Papers by Elisa Sepúlveda
Revista de otorrinolaringología y cirugía de cabeza y cuello, Mar 1, 2021
Los autores declaran no tener conflictos de interés.
Revista Medica De Chile, Aug 1, 2020
Cluster C personality traits and attention deficit disorder in medical students. An analytical cr... more Cluster C personality traits and attention deficit disorder in medical students. An analytical cross-sectional study Background: Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. Aim: To analyze the association between ADHD and cluster C personality traits in medical students. Material and Methods: Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). Results: We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their counterparts of Group 1, participants in Group 2 were more likely to have a history of psychiatric/psychological care, previous diagnosis of ADHD and traits of cluster B (37 and 68% respectively) and C (55 and 74% respectively). The odds ratio of having A, B or C traits when a likely or very likely ADHD was present, were 1.29 95% confidence interval (CI) [0.8-2.07], 3.79 95% CI [2.3-6.22] and 2.4 95% CI [1.46-3.96], respectively. Conclusions: Cluster C personality traits were frequent among medical students and were significantly associated with ADHD.
Revista chilena de neuro-psiquiatría, Mar 1, 2022
Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of effic... more Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of efficacy in traumatic spectrum disorders. Its efficacy in anxiety disorders (AD) and depressive disorders (DD) in children and adolescents has been scarcely studied. Methods: We conducted a narrative review to describe the available evidence on the efficacy of EMDR in AD and DD in children and adolescents. We searched for articles available in PubMed/Medline, SciELO, PsycInfo and the Cochrane Library. All primary and secondary studies evaluating the effect of EMDR on AD and DD in children and adolescents were included. Their references were reviewed as a second method of inclusion. Results: nine studies were identified (five in AD and four in DD); three were observational and six experimental. All had small sample sizes. In AD, studies corroborated the efficacy of EMDR on phobic fear in spider phobia, but not on avoidance behavior, where in vivo exposure would be superior. Two case series reported the efficacy of EMDR in choking phobia and AD associated with epilepsy. In DD, EMDR was effective in reducing depressive symptomatology in the context of major depressive disorder, acute stress disorder, and conduct disorders. EMDR was comparable to cognitive behavioral therapy. Conclusions: The evidence corroborates the efficacy of EMDR in AD and DD in children and adolescents. However, it is very scarce and has methodological limitations. It is necessary to carry out experimental studies with standardized and specialized EMDR protocols for AD and DD in the child and adolescent population.
Revista chilena de neuro-psiquiatría, 2017
Prenatal stress (PS) has been mainly investigated in animal models. It could trigger permanent ne... more Prenatal stress (PS) has been mainly investigated in animal models. It could trigger permanent neurobiological changes in the offpring through fetal programming, displayed as behavioral, cognitive, anxious, affective and psychotic disorders during infancy and adulthood. Main effects of PS have been related to the functioning of hypothalamic-pituitary-adrenal axis (HPA), serotonergic, glutamatergic and GABAergic systems, cortical (prefrontal, temporal and insular cortex) and subcortical structures (amygdala, hippocampus), cerebellum and placenta. Glucocorticoids are the most recognized transmission factors of maternal-fetal stress, with distinctive effects according to the moment of action, developmental stage and fetal gender. Alteration pattern of the HPA axis by PS would be similar to the one observed in some mental disorders. Other neuromodulators involved in the neurotoxicity of PS are nitric oxide and brain derived neurotrophic factor, associated to synaptic potentiation and depression. Also, serotonergic system has an important relationship with HPA axis, verifying a decreased number of serotonin transporters and an impaired placental synthesis of the neurotransmitter, essential for fetal neurodevelopment. Other epigenenomic mechanisms would be the modulation of synaptic plasticity by neurotrophins, adhesion and membrane molecules. Treatment with selective serotonin reuptake inhibitors has shown controversial outcomes. PS would affect fetal programming causing significant and permanent neurobiological alterations with clinical manifestations. This complex phenomenon must be further investigated, especially in human models.
Revista chilena de neuro-psiquiatría, Jun 1, 2016
Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during t... more Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during the last two decades in children and adolescents, although both are currently underdiagnosed. Objective: To review the evidence on SD and CD in children and adolescents. Method: A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results: There is a high intercurrence with affective and anxiety disorders and some risk factors have been identified, especially higher vulnerability to stress, family disfunction, parental overprotection, and limited mentalization of physical symptoms (alexithymia), which at the same time, perpetuate the symptomatology. From an ethiopathogenic perspective, psychodynamic, psychosomatic, traumatic-environmental and biological hypothesis have been invoked. Patients with SD and CD are frequently females, show more introversive personality features, more stressful life events and executive deficits. Psychogenic non-epileptic seizures are related with more psychiatric co-morbidities and worse outcome. Cognitive-behavioural psychotherapy and psychodynamic-hypnotherapy combined with selective serotonin reuptake inhibitors have been effective. Conclusions: SD and CD in child and adolescent populations have been observed in medical and psychiatric contexts. Their recognition is difficult due to their multifactorial ethiology, the lack of diagnosis consensus and the scarce clinical experience, involving a true therapeutic challenge; therefore, it is imperative to carry out future researches on this issue. Their management in primary care seems suitable, but in more complex cases the referral to the specialist is necessary.
Medwave, 2022
Stressful life situations can generate chronic symptomatology, so it is of great concern to analy... more Stressful life situations can generate chronic symptomatology, so it is of great concern to analyze preventive strategies. Psychological debriefing is an intervention for acute trauma, which verbalizes perceptions, thoughts, and emotions experienced during a recent traumatic event. The evidence surrounding its efficacy is controversial. This article discusses the efficacy of psychological debriefing based on systematic reviews and clinical practice guidelines. In all, nine systematic reviews were included. Only one of them found that psychological debriefing effectively decreased psychological stress, while the remaining eight found no significant effects for outcomes such stress, depressive and anxious symptoms, or development and severity of post-traumatic stress disorder. Moreover, two clinical trials found that the intervention had a significantly deleterious effect. Another study found a worsening in the symptomatology associated with the event. Of the eight clinical practice g...
Revista chilena de neuro-psiquiatría
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Revista medica de Chile, 2020
BACKGROUND Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderl... more BACKGROUND Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. AIM To analyze the association between ADHD and cluster C personality traits in medical students. MATERIAL AND METHODS Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). RESULTS We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their...
Revista de otorrinolaringología y cirugía de cabeza y cuello, 2021
Somatoform disorders (SD) make up a group of entities with polymorphic expression, characterized ... more Somatoform disorders (SD) make up a group of entities with polymorphic expression, characterized by the relevance of somatic symptoms associated to a significant psychological stress whether or not noticeable, but without a defined structural basis. When the symptomatology is related to the nervous system, they are known as conversion disorders (CD). Their etiology has a multicausal and complex nature, having expressions in all the body systems. SD and CD have been scarcely studied in pediatric otolaryngology and are poorly reviewed during medical training. We performed a systematic search on SD and CD in pediatric otolaryngology in PubMed/Medline, SciELO and Cochrane Library databases. We included 49 references, mostly observational studies and narrative reviews. The most described clinical pictures were functional stridor, psychogenic deafness, factitious disorder, and psychogenic vertigo. The diagnostic process requires otolaryngologic and psychiatric evaluations. All studies sho...
Revista chilena de neuro-psiquiatría
Body-focused repetitive impulsive behaviors (BFRIB) are characterized by skin, nail and hair remo... more Body-focused repetitive impulsive behaviors (BFRIB) are characterized by skin, nail and hair removing, scratching and/or biting, that configurate a mental disorder in some cases. Excoriation disorder (ED) or dermatillomania has been recently added as a specific disorder in DSM-5 obsessive-compulsive spectrum. Its phenomenology describes a behavior that emerges from anxiety, followed by a progressive psychic tension and then a pleasurable sensation, concluding in many times in guilt. Evidence has reported a greater incidence of ED in college students; however, studies in Latin America are scarce. Objective: To establish frequence and phenomenological features of BFRIB and ED in college students. Methods: We performed a cross-sectional study through the application of a self-administered questionnaire about ED aspects in college students. Results: 440 students were included; 22.2% felt always or almost always the impulse to scratch their skin until they were injured; 13.2% made these actions many times a day and 4.3% deployed considerable efforts in resisting them. Most frequent reported affects were guilt, shame, repentance, and self-reproach; 24.1% thought these behaviors were abnormal and 6.1% considered they constitute a pathology. According to DSM-5 and authors' criteria, four cases of ED were found (0.91%), when psychiatric and medical comorbidities were discarded. Conclusion: Although BFRIB were frequent in college students, dermatillomania frequency was similar to general population. A characteristic phenomenology was described, similar to the evidence reported one.
Revista chilena de neuro-psiquiatría
Revista chilena de neuro-psiquiatría, 2016
Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during t... more Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during the last two decades in children and adolescents, although both are currently underdiagnosed. Objective: To review the evidence on SD and CD in children and adolescents. Method: A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results: There is a high intercurrence with affective and anxiety disorders and some risk factors have been identified, especially higher vulnerability to stress, family disfunction, parental overprotection, and limited mentalization of physical symptoms (alexithymia), which at the same time, perpetuate the symptomatology. From an ethiopathogenic perspective, psychodynamic, psychosomatic, traumatic-environmental and biological hypothesis have been invoked. Patients with SD and CD are frequently females, show more introversive personality features, more stressful life events and executive deficits. Psychogenic non-epileptic seizures are related with more psychiatric co-morbidities and worse outcome. Cognitive-behavioural psychotherapy and psychodynamic-hypnotherapy combined with selective serotonin reuptake inhibitors have been effective. Conclusions: SD and CD in child and adolescent populations have been observed in medical and psychiatric contexts. Their recognition is difficult due to their multifactorial ethiology, the lack of diagnosis consensus and the scarce clinical experience, involving a true therapeutic challenge; therefore, it is imperative to carry out future researches on this issue. Their management in primary care seems suitable, but in more complex cases the referral to the specialist is necessary.
Frontiers in psychiatry, 2018
In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns,... more In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns, known as trypophobia. This condition has not yet been recognised by diagnostic taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. Trypophobia usually involves an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies. It is commonly accompanied by neurovegetative symptoms. In the case we present here, the patient also suffered from generalised anxiety disorder and was treated with sertraline. After she was diagnosed, she showed symptoms of both fear and disgust towards trypophobic images. After some time following treatment, she only showed disgust towards said images. We finish this case report presenting a comprehensive literature review of the peer reviewed articles we retrieved after an exhaustive search about trypophobia, we ...
Frontiers in Psychiatry, 2018
In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns,... more In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns, known as trypophobia. This condition has not yet been recognised by diagnostic taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. Trypophobia usually involves an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies. It is commonly accompanied by neu-rovegetative symptoms. In the case we present here, the patient also suffered from generalised anxiety disorder and was treated with sertraline. After she was diagnosed, she showed symptoms of both fear and disgust towards trypophobic images. After some time following treatment, she only showed disgust towards said images. We finish this case report presenting a comprehensive literature review of the peer reviewed articles we retrieved after an exhaustive search about trypophobia, we discuss how this case report contributes to the understanding of this anxiety disorder, and what questions future studies should address in order to achieve a better understanding of trypophobia.
Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during t... more Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during the last two decades in children and adolescents, although both are currently underdiagnosed. Objective: To review the evidence on SD and CD in children and adolescents. Method: A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results: There is a high intercurrence with affective and anxiety disorders and some risk factors have been identified, especially higher vulnerability to stress, family disfunction, parental overprotection, and limited mentalization of physical symptoms (alexithymia), which at the same time, perpetuate the symptomatology. From an ethiopathogenic perspective, psychodynamic, psychosomatic, traumatic-environmental and biological hypothesis have been invoked. Patients with SD and CD are frequently females, show more introversive personality features, more stressful life events and executive deficits. Psychogenic non-epileptic seizures are related with more psychiatric co-morbidities and worse outcome. Cognitive-behavioural psychotherapy and psychodynamic-hypnotherapy combined with selective serotonin reuptake inhibitors have been effective. Conclusions: SD and CD in child and adolescent populations have been observed in medical and psychiatric contexts. Their recognition is difficult due to their multifactorial ethiology, the lack of diagnosis consensus and the scarce clinical experience, involving a true therapeutic challenge; therefore, it is imperative to carry out future researches on this issue. Their management in primary care seems suitable, but in more complex cases the referral to the specialist is necessary.
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Papers by Elisa Sepúlveda