BackgroundThere is a high prevalence of depression in individuals with type 2 diabetes mellitus. Depressive disorders are associated with increased medical morbidity and mortality in individuals with diabetes. It has been demonstrated that there is a higher prevalence of diabetic complications among individuals with diabetes and depression compared to those without depression. Several biological alterations have been reported in individuals with depressive disorders, particularly abnormal levels of endocrine-inflammatory markers.This study aims to determine the prevalence of major depressive disorder (MDD) in type 2 diabetes patients, the prevalence of cardiovascular events in individuals with and without MDD and to compare the endocrine-inflammatory profile between groups.MethodsThe study was approved by the “Comité de Etica de Protocolos de Investigación del Departamento de Docencia e Investigación del Hospital Italiano de Buenos Aires” with the number “1262” and included only patients who provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki and the Habeas Data law on protection of personal data (Law Nª 25326, Argentina).Type 2 diabetes patients (n = 61) were included and they were classified as having MDD or not according to DSM-IV. Macrovascular disease was obtained from the medical history. Additionally, the intima-media thickness of the common carotid, carotid bifurcations and internal carotid arteries was measured non-invasively by two-dimensional ultrasound imaging. Fasting glucose, fasting lipid profile, inflammatory (CRP, TNF-α) and endocrine (urine free cortisol and saliva cortisol) markers. Student t tests were used to compare means for normally distributed variables and Mann-Whitney test for variables without normal distribution. Relative frequencies were calculated and a chi-square analysis was conducted. Data were expressed as mean ± standard deviation (SD) or median and interquartile range. Multivariable logistic regression was used to determine the relative odds of clinical cardiovascular disease in individuals with compared to those without depression. Differences were considered significant using a two-sided p < 0.05.Results21 patients (34%) had MDD and 40 patients (66%) didn’t have MDD. Diabetic patients with MDD had significantly higher CRP levels (4.1(1.9-7.6) vs 1.5(0.5-4.4) mg/l; p = 0.02) and 24-hour urine free cortisol (71.4 ± 21.3 vs 59.8 ± 29.3 ug/24 h; p = 0.03). The other metabolic and inflammatory parameters were not statistically different between groups. There was a significantly higher prevalence of cardiovascular events in individuals with MDD: 38% for the depressive group vs 15% for non-depressive group, p = 0.04). Patients with MDD had a 3.5-fold greater odd of having cardiovascular disease.ConclusionsDiabetic patients with depression are more likely to have cardiovascular events, and different factors can determine this high association.

Introducción: Los antipsicóticos incrementan la morbimortalidad por su impacto metabólico. Es escasa la información sobre su prescripción y seguimiento. El objetivo fue estimar la prevalencia de prescripción de antipsicóticos crónicos y evaluar el monitoreo metabólico.  Métodos: Cohorte retrospectiva de pacientes ambulatorios mayores de 18 años de un hospital de Argentina. Se estimó la prevalencia cruda y ajustada de prescripción crónica de antipsicóticos mediante estandarización indirecta por la población de la Organización Mundial de la Salud (OMS), con su intervalo de confianza 95%. Se evaluó si los pacientes en tratamiento tenían determinaciones bioquímicas, tensión arterial sistólica (TAS) e índice de masa corporal (IMC), al inicio y a los 12 meses.  Resultados: La prevalencia cruda de prescripción de antipsicóticos fue 23,8‰ (IC del 95% 23,0 – 24,6) y la ajustada fue 10,1 ‰ (95% CI 9,5-10,7). Se evaluaron 3702 pacientes. La razón hombre/mujer fue 0,6. La mediana de edad 77,5 años (IQR 25-75: 59,5-86,1). Predominó quetiapina. Pacientes con determinaciones al inicio: lipidograma 1804 (48,7%), glucemia 2034 (54,9 %), TAS 2546 (68,8 %) e IMC 1584 (42,8%). A los 12 meses: lipidograma 680 (18,4%), glucemia 898 (24,3%), TAS 1609 (43,5%) e IMC 1584 (21,7%).  Conclusiones: Observamos una mayor prescripción de antipsicóticos atípicos en la población anciana y femenina, y un escaso registro de determinaciones clínico-bioquímicas para control de efectos adversos.

Variations in the serotonin transporter gene (SLC6A4) have been implicated in a wide range of neuropsychiatric disorders such as major depression. However, the results are still controversial. A polymorphism in SLC6A4 gene characterized by an insertion/deletion of 44 bp (5-HTTLPR) in the promoter region (alleles L and S) and a variable number of tandem repeats polymorphism (5-HTTVNTR) in intron 2 (common alleles: 10 and 12) (Lesch et al., 1994) would present a differential regulatory effect on gene transcription.The association between these polymorphisms and major depression was analysed in 95 patients and 107 healthy controls in a sample of Argentinean population. This protocol has been approved by an independent Bioethic board. All the genotypes were obtained by standard procedures (Assal et al., 2004).Patients and controls were interviewed based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Hamilton depression scale, self-administered Beck scale and MINI structured diagnostic interview. Only patients with Hamilton depression scale greater than 18 points were included.The comparison of frequencies was carried out through logistic regression. A multiple testing correction was applied.The frequencies in patients and controls for both markers were in Hardy-Weingberg equilibrium (cases: L/L = 22%; L/S = 54%; S/S = 24%; controls: L/L = 27.1%; L/S = 52.3%; S/S = 20.6% and cases: 12/12 = 39%; 12/10 = 54%; 10/10 = 7%; controls: 12/12 = 46%; 12/10 = 42%; 10/10 = 12%).The linkage disequilibrium between polymorphisms was evaluated (D 0 = 0.29; r 2 = 0.04). The results indicate an independent distribution of the polymorphic loci; others authors observed the low rate of linkage between the 5-HTTLPR polymorphism and other polymorphisms could be due to recombination events in hot-spots located in the first intron. When a single marker association was evaluated between patients and controls, no significant differences were found. However, considering the findings of Hranilovic et al. 2004, a combinatorial effect of both polymorphisms is considered to be possible. The genotypes were grouped and compared according to their expression levels (no low expression at both loci, 11% vs. 6%; low expression at one locus: 40% vs. 60%; low expression at both loci: 49% vs. 34%, patients vs. controls, respectively). Although genotypes of the low expression group at one locus would confer protection with P = 0.005 [corrected P < 0.03; odds ratio (OR) = 0.45, 95% confidence interval (CI) = (0.25-0.78)], genotypes of the low expression group in both loci would confer risk with a P = 0.02 [corrected P < 0.03; OR = 1.93, 95% CI = (1.1-3.4)]. There are differences between the groups regarding their carrier status (being or not carriers of risk alleles S and 10). Those individuals carrying S and 10 alleles have an increased risk of having the depressive phenotype.We think it is necessary to increase not only the number of local individuals but also the number of markers under analysis. It shou...

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Objetivo: Explorar la frecuencia de diferentes variables sociodemográficas, clínicas y terapéuticas en los pacientes internados en la Sala de Psiquiatría del Hospital Italiano de Buenos Aires (HIBA). Introducción: Considerando que la Sala de Psiquiatría del HIBA se encuentra emplazada en un hospital general privado metropolitano de comunidad, referente a nivel nacional e internacional, resulta relevante realizar una descripción actualizada de la población usuaria de dicho dispositivo a la luz de los cambios producto de la sanción de la Ley Nacional de Salud Mental N° 26.657. Materiales y métodos: Se realizó  un estudio observacional descriptivo y analítico de corte transversal de pacientes que fueron internados en la Sala de Psiquiatría del HIBA durante el período comprendido entre el 1 de octubre de 2018 hasta el 30 de septiembre de 2019 inclusive. Resultados: Durante el período del estudio se valoraron 254 internaciones. Edad promedio de 51,85 años (D.E.=21,23), Mediana de la duración de internación correspondió a 22 días [IQR=14.00, 34.00], siendo el 31.5% de las mismas de carácter involuntario. Los motivos de ingreso más frecuentes fueron: cuadros depresivos (32.7%), descompensación psicótica (22.8%) y demencia/síntomas conductuales (13%). El 10.6% de los pacientes ingresaron tras haber realizado una tentativa suicida. Discusión: El presente trabajo permite tener una noción actualizada de las características de los pacientes que atendemos en la Sala de Internación teniendo en cuenta los cambios en la legislación vigente y en la sociedad en su conjunto. Conclusiones: Caracterizar los determinantes epidemiológicos del patrón de internaciones psiquiátricas permite realizar diagnóstico de situación local y actualizado que favorecerá el desarrollar y repensar estrategias de planificación y gestión informadas.