
Short-term psychodynamic psychotherapy focusing on awareness and processing of emotionally laden material can be helpful for somatization.
Is psychodynamic psychotherapy still relevant? Researchers addressed this question in a meta-analysis of 17 randomized, controlled trials involving 2004 patients (mean age, 43) with disorders characterized by functional somatic complaints such as irritable bowel syndrome, fibromyalgia, and chronic pain disorders.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-GLB-1595
An algorithm developed with artificial intelligence was applied to electrocardiograms of patients presenting with dyspnea to the emergency department.
New articles about artificial intelligence–related decision-support tools are being published at a rapid pace.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CVP-GLB-0370
The Gpld1 molecule seems to improve neurogenesis and cognition in mice. In both animals and humans, regular exercise improves neurogenesis and cognition.
Transfer of blood from young mice to old mice also improves neurogenesis and cognition, which suggests that such improvements are mediated by specific molecules.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-GLB-1594
In patients with type 2 diabetes, less-processed whole-grain products are associated with lower postprandial glucose levels.
Dietary recommendations for patients with diabetes include consumption of whole-grain foods. However, whole-grain foods differ in the extent to which they are processed: For example, wheat, brown rice, and oats can be finely milled or less processed.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-IMU-GLB-0057
Risks for suicide attempts are strongly transmitted, with nature and nurture contributing equally, whereas the modest intergenerational transmission of completed suicide is largely genetic.
Suicide attempts and suicides have long been known to run in families, but questions remain about the genetic versus environmental contributions to these phenomena.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-GLB-1598
CT angiography might be useful to personalize decision-making about preventive therapies in low- or intermediaterisk patients.
Coronary computed tomography angiography (CCTA) can assess the degree and progression of coronary atherosclerosis and higher-risk plaque features, such as remodeling of the blood vessel wall, low attenuation lesions, and spotty calcification.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CVP-GLB-0372
Earlier age at first episode and personal or family history of migraine were associated with greater risk.
Transient global amnesia (TGA) is a benign but highly distressing event of antegrade amnesia that usually lasts a few hours.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-GLB-1597
Iron deficiency is a common, delayed consequence of malabsorptive weight-loss surgery, especially in younger women.
Bariatric surgery can reduce the impact of obesity-associated comorbidities, but it increases the risk for iron deficiency (ID) and iron deficiency anemia (IDA).
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-IMU-GLB-0058
Disturbances are seen in white-matter structures responsible for the appropriate inhibition and control of emotions.
Many of the core features of borderline personality disorder (BPD; irritability, impulsivity, emotional instability) suggest disruption in frontolimbic brain circuits.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-CHL-0024
A meta-analysis indicates that almost two thirds of women have another psychotic episode, predominantly outside the postpartum period.
Postpartum psychosis denotes a severe mood disorder episode having psychotic, manic, or mixed affective symptoms and occurring within the first few weeks after childbirth.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-CHL-0022
In a retrospective study, researchers examined associations between laryngeal disorders and fibromyalgia, irritable bowel, and chronic fatigue.
Fibromyalgia, irritable bowel, and chronic fatigue are syndromes that share chronic pain and other unexplained symptoms among their clinical manifestations.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-PPF-CHL-0017
During 2 years of follow-up, most cases resolved, but one quarter developed into chronic inflammatory disease.
The differential diagnosis of recent-onset monoarthritis is broad and includes early presentation of what eventually is identifiable as chronic inflammatory rheumatic disease (CIRD),
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-PPF-CHL-0016
Meta-analyses of studies of both surgical and nonsurgical patients confirm the long-suspected association.
Delirium is common in postoperative and critically ill hospitalized patients and has been estimated to occur in 25% of postsurgical patients and up to 82% of patients admitted to intensive care units.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-CHL-0023
In the laboratory, median nerve stimulation reduced tic frequency and intensity and premonitory sensorimotor urges to tic.
Tourette syndrome (TS) is a neuropsychiatric disorder marked by involuntary tics, often associated with premonitory urges. Current treatments, including medications and psychological interventions, are often inadequate.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-CHL-0021
The widely accepted pooled cohort equations overestimate 5-year risk in a cohort of Veterans Affairs patients, with implications for statin eligibility.
The pooled cohort equations (PCE) were developed to estimate the risk for an initial atherosclerotic cardiovascular disease (ASCVD) event.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CVP-CHL-0015
In a prospective 4-year study, more of those with elevated cytokine levels had evidence of disease activity.
Although multiple sclerosis (MS) is often considered a disease of the white matter, appreciation is growing that pathology also directly affects the cortex.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM
Código de aprobación: PP-CNS-CHL-0019
Almost 40 years of international data show that the highest mean non-HDL cholesterol levels shifted to East and Southeast Asia from high-income Western regions.
With the epidemiological transition (the movement toward noncommunicable disease with economic development), cardiovascular disease has emerged as a leading cause of death in countries with developing economies.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-IMU-CHL-0007
Letter from the Editor
This collection (a seminal study from Denmark and several summaries of related studies along the medical-psychiatric interface) reminds us that the mind and body are continually interacting and affecting one another.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0018
Letter from the Editor
Access to medical care varies tremendously around the globe. It is especially in advanced technology that this variability exists, and particularly between underdeveloped and developed countries.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CVP-CHL-0011
Low-to-moderate physical activity might be protective.
Patients and some clinicians still are concerned that physical activity, particularly vigorous physical activity, might be associated with excess risk for knee osteoarthritis (OA), despite considerable evidence to the contrary.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-PPF-CHL-0008
Plasma amyloid and neurofilament levels were associated with dementia risk in a population-based cohort.
Assessment of plasma biomarkers is emerging as a potential noninvasive way to determine risk for dementia.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0014
Many diagnoses are missed using serum aldosterone and renin levels alone.
Guideline-recommended screening for primary aldosteronism in patients with resistant hypertension usually is accomplished by measuring serum aldosterone-renin ratio (ARR); however, screening rates are very low, and ARR might have low sensitivity for disease detection (J Clin Endocrinol Metab 2016; 101:1889).
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-IMU-CHL-0006
Long-term associations between mental and physical health are examined in a prospective study.
To address the relationship between health and affective symptoms (anxiety or depression), researchers analyzed data from a British prospective study of 3001 people followed repeatedly since birth in 1946.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0010
Acute coronary syndrome is infrequent, presents most often as non-STEMI, but is associated with high early mortality.
Although as many as 50% of patients who undergo transcatheter aortic-valve replacement (TAVR) have known coronary artery disease, the incidence of acute coronary syndrome (ACS) after TAVR is unknown.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CVP-CHL-0005
A study suggests that asking about pain tolerability has advantages over using a 0-to-10–point numerical rating.
The common practice of asking patients to rate their pain on a 10-point scale might suggest that the goal of pain therapy always is to achieve a score of 0.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-PPF-CHL-0004
Self-ratings of higher stress coping ability correlated with lower tau burden on brain scans in older adults.
The relationship between psychological stress and neurodegenerative syndromes has been established clinically.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0009
Auditory hallucinations are common in women with severe PTSD, especially among those who were younger at the initial trauma.
Clinically, auditory hallucinations are most often linked to psychotic disorders, such as schizophrenia, severe bipolar disorders, drug-induced psychoses, and neurodegenerative diseases.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0008
Remote sessions might become a convenient alternative to traveling for face-to-face care.
Telehealth programs are both cost-effective and more convenient alternatives to in-person interventions in people with dementia, especially as the dementia progresses.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-CNS-CHL-0007
Prescription of supplemental oxygen to critically ill adults in an intensive care unit (ICU) is a ubiquitous intervention practiced for decades. Surprisingly, research on the correct supplemental oxygen dose for critically ill patients has only been available within the last decade.
Greater BP variability in early adulthood correlated with worse echocardiographic features at middle age. Visit-to-visit blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, independent of BP level. To understand if BPV in early adulthood is associated with later subclinical alterations in cardiac structure and function, researchers used data from a U.S.-based community cohort study (CARDIA) in which participants aged 18 to 30 at enrollment underwent eight BP evaluations over 25 years of follow-up and an echocardiogram at year 25.
NEJM Journal Watch
The number of patients undergoing hip or knee arthroplasty is increasing, due in considerable part to the increasing prevalence of obesity. This rise has led to an increasing number of clinical decision points for both surgeons and primary care physicians. In the NEJM article, The HEALTH Investigators suggest that hemiarthroplasty (replacement of only the femoral head) in patients with displaced fractures of the femoral neck may be more appropriate than total arthroplasty despite expert recommendations to the contrary.
NEJM Journal Watch summary, reutilizado con permiso del Grupo
Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.
Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).
NEJM Journal Watch summary,
Papilledema detection by nonophthalmologists can be challenging. Conversely, the classification of anomalous optic discs as papilledematous may subject patients to anxiety regarding the diagnosis and to expensive and invasive testing, such as MRI and lumbar puncture, that ultimately proves unnecessary. In the NEJM article “Artificial Intelligence to Detect Papilledema from Ocular Fundus Photographs,” Milea and colleagues report on a deep-learning system developed to distinguish papilledematous discs from normal optic discs or discs with other abnormalities.
NEJM Journal Watch
A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.
To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-UMC-CHL-0034
Most of these fractures can be treated conservatively and are not associated with neurologic sequelae.
To better understand the rate and sequelae of thoracic spine fractures identified in the modern era of liberal computed tomography (CT) scanning of trauma patients, researchers performed a secondary analysis of data from the NEXUS Chest CT study.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-UMC-CHL-0033
Using MRI to score cerebral small-vessel disease may help predict dementia.
Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-UMC-CHL-0032
In recent years, two types of infection seem to be on the rise. Zoonosis is infection carried in animals and transferred to human by direct contact (e.g., rabies, perhaps COVID-19) or via an insect vector, such as mosquitoes (e.g., Zika virus, West Nile virus, Lyme disease).
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-IMU-CHL-0001
Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.
Cardiac testing could potentially identify at-risk patients who might benefit from early intervention.
Hepatorenal syndrome (HRS) is a serious complication of cirrhosis associated with high morbidity and mortality. Recent studies suggest that cardiac dysfunction may play a role in the pathogenesis of HRS.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-UMC-CHL-0015
The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.
Código de aprobación: PP-UMC-CHL-0008
Brain regions showing consistent alterations in migraineurs converge to a common brain network, which includes areas with a pivotal role in migraine pathophysiology.
Neuroimaging studies have shown functional and structural alterations of different brain areas in migraine patients, raising new questions. How do these regions interact with each other? Does a unique network enclose all these brain areas? Are these neuroimaging findings migraine specific?
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0198
Researchers in China find heightened short-term risks for cardiovascular hospitalizations.
Studies are accumulating about the relationship between air quality and cardiovascular risk. Because air quality in many areas of the world is deficient, we need to quantify the health effects at levels exceeding those that have been designated as safe, particularly with respect to short-term exposure.
Although overall mortality has changed little between 2002 and 2013, noncardiovascular mortality has increased, especially among the oldest old.
We have made substantial progress in improving outcomes for patients with ischemic heart disease, but what about for patients with heart failure? Investigators examined a clinical database of about 7% of the U.K. population to assess trends in 1-year mortality and hospital admissions among 86,833 patients with a diagnosis of incident heart failure from 2002 through 2013 (aged ≥80, 48%; ≥3 comorbidities, 79%; women, 49%).
NEJM Journal Watch
A long-term study suggests so.
Researchers sought to uncover a potential relationship between physical activity and prodromal features of Parkinson disease (PD) — features that precede the clinical diagnosis — using the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants were followed from 1986 through 2012, with assessments at baseline and longitudinally at many consecutive 24-month periods thereafter.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0190
The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-LIP-CHL-0013
In 2010, itwas estimated that more than 200million peopleworldwide were living with peripheral arterial disease. Chronic limbthreatening ischemia (CLTI) represents the end stage of peripheral arterial disease, which, left untreated, incurs a risk of major amputation, approaching 25%at 1 year.
© 2020 American Medical Association. All rights reserved. This journal and the individual contributions contained in it are protected under copyright by AMA, and the following terms and conditions apply to their use. JAMA® is a registered trademark of AMA, used under license.
1+1=3: Autism significantly increases risks for both mood and anxiety disorders.
When Kanner described autistic disturbances of affective contact in 1943, he observed that one of the hallmark clinical features was an “anxiously obsessive desire for the maintenance of sameness.” Many studies since have documented the prevalence of co-occurring psychiatric disorders in patients with autism spectrum disorder (ASD).
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0188
Catheter-based edge-to-edge repair may provide benefit, according to results from a preliminary single-arm trial.
Tricuspid regurgitation (TR), a common form of valvular heart disease, frequently results from right ventricular dilatation and leaflet tethering, leading to malcoaptation of the leaflets. TR has been associated with poor long-term survival and with impaired response to correction of left-sided cardiac pathology.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0187
Primary care clinicians are encouraged to refer early, partner with families to make treatment decisions, and know their community resources.
With the prevalence of autism spectrum disorder (ASD) now estimated at 1 in 59 U.S. children, the American Academy of Pediatrics (AAP) has updated its 2007 clinical report on ASD screening and management. Important points for clinicians include the following:
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0184
Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation,
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-MCM-CHL-0181
Improvement with 1 week of treatment with transcranial direct current stimulation is sustained for 12 weeks.
Because negative symptoms of schizophrenia have been associated with low activity in the prefrontal cortex (PFC), researchers in a sham-controlled, Brazilian study examined the effects of transcranial direct current stimulation (tDCS) in 95 schizophrenia patients with prominent negative symptoms.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-ZOL-CHL-0029
Multiple stress disorders, but most strongly post-traumatic stress disorder, increase the risk for serious infections.
The poor physical health of individuals with post-traumatic stress disorder (PTSD) is presumed to occur through the stress-related compromise of multiple physiological systems producing an excess of somatic complaints and bona fide medical illnesses.
NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.
Código de aprobación: PP-ZOL-CHL-0030
Interventions affecting circadian rhythm can be therapeutic, with some approaches more effective than others.
Chronotherapies, interventions that affect the circadian rhythm, have been studied in both the depressive and the manic stages of bipolar disorder through the years (e.g., NEJM JW Psychiatry Nov 2017 and Am J Psychiatry 2017; 175:131; NEJM JW Psychiatry Nov 2009 and Biol Psychiatry 2009; 66:298).
Código de aprobación: PP-MCM-CHL-0177
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La ansiedad por el estado de salud o hipocondría, es una experiencia que surge cuando se cree que las sensaciones o los cambios corporales son indicativos de una enfermedad grave. Aunque la hipocondría se clasifica en el DSM - IV como un trastorno somatomorfo, se han sugerido varias alternativas para su clasificación. Estas incluyen, por ejemplo, la reclasificación como un trastorno de ansiedad, como parte de los trastornos del espectro obsesivo compulsivo, o como un nuevo trastorno somatomorfo complejo.
En el DSM-5 se han propuesto diversos cambios para los trastornos del estado de ánimo, con especial enfoque en trastornos mixtos, trastorno bipolar y abordaje correcto del suicidio. Existen dos nuevos diagnósticos en adultos: trastorno mixto de ansiedad y depresión, y síndrome premenstrual disfórico.
Aunque se tiende a pensar en la depresión como un trastorno tratable, las tasas de remisión no son tan impresionantes. Se estima que sólo 1 de cada 3 pacientes remitirá después de un esquema breve de tratamiento, que dura varios meses; y sólo 2 de cada 3 remitirá después de un tratamiento prolongado, que dura hasta un año. Por lo que se han realizado múltiples estudios en los que se evidencia la importancia de la terapia cognitivo conductual (TCC) asociada a la terapia farmacológica en pacientes con depresión.
El Instituto Nacional de Salud Mental de Estados Unidos, estima que casi 15 millones de estadounidenses padecen trastorno depresivo mayor, convirtiéndose en un problema de salud alarmante. En la búsqueda de nuevos objetivos terapéuticos para controlar la depresión recientemente, grupos de expertos se han enfocado en la epigenética, la cual parece tener respuestas potenciales.
En la actualidad no se han podido superar los comentarios discriminatorios para con los que han construido nuestra historia y forjado nuestras raíces, con gran sacrificio. Dichas aseveraciones olvidan que en aquellos tiempos nuestros abuelos, sin los avances tecnológicos actuales, afrontaron todos los desafíos con tesón, empuje y gran entrega. Así, se logró la construcción de nuestras naciones y con ello las expectativas y proyecciones hacia el siglo XXI.
El “Edadismo” y llevándolo a un término más entendible para nosotros el “Viejismo”, ha