Libro Medicina Basada en Evidencias MBE Alberto Narvaez | Page 243

Pregunta 7.9. Tomando en cuenta el diseño de estudio, la significación clínica (eficacia
y precisión) identifique el Nivel de Evidencia y Grado de Recomendación de este
estudio.
Ejercicio 8. Con base a la lectura del siguiente resumen identifique el tipo de diseño
de estudio y argumente las razones de su selección. :
Stage managing bipolar disorder.
Berk M; Berk L; Dodd S; Cotton S; Macneil C; Daglas R; Conus P; Bechdolf A; Moylan S; Malhi
GS.
Bipolar Disord; 16(5): 471-7, 2014 Aug.
Resumo
Objectives: Clinical staging is widespread in medicine - it informs prognosis, clinical course,
and treatment, and assists individualized care. Staging places an individual on a probabilistic
continuum of increasing potential disease severity, ranging from clinically at-risk or latency
stage through first threshold episode of illness or recurrence, and, finally, to late or end-stage
disease. The aim of the present paper was to examine and update the evidence regarding
staging in bipolar disorder, and how this might inform targeted and individualized intervention
approaches.
Methods: We provide a review of the relevant information.
Results: In bipolar disorder, the validity of staging is informed by a range of findings that
accompany illness progression, including neuroimaging data suggesting incremental volume
loss, cognitive changes, and a declining likelihood of response to pharmacological and
psychosocial treatments. Staging informs the adoption of a number of approaches, including
the active promotion of both indicated prevention for at-risk individuals and early intervention
strategies for newly diagnosed individuals, and the tailored implementation of treatments
according to the stage of illness.
Conclusions: The nature of bipolar disorder implies the presence of an active process of
neuroprogression that is considered to be at least partly mediated by inflammation, oxidative
stress, apoptosis, and changes in neurogenesis. It further supports the concept of
neuroprotection, in that a diversity of agents have putative effects against these molecular
targets. Clinically, staging suggests that the at-risk state or first episode is a period that
requires particularly active and broad-based treatment, consistent with the hope that the
temporal trajectory of the illness can be altered. Prompt treatment may be potentially
neuroprotective and attenuate the neurostructural and neurocognitive changes that emerge
with chronicity. Staging highlights the need for interventions at a service delivery level and
implementing treatments at the earliest stage of illness possible.
Pregunta 8.1. Consulte en Decs y Mesh las palabra indexada o descriptor y definición
de: bipolar disorder. Compare las definiciones en español e inglés.
Palabra
indexada
Definición español
Definición inglés
Pregunta 8.2. Consulte cuales son los tratamientos recomendados para desordenes
bipolares.
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