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Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
Long-term Depression01:03

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Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
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¿Está este paciente clínicamente deprimido?

John W Williams1, Polly Hitchcock Noël, Jeffrey A Cordes

  • 1Department of Veterans Affairs Medical Center, 508 Fulton St, HSR&D, Bldg 6, Durham, NC 27705, USA. jw.williams@duke.edu

JAMA
|March 7, 2002
PubMed
Resumen

El diagnóstico preciso de la depresión es posible utilizando varios cuestionarios y entrevistas clínicas. Estas herramientas ayudan a los médicos a identificar la depresión mayor con resultados confiables.

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Área de la Ciencia:

  • Psiquiatría y salud mental.
  • Estudios de precisión de diagnóstico Estudios de precisión de diagnóstico.
  • Medicina de la Atención Primaria La medicina de la atención primaria es la medicina de la atención primaria.

Sus antecedentes:

  • Los trastornos depresivos son comunes, pero el diagnóstico es difícil debido a la ausencia de una prueba de diagnóstico definitiva.
  • Las herramientas efectivas de detección y diagnóstico son cruciales para la intervención oportuna y el manejo de la depresión.

Objetivo del estudio:

  • Revisar sistemáticamente la exactitud y precisión del diagnóstico de los cuestionarios de depresión.
  • Evaluar la fiabilidad de los exámenes clínicos en el diagnóstico de la depresión mayor.
  • Para comparar el rendimiento de varios instrumentos de detección y métodos de diagnóstico.

Principales métodos:

  • Búsqueda exhaustiva de la literatura de estudios de la lengua inglesa desde 1970-2000 utilizando MEDLINE y registros especializados.
  • La inclusión de estudios de hallazgo de casos (≥100 pacientes de atención primaria, cuestionarios validados) y estudios de fiabilidad (≥2 clínicos, diagnósticos basados en criterios).
  • Evaluación rigurosa de la calidad de los estudios incluidos, centrándose en el tamaño de la muestra, la selección de pacientes, el cegamiento y los procedimientos de diagnóstico.

Principales resultados:

  • Once cuestionarios de depresión, que tardaron de 1 a 5 minutos en administrarse, mostraron características de rendimiento comparables.
  • El promedio de probabilidad positiva para la depresión mayor fue de 3,3; el promedio de probabilidad negativa fue de 0,19.
  • Se observó una alta confiabilidad interrater (kappa=0.64-0.93) para los profesionales de la salud mental que utilizan entrevistas semiestructuradas; los médicos de atención primaria también demostraron un alto acuerdo (kappa=0.71).

Conclusiones:

  • Numerosos cuestionarios de depresión prácticos con buen rendimiento están disponibles para ayudar a los médicos.
  • Las entrevistas clínicas, en particular las semiestructuradas, realizadas por profesionales de la salud mental o médicos de atención primaria, ofrecen una confirmación diagnóstica confiable.
  • Estas herramientas validadas mejoran la identificación y el diagnóstico del trastorno depresivo mayor en entornos clínicos.