Consenso español de salud física del paciente con depresión

Consensus on the detection and management of patients with depression and pain as an associated somatic symptom

INTRODUCTION

Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice.

MATERIAL AND METHODS

The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations.

RESULTS

The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources.

CONCLUSIONS

Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.

Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association

INTRODUCTION

Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association.

METHODS

A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed.

RESULTS

After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate.

DISCUSSION AND CONCLUSIONS

Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.

WHO-mhGAP Training in Mexico: Increasing Knowledge and Readiness for the Identification and Management of Depression and Suicide Risk in Primary Care

BACKGOUND

In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally.

AIM OF THE STUDY

To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico.

METHODS

PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions.

RESULTS

The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1 ± 1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91 ± 2.19 vs. mhGAPpost:8.77 ± 1.34, p = 0.01; SuicidePRE:29.16 ± 9.35 vs. SuicidePOST:39.24 ± 6.83, p = 0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed.

CONCLUSIONS

A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.

Multidisciplinary consensus on the therapeutic recommendations for iatrogenic hyperprolactinemia secondary to antipsychotics

Hyperprolactinemia is an underappreciated/unknown adverse effects of antipsychotics. The consequences of hyperprolactinemia compromise therapeutic adherence and can be serious. We present the consensus recommendations made by a group of experts regarding the management of antipsychotic-induced hyperprolactinemia. The current consensus was developed in 3 phases: 1, review of the scientific literature; 2, subsequent round table discussion to attempt to reach a consensus among the experts; and 3, review by all of the authors of the final conclusions until reaching a complete consensus. We include recommendations on the appropriate time to act after hyperprolactinemia detection and discuss the evidence on available options: decreasing the dose of the antipsychotic drug, switching antipsychotics, adding aripiprazole, adding dopaminergic agonists, and other type of treatment. The consensus also included recommendations for some specific populations such as patients with a first psychotic episode and the pediatric-youth population, bipolar disorder, personality disorders and the elderly population.

Depression and associated variables in people over 50 years in Spain

INTRODUCTION

Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability.

OBJECTIVES

To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries.

MATERIAL AND METHODS

There were 5,830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life).

STATISTICAL ANALYSIS

Bivariate, and binary logistic.

RESULTS

The variables associated with depression in the binary logistic regression (EURO-D ≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74-18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13-6.34) and female gender (OR=2.16; 95% CI: 1.83-2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%).

CONCLUSIONS

The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.