IntroductionThere is no general agreement on the prevalence of mental disorders in the elderly, although it is estimated that 25%. of them present psychiatric symptoms. Geriatric psychiatry is one of the most rapidly advancing fields and requires a comprehensive approach.ObjectivesTo analyse the characteristics of patients older than 65 who are attended at the psychiatry emergency room.MethodsA descriptive study was conducted among all elderly pacients seen during May 2010 at the psychiatry emergency room at Vall d’Hebron University Hospital. Clinical variables (functional status, reason to show up, medical history, diagnosis), treatment and referral at discharge were analysed.Results36 patients (44.4% men, mean age 75.3 years) were identified. Charlson comorbidity index was 2.08. Suicide attempts were the most frequent reason for admission (27.8%), followed by psychomotor agitation (16.7%), anxiety disorders (13.9%), delirium (13.9%), depression (11.1%), and behaviour disorders (8.3%). Concerning psychiatric antecedents 58.3% had depressive disorder and 40% reported somatic symptoms during the month prior to their consultation.The most common diagnosis at discharge were anxiety-depressive disorders (52.7%) and delirium (16.7%). The most widely prescribed psychotropics were antipsychotics (19.4% haloperidol, 13.9% quetiapine) followed by benzodiazepines (13.9%). Referral at discharge was: 41.7% home, 13.9% midterm psychiatric units, 27.8% acute psychiatric inpatient unit and 16.7% Internal Medicine.ConclusionsTypically, elderly patients attended at the psychiatric emergency room are diagnosed of an anxiety-depressive disorder and often present with a suicidal attempt, but only 41.7% are admitted as psychiatric inpatients.

Introduction: TBI is a significant health problem which often affects young people with high life expectancy and it is associated with a high rate of psychological morbidity. Symptoms such lack of attention and apathy are responsible for a significant degree of discomfort that interferes negatively on the quality of life. Cognitive remediation and treatment with stimulants seem to be useful in these patients, however, few studies are been conducted about the most appropriate management of TBI patients. Objective: Systematic review the existing evidence on the combined use of psychostimulants and cognitive remediation in the treatment of attention problems in patients with TBI. Methods: Performs search in PUBMED and PsycINFO of randomized controlled trials in TBI patients with a psychostimulants and cognitive remediation groups. Analyses the effect of these interventions in a variety of measures attention. Results: Randomized controlled trials have examined the combined effect of psychostimulants and cognitive rehabilitation. Preliminary results indicate that the mix of strategies is more effective than cognitive rehabilitation and the use of psychostimulants separately. It is described the effectiveness of the combination as well as psychostimulants used and the effect on other symptoms as apathy and slackness. Conclusions: The effectiveness of both treatments warranted of protocols standardized in the early management of attention difficulties in patients with TBI.

Uno de los elementos claves en la medicina de la segunda década del siglo XXI es el crecimiento exponencial de la información producida por los pacientes que se debe no solo a la transición hacia la digitalización de las historias clínicas, sino también a la aparición de nuevas fuentes de información y a la capacidad de análisis e interpretación de las ya existentes. Se estima que la cantidad de información médica se duplica cada 2 años, lo que supone que en 2020 existirá 50 veces más información que en 2011. En este contexto, el manejo adecuado de grandes cantidades de datos o big data debe traducirse en nuevas iniciativas que mejoren el diagnóstico, tratamiento y pronóstico de los pacientes en el camino hacia la medicina personalizada. El concepto de personalización o de medicina de precisión cobra especial interés en la patología respiratoria crónica. En los últimos años la investigación en entidades como el asma, la EPOC, el cáncer o el SAHS se ha centrado en la identificación de alteraciones genómicas, moleculares, metabólicas y proteicas (biomarcadores). Su análisis mediante herramientas de análisis de big data permite dejar atrás los modelos centrados en la respuesta media al tratamiento, que a su vez resultan subóptimos para la mayoría, para dar paso a la respuesta individualizada. En este camino se incorpora la medicina de sistemas, que, integrando también datos clínicos y poblacionales, aporta una visión multidimensional de la enfermedad y facilita el establecimiento de asociaciones causales, la mayoría de las cuales solo son apreciables mediante análisis de big data .