Examen final Epidemiologiìa 2 Verano 2021

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Examen final Epidemiología 2 Verano 2021 
 
Anote su nombre completo: _Diego Joel Padilla Benítez_______ 
 
Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder. A Randomized Clinical 
Trial 
IMPORTANCE Major depressive disorder (MDD) is a substantial public health burden, but 
current treatments have limited effectiveness and adherence. Recent evidence suggests that 1 
or 2 administrations of psilocybin with psychological support produces antidepressanteffects 
in patients with cancer and in those with treatment-resistant depression. 
OBJECTIVE To investigate the effect of psilocybin therapy in patients with MDD. 
DESIGN, SETTING, AND PARTICIPANTS This randomized,waiting list–controlled clinical 
trialwas conducted at the Center for Psychedelic and Consciousness Research at Johns 
HopkinsBayview Medical Center in Baltimore, Maryland. Adults aged 21 to 75 years with an 
MDD diagnosis, not currently using antidepressant medications, and without histories of 
psychotic disorder, serious suicide attempt, or hospitalization were eligible to participate. 
Enrollment occurred between August 2017 and April 2019, and the 4-week primary outcome 
assessments were completed in July 2019. A total of 27 participants were randomized to an 
immediate treatment condition group (n = 15) or delayed treatment condition group (waiting 
list control condition; n = 12). Data analysis was conducted from July 1, 2019, to July 31, 2020, 
and included participants who completed the intervention (evaluable population). 
INTERVENTIONS Two psilocybin sessions (session 1: 20mg/70 kg; session 2: 30mg/70 kg) 
were given (administered in opaque gelatin capsules with approximately 100 mL of water) in 
the context of supportive psychotherapy (approximately 11 hours). Participants were 
randomized to begin treatment immediately or after an 8-week delay. 
MAIN OUTCOMES AND MEASURES The primary outcome, depression severitywas assessed 
with the GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores at baseline (score of 
_17 required for enrollment) and weeks 5 and 8 after enrollment for the delayed treatment 
group, which corresponded to weeks 1 and 4 after the intervention for the immediate 
treatment group. Secondary outcomes included the Quick Inventory of Depressive 
Symptomatology-Self Rated (QIDS-SR). 
RESULTS Of the randomized participants, 24 of 27 (89%) completed the intervention and the 
week 1 and week 4 postsession assessments. This population had a mean (SD) age of 39.8 
(12.2) years,was composed of 16women (67%), and had a mean (SD) baseline GRID-HAMD 
score of 22.8 (3.9). The mean (SD) GRID-HAMD scores atweeks 1 and 4 (8.0 [7.1] and 8.5 
[5.7]) in the immediate treatment groupwere statistically significantly lower than the scores 
at the comparable time points ofweeks 5 and 8 (23.8 [5.4] and 23.5 [6.0]) in the delayed 
treatment group. The effect sizes were large at week 5 (Cohen d = 2.5; 95%CI, 1.4-3.5; P < 
.001) and week 8 (Cohen d = 2.6; 95%CI, 1.5-3.7; P < .001). The QIDS-SR documented a rapid 
decrease in mean (SD) depression score from baseline to day 1 after session 1 (16.7 [3.5] vs 
6.3 [4.4]; Cohen d = 2.6; 95%CI, 1.8-3.5; P < .001), which remained statistically significantly 
reduced through the week 4 follow-up (6.0 [5.7]; Cohen d = 2.3; 95%CI, 1.5-3.0; P < .001). In 
the overall sample, 17 participants (71%) at week 1 and 17 (71%) atweek 4 had a clinically 
significant response to the intervention (_50% reduction in GRID-HAMD score), and 14 
participants (58%) at week 1 and 13 participants (54%) at week 4were in remission (_7 
GRID-HAMD score). 
CONCLUSIONSANDRELEVANCE Findings suggest that psilocybin with therapyis efficacious in 
treating MDD, thus extending the results of previous studies of this intervention in patients 
with cancer and depression and of a non randomized study in patients with treatment-
resistant depression. 
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1. Este estudio no mostró diferencias significativas entre el grupo experimental 
contra el grupo control en el descenso de la depresión mayor Falso (X) Cierto ( ) 
 
2. Debido a que 
a) Hubo un descenso similar de los valores la encuesta QUDS-SR en ambos grupos 
b) Huno un descenso no significativo de los valores la encuesta QUDS-SR entre ambos 
grupos 
c) Hubo un descenso significativo los valores la encuesta QUDS-SR con P=0.001 
 
 
 
Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, 
Outcomes, and Risk Reduction Strategies 
Stephen V. Faraone, 
Objective: To review all literature on the nonmedical use (NMU) and diversion of 
prescription stimulants to better understand the characteristics, risk factors, and 
outcomes of NMU and to review risk-reduction strategies. 
Method: We systematically searched PubMed, PsycINFO, and SCOPUS from inception 
to May 2018 for studies containing empirical data about NMU and diversion of 
prescription stimulants. Additional references identified by the authors were also 
assessed for inclusion. 
Results: A total of 111 studies met inclusion criteria. NMU and diversion of stimulants 
are highly prevalent; self-reported rates among population samples range from 2.1% 
to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to 
describe NMU, and most studies have examined college students. Although most NMU 
is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or 
minor, medical effects; however, adverse medical outcomes, including death, occur in 
some individuals, particularly when administered by non-oral routes. Although 
academic and occupational performance enhancement are the most commonly cited 
motivations, there is little evidence that academic performance is improved by NMU 
in individuals without attention-deficit/hyperactivity disorder. 
Conclusion: NMU of stimulants is a significant public health problem, especially in 
college students, but variations in the terms used to describe NMU and inconsistencies 
in the available data limit a better understanding of this problem. Further research is 
needed to develop methods to detect NMU, identify individuals at greatest risk, study 
routes of administration, and devise educational and other interventions to help 
reduce occurrence of 
NMU. Colleges should consider including NMU in academic integrity policies. 
J Am Acad Child Adolesc Psychiatry 2020;59(1):100–112. 
 
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3) Este es un estudio temático del uso de prescripción no médica de estimulantes: 
Falso ( X ) Cierto ( ) 
 
4) Cuántos estudios finalmente fueron tomados en cuenta en este estudio 
a) 1090 
b) 111 
c) 109 
 
Trastorno obsesivo-compulsivo durante el período perinatal: epidemiología, 
fenomenología, etiopatogenia y tratamiento. 
Resumen: El objetivo de la presente revisión teórica es describir los principales hallazgos e 
investigaciones sobre el trastorno obsesivo-compulsivo (TOC) durante el período perinatal. Por una 
parte, los estudios epidemiológicos señalan que en esta etapa aumenta el riesgo de debut y/o 
exacerbación del TOC, especialmente en el puerperio. A nivel fenomenológico, predominan 
las obsesiones agresivas y de contaminación relacionadas con la figura del feto o neonato. En 
cuanto a su etiopatogenia, existen evidencias indirectas para postular la participación de variables 
neuroendocrinas (p.e. esteroides gonadales femeninos y oxitocina) y cognitivo-conductuales (p.e. 
hiperresponsabilidad, sobreestimación de la amenaza y control mental), siendo necesaria una mayor 
contrastación empírica de estos correlatos y/o factores de vulnerabilidad específicos. En el ámbito 
interventivo, se carece de ensayos clínicos aleatorizados con grupo control adaptados a las 
características idiosincrásicas de este subgrupo de sujetos con TOC. Así mismo, se destaca el papel 
de la terapia cognitivo-conductual (TCC) en el marco de la prevención primaria selectiva. 
 
 
5) Este es un estudio sistemático del Trastorno obsesivo compulsivo (TOC) en el 
periodo prenatal 
 Falso ( X )Cierto ( ) 
 
6) Cual el la plausibilidad biológica origen del TOC en el periodo prenatal: 
a) predominan las obsesiones agresivas y de contaminación relacionadas con la figura 
del feto o neonato ( ) 
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b) evidencias indirectas para postular la participación de variables neuroendocrinas 
(p.e. esteroides gonadales femeninos y oxitocina) ( X ) 
c) hiperresponsabilidad, sobreestimación de la amenaza y control mental), ( ) 
 
Gender Differences in Suicide and Self-Directed Violence Risk Among Veterans 
With Post-traumatic Stress and Substance Use Disorders 
a b s t r a c t 
Background: Veterans have a high prevalence of both post-traumatic stress disorder (PTSD) 
and substance use disorders (SUDs), which are related to suicide risk. Exploring gender-
related differences in suicidal behavior risk among this subgroup of veterans is important to 
improve prevention and treatment strategies. To date, few studies have explored these 
differences. 
Methods: The sample included 352,476 men and women veterans from the Women Veterans 
Cohort Study with a diagnosis of PTSD. First, we conducted analyses to assess gender-related 
differences in sociodemographic and clinical variables at baseline, as well as by suicidal 
behavior. Then, we conducted a series of Cox proportional hazards regresión models to 
estimate the hazard ratios of engaging in self-directed violence (SDV) and dying by suicide by 
SUD status and gender, controlling for potential confounders. 
Results: Adjusted analyses showed that, among veterans with PTSD, the presence of a SUD 
significantly increased the risk of SDV and death by suicide. Women with PTSD had a 
decreased risk of dying by suicide compared with men. No gender-related difference was 
observed for SDV. SUD increased the risk of SDV behavior in both women and men but 
increased the risk of dying by suicide only among men. 
Conclusions: Our findings revealed gender-related differences in SDV and suicide among 
veterans with a PTSD diagnosis with or without a SUD. Our study, along with the increasing 
numbers of women serving in the military, stresses the need to conduct gender-based 
analyses to help improve prevention and treatment strategies. 
 
7) Este es un estudio: 
a) Casos y controles 
b) Cohorte fija 
c) longitudinal descriptivo 
 
8) El estudio señala que “. Women with PTSD had a decreased risk of dying by suicide 
compared with men.” Lo que contradice el título del artículo. 
Cierto ( ) Falso ( X ) 
 
Social media, internet use and suicide attempts in adolescents 
Rosemary Sedgwick 
Purpose of review 
Suicide is the second leading cause of death in youth aged 10–24 years old globally, but 
detecting those at risk is challenging. Novel preventive strategies with wide influence across 
populations are required. Interest in the potential for both detrimental and supportive 
influences of social media/internet use on suicidal behaviour has been growing; however, the 
relationship remains unclear. 
Recent findings 
A systematic search of articles from database inception up to 25 January 2019 across five 
databases: Medline, PsycINFO, EMBASE, HMIC and CINAHL revealed nine independent studies 
investigating social media/internet use and suicide attempts in young people less than 19 
 5 
years old (n.346 416). An independent direct association was found between heavy social 
media/internet use and increased suicide attempts in seven studies (adjusted ORs ranged 
from 1.03 to 5.10), although adjusting for cyberbullying victimization and sleep disturbance 
reduced the strength of this association. Two studies found that some social media/internet 
use, versus no use, may be associated with fewer suicide attempts. There were no studies 
investigating the relationship between social media/internet use and completed suicide. 
Summary 
There is an independent association between problematic use of social media/internet and 
suicide attempts in young people. However, the direction of causality, if any, remains unclear. 
Further evaluation through longitudinal studies is needed. 
 
 
9) Este es un estudio: 
a) Revisión temática 
b) Revisión sistemática 
c) Metaanálisis 
 
 
10. En resumen el artículo concluye que es independiente la asociación entre el uso 
problemático de las redes sociales/Internet y los intentos de suicidio en jóvenes. 
Cierto ( X ) Falso ( ) 
 
 
 
 
 
 
 
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pilón (es optativo) 
 
A Comprehensive Study of Mass Murder Precipitants and Motivations of 
Offenders 
Abstract 
Much speculation has been made in the media as to the causes of mass murder in the 
United States, yet little empirical research exists to verify factors leading to violence. 
Prior research primarily relies on case study methodologies or small data sets, but 
none have focused on the underlying issues observed in a comprehensive national 
sample. Data for the current study include 152 mass murders reported through the 
FBI’s Supplementary Homicide Reports and USA Today from 2007 to 2011, which 
were then matched with media reports for each event. The current study shows 
that mass murders typically occur following a triggering event, are committed by 
non-strangers, and are rarely committed by persons with mental illnesses. A more 
realistic image of these incidents is critical, as misperceptions of offenders and case 
characteristics can improperly shape public policies. 
 
11) Este es un estudio: 
a) Revisión temática 
b) Estudio transversal 
c) Serie de casos 
 
 
Gusto en ser su maestro 
Cuídense. 
MASM 
 
Gracias por su paciencia y trabajo ojalá sea nuestro maestro en un futuro no tan lejano 😊