the Ball Search Field Task (BSFT) as a neuropsychological tool for measuring cognitive and behavioral performance of individuals with disorders such as attention-deficit/hyperactivity disorder (ADHD), which are frequently accompanied by cognitive deficits and a lack of behavioral inhibition. The task provides a complementary method of assessment that attempts ecological validity by drawing on challenges faced in real-world situations. In this task, energetic costs and gross sensorimotor feedback are involved, as participants are required to search for targets in a large open area.

METHOD

We compared performance on the BSFT in a clinical sample of children and adolescents with a diagnosis of ADHD with their scores on two widely used neuropsychological tools, the Tower of London (ToLo) and the Behavior Rating Inventory of Executive Function (BRIEF).

RESULTS

We found no correlations between scores on the BRIEF and those on either the BSFT or ToLo. However, we found moderate correlations between rule violations on ToLo and several BSFT variables, suggesting the capacity of these tests to detect common aspects of executive dysfunction.

CONCLUSIONS

These findings, although modest, encourage further study of tasks like the BSFT, which may help assess cognitive dysfunction found in neurodevelopmental disorders such as ADHD in ecologically valid situations.

[Clinical research XXIV. From clinical judgment to ethics in research on humans]

Bioethics in research is an essential part of the structured review process of an article and it is based on three fundamental principles: respect for persons, beneficence and justice. In addition to not providing valid knowledge, a research with inadequate design, execution and statistical analysis is not ethical either, since these methodological deficiencies will produce information that will not be useful and, therefore, the risks that the participants were exposed to will have been in vain. Beyond scientific validity, there are other aspects that outline if an investigation is ethical, such as the clinical and social value of a study, a fair selection of participants, favorable risk-benefit balance, an independent review, the informed consent and respect for participants and potential participants. Throughout the article here presented, the documents that profile the behavior of investigators to protect the participants, such as the Declaration of Helsinki, the national regulations that rule us and the differences between research without risk, with minimal risk and with greater than minimal risk are discussed. That like in daily life, behavior in research involving human participants must be self-regulated, ie, people with knowledge of the existence of the law discover that the man is outside the realm of nature where work is done under the necessity of natural causality, and falls within the scope of the will; only if the man is free to decide their actions may be a law regulating their action.

[Clinical research XXIII. From clinical judgment to meta-analyses]

Systematic reviews (SR) are studies made in order to ask clinical questions based on original articles. Meta-analysis (MTA) is the mathematical analysis of SR. These analyses are divided in two groups, those which evaluate the measured results of quantitative variables (for example, the body mass index -BMI-) and those which evaluate qualitative variables (for example, if a patient is alive or dead, or if he is healing or not). Quantitative variables generally use the mean difference analysis and qualitative variables can be performed using several calculations: odds ratio (OR), relative risk (RR), absolute risk reduction (ARR) and hazard ratio (HR). These analyses are represented through forest plots which allow the evaluation of each individual study, as well as the heterogeneity between studies and the overall effect of the intervention. These analyses are mainly based on Student's t test and chi-squared. To take appropriate decisions based on the MTA, it is important to understand the characteristics of statistical methods in order to avoid misinterpretations.

[Clinical research XXII. From clinical judgment to Cox proportional hazards model]

Survival analyses are commonly used to determine the time of an event (for example, death). However, they can be used also for other clinical outcomes on the condition that these are dichotomous, for example healing time. These analyses only consider the relationship of one variable. However, Cox proportional hazards model is a multivariate analysis of the survival analysis, in which other potentially confounding covariates of the effect of the main maneuver studied, such as age, gender or disease stage, are taken into account. This analysis can include both quantitative and qualitative variables in the model. The measure of association used is called hazard ratio (HR) or relative risk ratio, which is not the same as the relative risk or odds ratio (OR). The difference is that the HR refers to the possibility that one of the groups develops the event before it is compared with the other group. The proportional hazards multivariate model of Cox is the most widely used in medicine when the phenomenon is studied in two dimensions: time and event.

[Clinical research XX. From clinical judgment to multiple logistic regression model]

The complexity of the causality phenomenon in clinical practice implies that the result of a maneuver is not solely caused by the maneuver, but by the interaction among the maneuver and other baseline factors or variables occurring during the maneuver. This requires methodological designs that allow the evaluation of these variables. When the outcome is a binary variable, we use the multiple logistic regression model (MLRM). This multivariate model is useful when we want to predict or explain, adjusting due to the effect of several risk factors, the effect of a maneuver or exposition over the outcome. In order to perform an MLRM, the outcome or dependent variable must be a binary variable and both categories must mutually exclude each other (i.e. live/death, healthy/ill); on the other hand, independent variables or risk factors may be either qualitative or quantitative. The effect measure obtained from this model is the odds ratio (OR) with 95 % confidence intervals (CI), from which we can estimate the proportion of the outcome's variability explained through the risk factors. For these reasons, the MLRM is used in clinical research, since one of the main objectives in clinical practice comprises the ability to predict or explain an event where different risk or prognostic factors are taken into account.

Adversidad psicosocial, psicopatología y funcionamiento en hermanos adolescentes en alto riesgo (HAR) con y sin trastorno por déficit de atención con hiperactividad (TDAH)

Introducción. El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente heredable. La determinación de las características clínicas, los factores de adversidad y el nivel de funcionamiento en hermanos de probandos con TDAH, denominados en alto riesgo (HAR), podría ayudar a establecer el riesgo al cual están sometidos. Objetivo. Determinar la frecuencia de TDAH y otros trastornos psiquiátricos en HAR. Como objetivos secundarios, establecer los factores de adversidad psicosocial que predicen el TDAH en HAR y determinar la magnitud del efecto sobre el funcionamiento y otros trastornos psiquiátricos cuando los hermanos tienen TDAH (HAR TDAH +) comparados con quienes no lo tienen (HAR TDAH -). Material y método. Este estudio multicéntrico es descriptivo, transversal y analítico. La muestra (n=84) se conformó por hermanos adolescentes de probandos diagnosticados con TDAH que compartían a ambos padres. Resultados. El 45.2% (n=38) tuvo TDAH. El 17.9% (n=15) no presentó trastorno psiquiátrico alguno. Ser HAR TDAH+ incrementó al menos cuatro veces más la probabilidad de presentar trastorno negativista desafiante (RM=4.3; IC 95% 1.3-14.8), dato que mantuvo significancia al ajustarse por sexo, edad y número de adversidades (RM=3 IC 95% 1.8–10.9). Ser HAR TDAH+ incrementó casi cinco veces la probabilidad de presentar disfunción académica (RM=4.84 IC 95% 1.41-16.63). El promedio general de adversidades fue 3.3 (DE=1.4). Encontramos psicopatología en ambos padres en el 51.2% de la muestra (ES=0.055). La disfunción familiar grave incrementó 2.5 veces la probabilidad de presentar TDAH en los HAR (IC 95% 1.06–6.25). Al comparar los grupos con tres o más adversidades psicosociales, no existieron diferencias significativas (81.6% vs. 65.2%; p=0.14). Conclusiones. El estudio clínico de los HAR para TDAH es necesario debido a las distintas implicaciones que tiene a nivel de la prevención, la atención oportuna y la mejoría del pronóstico de estos sujetos

[Clinical research XIX. From clinical judgment to analysis of covariance]

The analysis of covariance (ANCOVA) is based on the general linear models. This technique involves a regression model, often multiple, in which the outcome is presented as a continuous variable, the independent variables are qualitative or are introduced into the model as dummy or dichotomous variables, and factors for which adjustment is required (covariates) can be in any measurement level (i.e. nominal, ordinal or continuous). The maneuvers can be entered into the model as 1) fixed effects, or 2) random effects. The difference between fixed effects and random effects depends on the type of information we want from the analysis of the effects. ANCOVA effect separates the independent variables from the effect of co-variables, i.e., corrects the dependent variable eliminating the influence of covariates, given that these variables change in conjunction with maneuvers or treatments, affecting the outcome variable. ANCOVA should be done only if it meets three assumptions: 1) the relationship between the covariate and the outcome is linear, 2) there is homogeneity of slopes, and 3) the covariate and the independent variable are independent from each other.

Estudio comparativo de psicopatología en hijos de padres con trastorno bipolar

Antecedentes. Los hijos de padres con diagnóstico de trastorno bipolar constituyen una población de alto riesgo para la presentación de múltiples trastornos psiquiátricos que requieren una evaluación sistemática temprana y un seguimiento longitudinal. Objetivo. Describir y comparar el perfil psicopatológico en hijos de padres con trastorno bipolar versus hijos de padres sin trastorno bipolar en una muestra comunitaria. Material y métodos. La evaluación de la psicopatología en los padres se realizó con la Entrevista Mini International Diagnostic Interview (MINI). Con base en los resultados, se crearon los grupos de padres con y sin trastorno bipolar (TBP). Posterior a la misma, se realizó la valoración de psicopatología en sus hijos con el Kiddie Schedule for Affective Disorders and Schizophrenia for School-aged Children Present and Lifetime Version (K-SADS-PL) y el funcionamiento con la Escala de Funcionamiento Global en niños (C-GAS). Resultados. El 90% de los hijos de padres con TBP ha presentado un trastorno psiquiátrico a lo largo de la vida; el grupo de trastornos externalizados fue el más frecuente (81%). Los hijos de padres con TBP mostraron mayor riesgo de presentar cualquier trastorno externalizado (RM=4.44; IC=95%; 1.43-13.84), mayor riesgo para trastorno por déficit de atención e hiperactividad (RM=3.38; IC=95%; 1.18-8.93) y trastorno negativista y desafiante (RM=3.06; IC=95%; 1.05-8.93). Conclusión. Los hijos de padres con TBP presentan una alta prevalencia de trastornos psiquiátricos, especialmente en el área de los externalizados. El curso longitudinal de la psicopatología de inicio temprano sugiere que esta población requiere estrategias tempranas de diagnóstico y tratamiento para cambiar las trayectorias discapacitantes de los trastornos crónicos.

Asociación de comorbilidades y funcionamiento global en hijos de padres con trastorno bipolar

La presencia de un trastorno psiquiátrico en los padres se asocia con una mayor frecuencia de psicopatología en sus hijos. Así, los hijos de padres con diagnóstico de Trastorno Bipolar (TB) comparados con aquellos hijos de padres sin psicopatología tienen mayor riesgo de presentar distintos trastornos psiquiátricos, a edades más tempranas, así como disminución en su funcionamiento global, sin embargo aún no se han determinado con precisión cuáles son los factores clínicos y socio demográficos asociados a la presentación de trastornos psiquiátricos en este grupo de niños y adolescentes en riesgo. El objetivo del presente estudio fue determinar y comparar las variables clínicas y socio demográficas asociadas a un menor funcionamiento global en una muestra de niños y adolescentes hijos de padres con TB. Previo asentimiento y consentimiento informado se reclutaron 61 menores de entre seis y 17 años de edad, hijos de padres con TB que fueran pacientes de la Clínica de Trastornos Afectivos del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. El diagnóstico de los menores se estableció mediante entrevista clínica utilizando el K-SADS-PL, y con la escala C-GAS se determinó el funcionamiento global. De los 61 evaluados, 62.3% fueron mujeres, el menor funcionamiento (definido por una puntuación <81) se encontró en el 44.3% de las mujeres vs. el 18% de los hombres (?2=3.29, p<0.043). Al evaluar la comorbilidad se encontró que los sujetos con trastorno depresivo mayor (TDM), trastorno por déficit de atención con hiperactividad (TDAH) y trastorno negativista desafiante (TND) presentaron 10 veces mayor riesgo de cursar con menor funcionamiento global. Ser mujer confiere tres veces mayor riesgo para un menor funcionamiento. Conclusión. Se encontró que la comorbilidad con trastornos externalizados y depresión, así como el género femenino, son las características vinculadas al menor funcionamiento global en hijos de padres con TB.

Adversidad social y trastornos psiquiátricos: Estudio comparativo entre estudiantes de secundarias públicas y privadas

Los trastornos psiquiátricos en la adolescencia se vinculan con algunas adversidades sociales como la disfunción familiar y el abuso. En la Ciudad de México, hasta el 68% de los adolescentes ha sufrido al menos una adversidad crónica y los problemas de salud mental, como la depresión y el trastorno por déficit de atención con hiperactividad, son frecuentes y ocasionan problemas académicos. Las diferencias sociales y económicas de los alumnos de secundarias públicas y privadas son bien conocidas, sin embargo no se ha establecido cuáles son las diferencias entre la adversidad social y los trastornos psiquiátricos entre estas poblaciones. El objetivo de esta investigación fue diagnosticar, en un procedimiento clínico de dos pasos, y comparar estas características en los adolescentes de secundarias del sur de la Ciudad de México. Método. Se realizó un acuerdo por conveniencia con siete secundarias del sur de la Ciudad de México, cuatro públicas y tres privadas. Previo consentimiento de los padres y asentimiento de los adolescentes, se aplicó un tamizaje clínico que evaluó sintomatología internalizada y externalizada en 1 474 alumnos. El tamizaje positivo a probable psicopatología se encontró en 419 alumnos, de los cuales 319 aceptaron la entrevista clínica y se presentaron a la misma 117. Resultados. De los 117 adolescentes entrevistados, 83.8% fueron casos, más frecuentes en los alumnos de escuelas públicas que en las privadas: 64 (91%) vs. 34 (71%), (?2=7.85; P=0.005). La edad promedio fue de 13.39 años (DE=0.98). La disfunción familiar se encontró en 57 (48.71%) de los 117 adolescentes. El funcionamiento general fue evaluado mediante el GAF, la puntuación media de todos los alumnos fue de 65.48 (DE=11.68). El trastorno depresivo mayor y el trastorno por déficit de atención con hiperactividad fueron los diagnósticos más frecuentes: 48.7% y 59.8%, respectivamente. El abuso psicológico y físico, la disfunción familiar y el trastorno depresivo mayor se presentaron significativamente más en los alumnos de las escuelas públicas. Conclusiones. La adversidad social y la depresión se presentan y se asocian más frecuentemente en alumnos de secundarias públicas que en las privadas. Esto representa un reto para los servicios educativos y de salud mental para el reconocimiento temprano y la atención oportuna, ya que existe una vinculación entre el bienestar social y la salud mental.

[From clinical judgment to linear regression model.]

When we think about mathematical models, such as linear regression model, we think that these terms are only used by those engaged in research, a notion that is far from the truth. Legendre described the first mathematical model in 1805, and Galton introduced the formal term in 1886. Linear regression is one of the most commonly used regression models in clinical practice. It is useful to predict or show the relationship between two or more variables as long as the dependent variable is quantitative and has normal distribution. Stated in another way, the regression is used to predict a measure based on the knowledge of at least one other variable. Linear regression has as it's first objective to determine the slope or inclination of the regression line: Y = a + bx, where "a" is the intercept or regression constant and it is equivalent to "Y" value when "X" equals 0 and "b" (also called slope) indicates the increase or decrease that occurs when the variable "x" increases or decreases in one unit. In the regression line, "b" is called regression coefficient. The coefficient of determination (R²) indicates the importance of independent variables in the outcome.

Conocimientos y creencias sobre el trastorno por déficit de atención con hiperactividad en maestros de tres países latinoamericanos

Antecedentes. El trastorno por déficit de atención con hiperactividad (TDAH) es un problema de salud que afecta el funcionamiento escolar de quienes lo padecen. Comprender los conocimientos y creencias (CC) de los maestros resulta fundamental para el desarrollo de estrategias psicoeducativas y de capacitación para los docentes. Son pocos los reportes en Latinoamérica sobre los CC en los maestros y ninguno que compare reportes en más de un país. Objetivo. Evaluar y comparar los CC de los maestros de niños y adolescentes en tres países latinoamericanos (México, República Dominicana [RD] y Bolivia). Método. Previo consentimiento verbal informado, se aplicó la versión para maestros de la Cédula de Autorreporte sobre el TDAH (CASO TDAH), que fue construida a partir de otros instrumentos. Se examinaron las respuestas con estadística descriptiva y comparativa. Resultados. Se evaluaron 311 profesores de escuelas públicas y privadas, 192 (61,7%) de RD, 84 (27%) de México y 35 (11.3%) de Bolivia. El 79.3% consideró el TDAH como una enfermedad; la mayor parte de la muestra consideró al psicólogo como el profesional de salud indicado para su diagnóstico y tratamiento. El tratamiento combinado fue el más frecuentemente señalado como el ideal (44.1%). Con respecto a sus CC acerca del tratamiento farmacológico, sólo el 14.7% señaló al fármaco como el componente más importante del tratamiento integral. Los maestros reconocieron los efectos del tratamiento en el funcionamiento social, además del académico. Sin embargo, existieron diferencias entre países con respecto al grado de impacto del mismo o la necesidad de tratamiento combinado. Conclusiones. Los maestros identificaron al TDAH como una enfermedad, aunque el reconocimiento de sus aspectos biológicos no fue claro. Existen diferencias por país que deben ser tomadas en cuenta en los diseños de los programas locales de atención a la salud.

[Concurrent validity in Mexican college population of the adult ADHD self report scale]

INTRODUCTION

In order to make a valid adult ADHD diagnostic, the clinician must overcome a series of difficulties, the main of which may be the fact that the current DSM-IV diagnostic criteria for ADHD were designed for children, hence having valid and reliable instruments in order to screen for possible patients be very helpful.

OBJECTIVE

To validate the ASRS for its use on Mexican college population through concurrent validity with the FASCT scale.

MATERIAL AND METHODS

We evaluated 447 (287 women, average age 23.59 years) undergraduate students from 4 universities in Mexico City. All participants answered the ASRS and FASCT scales.

RESULTS

Positive and statistically significant correlations were found between the ASRS and FASCT (r = 0.79) and the agreement in diagnostic was moderate (k = 0.58).

CONCLUSIONS

ASRS seems to have adequate concurrent validity with the FASCT, nevertheless further research comparing it with a semi-structured or highly structured interview is needed.

Asociación de los trastornos externalizados y la edad de inicio en pacientes con trastorno bipolar tipo I y II ¿Son los síntomas de los trastornos externalizados predictores de una edad de inicio más temprano?

Antecedentes. La manía de inicio muy temprano (MIMT), comparada con la manía de inicio en la adolescencia (MIA), tiene una presentación clínica distinta a la manía clásica de inicio en la adultez (MIEA). Los pacientes con MIA tienen un curso más parecido a la MIEA. Los trastornos externalizados (TDAH, TND y TC) se han asociado con una edad de inicio más temprano del TBP y como un marcador de mal pronóstico. Nuestro objetivo es determinar la frecuencia de los síntomas relacionados con los trastornos de la conducta disruptiva en pacientes con TBP de inicio muy temprano, temprano y en el adulto evaluados de manera retrospectiva. Método. La muestra total (N=64) de pacientes adolescentes y adultos se obtuvo de distintas clínicas del Instituto Nacional de Psiquiatría (INPRF). El diagnóstico fue confirmado por el equipo de investigación y se solicitó la firma del asentimiento y consentimiento informado. Se aplicaron el K SADS PL México, MINI y MINI KID. Se utilizó la EEPE-AA para los trastornos externalizados. Resultados. Se encontraron diferencias significativas en las puntuaciones del EEPE AA comparadas por los grupos de EIED, en la Subescala de Inatención para el GIMT. La presencia de TDAH, TND, TC y riesgo suicida en el momento de la evaluación se relacionó significativamente con un inicio más temprano. Discusión y conclusión. Nuestros datos apoyan la importancia y utilidad clínica de separar el TBP por edad de inicio y la detección de trastornos externalizados podría hablarnos de un inicio temprano del trastorno. Asimismo, tiene implicaciones en el pronóstico y tratamiento psicofarmacológico, ya que el TBP de inicio en la infancia permanece en la adultez con características similares, así como de difícil manejo. Es necesario tener una visión longitudinal de este padecimiento.