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Malestar psicológico en portadores y no portadores de la mutación causante de enfermedad de Huntington y su relación con la carga de la enfermedad
Psychological discomfort in carriers and non-carriers of the mutation that causes Huntington's disease and its relationship with the burden of the disease
Y. Rodríguez-Agudeloa, M. Chávez-Oliverosa, A. Ochoa-Moralesb, L. Martínez-Ruanob, A. Camacho-Molinab, F. Paz-Rodrígueza,
Autor para correspondencia
fpaz@innn.edu.mx

Autor para correspondencia.
a Laboratorio de Neuropsicología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
b Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
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rigidez y bradicinesia&#46; Los cambios cognitivos se caracterizan por problemas progresivos en el aprendizaje&#44; atenci&#243;n y funciones ejecutivas&#44; lo que puede generar un cuadro demencial<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">3</span></a>&#46; Las manifestaciones psiqui&#225;tricas reportadas con frecuencia son depresi&#243;n&#44; irritabilidad&#44; apat&#237;a&#44; perseveraciones&#44; obsesiones y ocasionalmente psicosis<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas psiqui&#225;tricos son un aspecto relevante en la EH&#59; su presentaci&#243;n y progresi&#243;n es variable debido a la degeneraci&#243;n diferencial de los circuitos estriato-corticales&#44; su curso no se correlaciona con la progresi&#243;n de los s&#237;ntomas motores o cognitivos a excepci&#243;n de la apat&#237;a<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Pueden surgir en diferentes fases de la enfermedad&#44; de forma at&#237;pica&#44; incluso 20 a&#241;os previos al inicio de las manifestaciones motoras<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Epping et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> encontraron que la prevalencia de s&#237;ntomas en pacientes prodr&#243;micos con EH no es diferente a la de la poblaci&#243;n general&#46; Aunque existe una asociaci&#243;n entre el n&#250;mero de repeticiones de CAG y la edad de inicio de la EH&#44; esta explica s&#243;lo una proporci&#243;n &#40;60&#37;&#41;&#59; aun cuando considera factores ambientales&#44; no cuestiona la variaci&#243;n gen&#233;tica subyacente&#44; ni se ha asociado a la gravedad de las manifestaciones psicol&#243;gicas y psiqui&#225;tricas&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Varios estudios han cuestionado la prevalencia de los s&#237;ntomas psiqui&#225;tricos en portadores de la mutaci&#243;n causante de la enfermedad&#44; reportando aumento de dichos s&#237;ntomas en la fase prodr&#243;mica de la EH<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46; El grupo de investigaci&#243;n PREDICT-HD<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">13</span></a> analiz&#243; trastornos del estado de &#225;nimo o afectivos &#40;depresi&#243;n&#44; desesperanza y angustia emocional&#41;&#44; utilizando evaluaciones autoinformadas y contestadas por el informante&#44; reportando que el nivel promedio de malestar psicol&#243;gico de las personas portadoras de la mutaci&#243;n causante de la EH es mayor en comparaci&#243;n con aquellas que no son portadoras de la mutaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Estos autores sugieren&#44; adem&#225;s&#44; que los niveles de angustia se asocian en forma positiva con las puntuaciones motoras&#44; por lo que las personas con probable EH&#44; sin sintomatolog&#237;a motora&#44; tienden a estar emocionalmente m&#225;s estables que aquellos que s&#237; la presentan<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Gracias a las pruebas de diagn&#243;stico predictivo para la EH&#44; y al estudio de la carga y cercan&#237;a de la enfermedad&#44; se han podido describir caracter&#237;sticas cl&#237;nicas incipientes que se presentan en la fase prodr&#243;mica y proponer marcadores cl&#237;nicos de la enfermedad&#44; adem&#225;s de estudiar el desarrollo de manifestaciones cl&#237;nicas&#44; como las psiqui&#225;tricas&#44; a lo largo del tiempo&#46; Por manifestaciones psiqui&#225;tricas nos referimos a s&#237;ntomas emocionales&#44; conductuales&#44; psicol&#243;gicos y psiqui&#225;tricos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para este estudio utilizamos el Inventario de S&#237;ntomas de Derogatis &#40;SCL-90-R&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a>&#44; con el objetivo de describir y analizar el malestar psicol&#243;gico entre portadores &#40;sin s&#237;ntomas motores&#41; y no portadores de la mutaci&#243;n causante de EH&#46; Nuestras hip&#243;tesis sugieren que algunos dominios espec&#237;ficos del SCL-90-R permitir&#225;n identificar manifestaciones psicol&#243;gicas en portadores de la mutaci&#243;n causante de la EH sin s&#237;ntomas motores&#44; adem&#225;s de que dichas manifestaciones se relacionan con la carga y cercan&#237;a de la enfermedad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todo</span><p id="par0040" class="elsevierStylePara elsevierViewall">El Instituto Nacional de Neurolog&#237;a y Neurocirug&#237;a Manuel Velasco Su&#225;rez &#40;INNNMVS&#41;&#44; a trav&#233;s del departamento de Gen&#233;tica&#44; ofrece a personas en riesgo de heredar EH participar en el Programa de Diagn&#243;stico Predictivo para la Enfermedad de Huntington &#40;PDP-EH&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">17</span></a>&#44; siguiendo las directrices recomendadas por la Asociaci&#243;n Internacional de Huntington&#44; la Federaci&#243;n Mundial de Neurolog&#237;a y el Grupo de Investigaci&#243;n sobre la Corea de Huntington<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> y est&#225; aprobado por los comit&#233;s de investigaci&#243;n y &#233;tica del INNNMVS&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El procedimiento del PDP-EH es&#58; primero&#44; se brinda asesoramiento gen&#233;tico&#44; se solicita consentimiento informado de manera verbal y escrita<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a> &#40;para las evaluaciones y muestra de sangre&#41;&#44; se realizan todas las valoraciones &#40;neurol&#243;gica&#44; neuropsicol&#243;gica y psiqui&#225;trica&#41;&#44; y posteriormente se toma la muestra sangu&#237;nea y finalmente se realiza el an&#225;lisis gen&#233;tico&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para fines de este trabajo se analizaron datos de 175 participantes del PDP-EH&#44; que durante el per&#237;odo de 2002 a 2019 cumplieron criterios de inclusi&#243;n como ser mayores de 18 a&#241;os&#44; tener antecedentes familiares confirmados &#40;con diagn&#243;stico molecular&#41; para la EH&#44; no estar embarazada&#44; no acudir bajo presi&#243;n externa&#46; El no otorgar el consentimiento y&#47;o no concluir alguna fase del programa se consideraron como criterios de exclusi&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se aplic&#243; la Escala Unificada de valoraci&#243;n de la EH &#40;UHDRS&#41;&#59; como parte de la evaluaci&#243;n neuropsicol&#243;gica se utiliz&#243; el <span class="elsevierStyleItalic">Mini Mental State Examination</span> &#40;MMSE&#41;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">20</span></a>&#44; los inventarios de depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> y ansiedad de Beck<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a>&#44; as&#237; como la evaluaci&#243;n de s&#237;ntomas psiqui&#225;tricos obtenida mediante el inventario SCL-90-R<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El Inventario de Depresi&#243;n de Beck &#40;BDI-IA&#41;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">21</span></a> valora la presencia de s&#237;ntomas de depresi&#243;n en la semana previa a la aplicaci&#243;n mediante autoinforme&#44; y consta de 21 &#237;tems&#46; La puntuaci&#243;n de severidad va de 0 a 63&#44; y tiene adecuada consistencia interna &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;87&#41;&#46; La puntuaci&#243;n utilizada como punto de corte para depresi&#243;n y ansiedad severa fue de 31 puntos o m&#225;s en las escalas de Beck&#46; El Inventario de Ansiedad de Beck &#40;BAI&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">22</span></a> consta de 21 &#237;tems que eval&#250;an la presencia de s&#237;ntomas de ansiedad durante la &#250;ltima semana&#46; La puntuaci&#243;n va de 0 a 63&#44; y cuenta con una adecuada consistencia interna &#40;&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;911&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El SCL-90-R<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">16</span></a> es un instrumento autoaplicado que eval&#250;a el grado de malestar psicol&#243;gico actual que experimenta una persona&#46; Se utiliz&#243; la versi&#243;n validada en poblaci&#243;n mexicana&#44; que consta de un listado de 90 s&#237;ntomas psiqui&#225;tricos con varios niveles de severidad&#44; frente a los cuales la persona debe indicar en qu&#233; medida lo han molestado o perturbado cada uno de esos problemas durante el per&#237;odo comprendido entre el d&#237;a de la evaluaci&#243;n y la semana inmediatamente anterior&#46; Para responder&#44; se ofrece una escala de 5 opciones&#58; &#171;nada&#187;&#44; &#171;muy poco&#187;&#44; &#171;poco&#187;&#44; &#171;bastante&#187; y &#171;mucho&#187;&#44; valorada en un rango de 0 a 4 puntos&#46; Una vez puntuadas las respuestas es posible caracterizar la sintomatolog&#237;a del evaluado en un perfil compuesto por 9 dimensiones primarias de s&#237;ntomas <span class="elsevierStyleItalic">&#40;somatizaci&#243;n&#44; obsesiones&#44; sensibilidad interpersonal&#44; depresi&#243;n&#44; ansiedad&#44; hostilidad&#44; ansiedad f&#243;bica&#44; ideaci&#243;n paranoide</span> y <span class="elsevierStyleItalic">psicoticismo&#41;</span> y 3 &#237;ndices globales de psicopatolog&#237;a&#58; el &#237;ndice de Gravedad Global &#40;<span class="elsevierStyleItalic">Global Severity &#237;ndex</span> &#91;GSI&#93;&#41;&#59; el &#205;ndice de malestar por s&#237;ntomas positivos &#40;<span class="elsevierStyleItalic">Positive Symptom Distress Index</span> &#91;PSDI&#93;&#41;<span class="elsevierStyleItalic">&#44;</span> que eval&#250;a el estilo de respuesta&#44; detectando tendencias a la minimizaci&#243;n o a la exageraci&#243;n del estado de malestar&#44; y el Total de S&#237;ntomas Positivos &#40;<span class="elsevierStyleItalic">Positive Symptom Total</span> &#91;PST&#93;&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Manejo de datos y an&#225;lisis estad&#237;stico</span><p id="par0070" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en las diferentes evaluaciones del PDP-EH se ingresaron a una base de datos en el programa SPSS versi&#243;n 22&#46;0&#46; Para cumplir con los objetivos de este estudio se realiz&#243; la depuraci&#243;n de datos de dicha base de acuerdo a los siguientes criterios de exclusi&#243;n&#58; antecedentes de riesgo suicida o cualquier trastorno psiqui&#225;trico no tratado&#44; desconocimiento del resultado molecular&#44; s&#237;ntomas evidentes de la EH o de alg&#250;n otro padecimiento neurol&#243;gico&#46; Finalmente&#44; la muestra estuvo constituida por 175 personas&#44; quienes completaron las escalas de valoraci&#243;n aplicadas y cumplieron los criterios establecidos&#44; representando un 92&#44;5&#37; de la muestra total de 189 solicitantes de PDP-EH&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La muestra se categoriz&#243; como en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">23&#8211;26</span></a> y se dividi&#243; en dos grupos&#58; portadores de la mutaci&#243;n causante de la EH &#40;PEH&#41; aquellos que tuvieran &#8805;<span class="elsevierStyleHsp" style=""></span>36 repetidos CAG del gen de la huntingtina y no portadores de la mutaci&#243;n causante de la EH &#40;NPEH&#41; quienes tuvieran &#8804;<span class="elsevierStyleHsp" style=""></span>35 repeticiones CAG&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Una vez determinado el n&#250;mero de repetidos CAG en cada participante se busc&#243; el valor de la carga de enfermedad &#40;CAP<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;Age at entry&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span> &#40;CAG<span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleHsp" style=""></span>35&#44;5&#41;&#44; f&#243;rmula propuesta por Penney et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">25</span></a>&#44; que es la m&#225;s reportada y utilizada en estudios internacionales&#41;&#46; Se obtuvo un rango de 30&#44;00 a 957&#44;00 &#40;M<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>294&#44;65&#59; DE 122&#44;22&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se analiz&#243; la normalidad estad&#237;stica de los datos mediante la prueba de normalidad de Kolmogorov-Smirnov&#46; Se realiz&#243; an&#225;lisis descriptivo de los datos demogr&#225;ficos&#44; de las escalas de Ansiedad y Depresi&#243;n de Beck&#44; puntuaciones totales del MMSE y se compararon entre portadores &#40;PEH&#41; y no portadores &#40;NPEH&#41;&#59; dependiendo de la normalidad de los datos se utiliz&#243; Chi-cuadrada o Test de Fisher para las variables categ&#243;ricas y t-test o U de Mann-Withney para conocer las diferencias por grupos&#46; La correlaci&#243;n entre las variables se estudi&#243; mediante la prueba rho de Spearman&#46; Por &#250;ltimo&#44; se realiz&#243; regresi&#243;n lineal m&#250;ltiple para estimar la fuerza de las asociaciones entre carga de la enfermedad y s&#237;ntomas psiqui&#225;tricos&#46; Se calcularon el coeficiente de regresi&#243;n &#40;&#946;&#41;&#44; valor p&#44; R<span class="elsevierStyleSup">2</span> ajustado y los factores de inflaci&#243;n de la varianza&#46; Para todas las comparaciones&#44; se asumi&#243; un valor &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Posteriormente&#44; usamos la f&#243;rmula de Brandt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">26</span></a> para categorizar a los PEH en tres grupos&#58; 1&#41; un grupo denominado &#171;Lejos&#187;&#44; es decir&#44; lejano al diagn&#243;stico&#44; estimando que tardar&#225; m&#225;s de 15 a&#241;os en presentar s&#237;ntomas cognitivos y ser diagnosticado&#59; 2&#41; un grupo denominado &#171;Medio&#187;&#44; estimando la presencia de s&#237;ntomas cognitivos y&#47;o posible diagn&#243;stico entre 9 y 15 a&#241;os&#59; y 3&#41; un grupo denominado &#171;Cerca&#187; con probabilidad de presentar s&#237;ntomas cognitivos y diagn&#243;stico cercano&#44; estimado en menos de 9 a&#241;os&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Debido a que las personas que participaron en PDP-EH proven&#237;an de zonas urbanas&#44; se usaron datos de poblaci&#243;n general para producir puntuaciones T espec&#237;ficas para los resultados del SCL-90-R durante todo el an&#225;lisis estad&#237;stico&#46; Los puntajes del inventario SCL-90-R &#40;variables dependientes&#41; se compararon mediante Kruskal-Wallis&#44; siendo la variable independiente la <span class="elsevierStyleItalic">cercan&#237;a a la etapa manifiesta</span> &#40;cerca&#44; medio&#44; lejos&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">De los 175 participantes del PDP-EH&#44; 69 &#40;39&#44;4&#37;&#41; fueron PEH y 106 &#40;61&#44;6&#37;&#41; NPEH&#46; La media del n&#250;mero de repetidos CAG fue de 44&#44;2 &#40;DE 3&#44;3 &#91;R 37-53&#93;&#41; para los PEH y 20&#44;5 &#40;DE 3&#44;7 &#91;R 15-29&#93;&#41; para los NPEH &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; No hubo diferencias estad&#237;sticamente significativas en cuanto a edad y escolaridad entre grupos&#46; Se observa un porcentaje mayor de mujeres en el grupo NPEH&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Para este estudio solo se tuvieron en cuenta los participantes sin deterioro cognitivo evaluado con el MMSE y un UHDRS de &#40;0&#41;&#44; que obtuvieron puntuaciones en los rangos de leve a moderado en los cuestionarios de Depresi&#243;n y Ansiedad de Beck&#59; por criterios de exclusi&#243;n del PDP-EH los participantes con depresi&#243;n severa no fueron incluidos&#46; Del total de los participantes&#44; un 6&#44;3&#37; present&#243; depresi&#243;n leve&#44; el 1&#44;2&#37; moderada&#44; el 15&#44;3&#37; ansiedad leve y el 5&#44;1&#37; moderada&#46; No hubo diferencias estad&#237;sticamente significativas en los puntajes totales de depresi&#243;n y ansiedad entre grupos&#46; Se observaron diferencias significativas en el MMSE &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> describe dichas variables por grupo de pertenencia&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Al comparar los resultados obtenidos del inventario SCL-90-R de los PEH y los NPEH&#44; se observa que los portadores obtienen puntuaciones m&#225;s altas en todas las dimensiones de s&#237;ntomas psiqui&#225;tricos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; aunque solo se observan diferencias estad&#237;sticamente significativas en el &#237;ndice de malestar por s&#237;ntomas positivos&#44; donde el grupo PEH obtiene mayor puntuaci&#243;n promedio &#40;1&#44;32&#44; DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;32&#41; a diferencia del grupo NPEH &#40;1&#44;24&#44; DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;39&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Correlaciones de Spearman</span><p id="par0115" class="elsevierStylePara elsevierViewall">Los an&#225;lisis de correlaci&#243;n muestran relaci&#243;n entre la carga de enfermedad y el malestar psicol&#243;gico&#46; Las relaciones se presentan en las dimensiones&#58; obsesiones y compulsiones &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;169&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; sensibilidad interpersonal &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;167&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; hostilidad &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;192&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#44; &#237;ndice de severidad global &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;158&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; e &#237;ndice de malestar por s&#237;ntomas positivos &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;199&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46; En general&#44; se observan relaciones bajas&#59; sin embargo&#44; son relaciones positivas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestra el modelo de regresi&#243;n m&#250;ltiple para conocer la relaci&#243;n entre el malestar psicol&#243;gico obtenido del SCL-90-R y los PEH&#47;NPEH&#59; se ponder&#243; por depresi&#243;n&#44; observando que la hostilidad&#44; la ansiedad f&#243;bica y el psicoticismo mostraron ser los predictores de la CAP&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se muestra la interacci&#243;n entre estas variables con el ser o no portador de EH&#46; Finalmente calculamos que este modelo explica el 26&#44;9&#37; de la varianza&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Comparaci&#243;n por la cercan&#237;a a la etapa manifiesta &#40;edad de inicio de s&#237;ntomas&#41;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Se categorizaron 57 de los 69 participantes del grupo PEH &#40;82&#44;6&#37;&#41; de acuerdo a la cercan&#237;a de la etapa manifiesta de la enfermedad&#44; en 12 casos no se cont&#243; con los datos completos para poder realizar dicha categorizaci&#243;n&#44; quedando &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; en el grupo lejano&#44; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; en el grupo medio&#44; y &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; en el grupo cerca&#46; Las pruebas de Kruskal-Wallis nos indican los siguientes hallazgos post hoc&#58; para la dimensi&#243;n obsesiones y compulsiones de SCL-90-R&#44; el grupo &#171;Lejos&#187; es el que obtiene la puntuaci&#243;n m&#225;s baja a diferencia de los otros grupos&#59; esta misma tendencia se observa en los dominios sensibilidad interpersonal&#44; ansiedad&#44; ansiedad f&#243;bica&#44; ideaci&#243;n paranoide&#46; Esta misma tendencia se observa en el &#237;ndice de severidad global y total de s&#237;ntomas positivos &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">Diversos estudios reportan que tanto el grupo de NPEH como el grupo PEH tienen un funcionamiento cognitivo similar&#44; dentro de los rangos normales<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Sin embargo&#44; a pesar de que los dos grupos obtuvieron resultados dentro de par&#225;metros normales&#44; nosotros s&#237; encontramos diferencias estad&#237;sticas entre los grupos en el puntaje total del MMSE<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">19</span></a>&#46; Es de amplio conocimiento que las manifestaciones psiqui&#225;tricas tienden a afectar el funcionamiento cognitivo en las personas en riesgo de desarrollar EH&#59; por tal raz&#243;n&#44; el &#233;nfasis en el manejo de dichas alteraciones desde etapas presintom&#225;ticas de la enfermedad&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Este es el primer estudio en poblaci&#243;n hispana en analizar el malestar psicol&#243;gico en portadores y no portadores de la mutaci&#243;n causante de EH&#46; Aunque no se encontraron diferencias estad&#237;sticamente significativas entre grupos al valorar sintomatolog&#237;a de ansiedad y depresi&#243;n&#44; observamos mayor porcentaje de ansiedad &#40;leve 14&#44;3&#37; y moderada 5&#44;1&#37;&#41; que s&#237;ntomas de depresi&#243;n en el total de la muestra&#46; Estos resultados confirman los hallazgos de Berrios et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a> y Julien et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">4</span></a>&#44; quienes han reportado tasas de ansiedad en personas presintom&#225;ticas de EH que se encuentran entre el 11&#44;5 y el 17&#37;&#44; mismas que aumentan al acercarse al diagn&#243;stico motor<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Aunque los s&#237;ntomas de depresi&#243;n se pueden presentar en cualquier momento de la evoluci&#243;n de la enfermedad&#44; se han reportado niveles altos de depresi&#243;n y ansiedad durante el per&#237;odo en que los individuos se someten a pruebas gen&#233;ticas<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">31&#44;32</span></a>&#44; y antes del diagn&#243;stico cl&#237;nico motor de la EH<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">33</span></a>&#46; Los s&#237;ntomas psiqui&#225;tricos pueden considerarse parte de la fase prodr&#243;mica de la EH&#44; y ser los primeros marcadores de la enfermedad&#44; debido a que el diagn&#243;stico cl&#237;nico se hace hasta la aparici&#243;n de sintomatolog&#237;a motora&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En general&#44; encontramos que el grupo PEH&#44; en comparaci&#243;n con el grupo NPEH&#44; obtuvo un puntaje mayor en todas las dimensiones evaluadas con el SCL-90-R&#44; aunque no se observaron diferencias estad&#237;sticamente significativas&#44; lo cual se ha reportado en estudios previos<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">12</span></a>&#46; La &#250;nica diferencia estad&#237;stica se observa en el &#237;ndice de malestar som&#225;tico positivo&#44; en donde el grupo PEH puntu&#243; m&#225;s alto&#59; cabe mencionar que el puntaje obtenido &#40;menor de 4&#41; es sospechoso de negaci&#243;n de s&#237;ntomas o de minimizaci&#243;n de patolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">34</span></a>&#46; Puntajes mayores en todas las dimensiones del SCL-90-R en portadores de la mutaci&#243;n causante de la EH pueden sugerir un hallazgo temprano de sintomatolog&#237;a psiqui&#225;trica y pueden ser foco de atenci&#243;n en el tratamiento de los pacientes&#46; La sensibilidad interpersonal&#44; hostilidad<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> y apat&#237;a<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">35</span></a> son los s&#237;ntomas m&#225;s reportados en grupos de portadores de la mutaci&#243;n&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Se observaron relaciones bajas pero significativas entre la carga de enfermedad y el malestar psicol&#243;gico evaluado con el SCL-90-R en las dimensiones&#58; obsesiones y compulsiones&#44; sensibilidad interpersonal&#44; hostilidad&#44; &#237;ndice de severidad global y el &#237;ndice de malestar som&#225;tico&#46; Aunque no son relaciones altas&#44; son consistentes con lo reportado en otras investigaciones<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">30&#44;36</span></a>&#46; Tambi&#233;n se pudo mostrar que la hostilidad&#44; la ansiedad f&#243;bica y el psicoticismo son predictores de la CAP&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Al hacer comparaciones por cercan&#237;a a la etapa manifiesta&#44; se observ&#243; que varios de los dominios del SCL-90-R &#40;obsesiones y compulsi&#243;n&#44; sensibilidad interpersonal&#44; ansiedad&#44; ansiedad f&#243;bica&#44; ideaci&#243;n paranoide&#41; mostraron diferencias significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#59; el grupo &#171;Lejos&#187; es el que obtiene la puntuaci&#243;n m&#225;s baja a diferencia de los otros dos grupos&#46; Estos datos son similares a lo reportado en otras investigaciones donde se ha observado sintomatolog&#237;a psiqui&#225;trica antes de la aparici&#243;n cl&#237;nica de la enfermedad<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">7&#44;30&#44;36</span></a> y concuerdan con estudios en donde utilizaron la escala SCL-90-R para evaluar personas en etapas prodr&#243;micas de EH&#44; mostrando mayor gravedad de s&#237;ntomas psiqui&#225;tricos asociada con la proximidad del diagn&#243;stico motor estimado<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">30&#44;36</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Los trastornos obsesivos compulsivos se han asociado a la progresi&#243;n de la EH y d&#233;ficits neuropsicol&#243;gicos&#46; Un importante n&#250;mero de pacientes con EH presentan s&#237;ntomas obsesivos compulsivos&#44; sin cumplir necesariamente con los criterios de trastorno obsesivo compulsivo seg&#250;n el DSM-V<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">37</span></a>&#46; Los s&#237;ntomas pueden expresarse en fases precl&#237;nicas o de manera importante en las fases avanzadas de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">38</span></a>&#46; Se ha reportado que aproximadamente el 27&#37; de personas en estadios precl&#237;nicos de la EH presentan alg&#250;n s&#237;ntoma obsesivo-compulsivo y que el pensamiento obsesivo y la conducta compulsiva aumenta con la proximidad al diagn&#243;stico motor&#44; posteriormente se estabiliza<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">39</span></a>&#46; Otro estudio report&#243; un 13&#37; de s&#237;ntomas obsesivos compulsivos leves y un 13&#37; de moderados a graves<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La ansiedad es com&#250;n en la EH&#59; su prevalencia va del 13 al 71&#37; y se incrementa con el diagn&#243;stico motor y la progresi&#243;n de la enfermedad<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">30&#44;41</span></a>&#44; por eso la importancia de evaluar y tratar a los pacientes en las diferentes etapas del padecimiento&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Marshall et al&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">36</span></a> reportan puntuaci&#243;n significativamente m&#225;s alta en el grupo de portadores en comparaci&#243;n con el grupo de no portadores de la mutaci&#243;n para EH&#44; para 3 de las dimensiones de s&#237;ntomas de SCL-90-R &#40;ansiedad&#44; ideaci&#243;n paranoide y psicoticismo&#41;&#46; Se conoce que la degeneraci&#243;n del cuerpo estriado y el orbitofrontal-subcortical favorece la aparici&#243;n de conductas socialmente inapropiadas &#40;sensibilidad interpersonal&#44; ideaci&#243;n paranoide&#41;&#44; que al inicio de la enfermedad pueden presentarse de forma sutil e incrementar con el tiempo&#46; Como lo reportamos en este estudio&#44; dichas conductas tienen mayor probabilidad de presentarse en etapas cercanas al diagn&#243;stico de los s&#237;ntomas motores de la EH&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas psiqui&#225;tricos tienen gran impacto para los pacientes ya que disminuyen la autonom&#237;a&#44; aumentan el deterioro cognitivo y afectan la calidad de vida y funcionalidad del paciente&#44; y para la familia generando mayor sobrecarga en el cuidado<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">42&#44;43</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n en este estudio pudiera ser el n&#250;mero de muestra diferente entre grupos &#40;portadores y no portadores&#41;&#44; aunque la literatura internacional reporta mayor participaci&#243;n de personas con resultados negativos y la diferencia ha ido disminuyendo<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">44</span></a>&#46; Desde el inicio del PDP-EH&#44; se ha recibido mayor n&#250;mero de solicitudes de ingreso de personas con resultados negativos&#44; y m&#225;s de mujeres que de hombres<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">45</span></a>&#46; Es importante mencionar que la mayor&#237;a de poblaci&#243;n solicitante del PDP-EH es mestiza mexicana&#44; proveniente de zonas urbanas en la Ciudad de M&#233;xico o zona conurbada&#44; debido en parte a la ubicaci&#243;n de la instituci&#243;n y lejan&#237;a a comunidades rurales&#44; lo que no permite incluir m&#225;s personas a la investigaci&#243;n&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Aunque los criterios usados para la selecci&#243;n de los participantes en este estudio tienen implicaciones&#44; ya que los resultados no pueden generalizarse a todos las personas en riesgo de EH&#44; los resultados obtenidos concuerdan con estudios que concluyen que el trastorno afectivo es una caracter&#237;stica destacada de las etapas prodr&#243;micas de la EH y que existe una fuerte correlaci&#243;n con el inicio cl&#237;nico de los s&#237;ntomas motores<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">4</span></a>&#46; Los estudios longitudinales ser&#225;n fundamentales para caracterizar la aparici&#243;n y evoluci&#243;n de los s&#237;ntomas neuropsiqui&#225;tricos en pacientes con EH&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiaci&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ninguna beca espec&#237;fica de agencias de los sectores p&#250;blico&#44; comercial&#44; o sin &#225;nimo de lucro&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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              "titulo" => "Comparaci&#243;n por la cercan&#237;a a la etapa manifiesta &#40;edad de inicio de s&#237;ntomas&#41;"
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    "fechaAceptado" => "2022-06-29"
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            0 => "Enfermedad de Huntington"
            1 => "Alteraciones psiqui&#225;tricas"
            2 => "Pr&#243;dromo de enfermedad de Huntington"
            3 => "Carga de la enfermedad"
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            0 => "Huntington&#39;s disease"
            1 => "Psychological distress"
            2 => "Huntington&#39;s disease prodrome"
            3 => "Disease burden"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Huntington &#40;EH&#41; es un trastorno neurodegenerativo y hereditario&#46; A partir del diagn&#243;stico predictivo se han descrito caracter&#237;sticas cl&#237;nicas incipientes en la fase prodr&#243;mica&#44; y varios estudios han reportado aumento de s&#237;ntomas psiqui&#225;tricos en portadores de la mutaci&#243;n causante de la EH&#44; sin s&#237;ntomas motores&#44; en esta fase&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Objetivo Identificar malestar psicol&#243;gico en portadores de la mutaci&#243;n causante de la EH sin s&#237;ntomas motores&#44; mediante el <span class="elsevierStyleItalic">Symptom Checklist</span> 90 &#40;SCL-90&#41;&#44; y correlacionar con la carga y cercan&#237;a de la enfermedad&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Una muestra de 175 participantes de un Programa de Diagn&#243;stico Predictivo de EH &#40;PDP-EH&#41; se dividi&#243; en portadores PEH &#40;39&#44;4&#37;&#41; y no portadores NPEH &#40;61&#44;6&#37;&#41; de la mutaci&#243;n causante de EH&#46; Mediante f&#243;rmulas matem&#225;ticas se obtuvo la carga de enfermedad y cercan&#237;a a la etapa manifiesta en el grupo PEH y se correlacion&#243; con los resultados del inventario SCL-90-R&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Al comparar los resultados obtenidos en el SCL-90-R de los PEH y NPEH&#44; la diferencia se observa en el &#237;ndice de malestar por s&#237;ntomas positivos&#44; donde los portadores obtienen mayor puntuaci&#243;n promedio&#46; Las correlaciones entre carga de enfermedad y s&#237;ntomas psicol&#243;gicos se dan en los dominios&#58; obsesiones y compulsiones&#44; sensibilidad interpersonal&#44; hostilidad&#44; &#237;ndice de severidad global e &#237;ndice de malestar som&#225;tico positivo&#46; Se observa una correlaci&#243;n baja entre la carga de enfermedad y las puntuaciones obtenidas en el malestar psicol&#243;gico&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En general encontramos que el grupo PEH obtiene un puntaje mayor en las dimensiones evaluadas con el SCL-90&#44; muestran relaci&#243;n con la carga y diferencias por la cercan&#237;a de la enfermedad&#46; Puntajes mayores en las dimensiones del SCL-90-R en portadores del gen para la EH pueden sugerir un hallazgo temprano de la sintomatolog&#237;a psicol&#243;gica en la enfermedad&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0010"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Huntington&#39;s disease &#40;HD&#41; is a neurodegenerative and hereditary disorder&#44; due to the predictive diagnosis&#44; incipient clinical characteristics have been described in the prodromal phase&#46; Several studies have reported an increase in psychiatric symptoms in carriers of the HD gene without motor symptoms&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To identify psychological distress in carriers of the mutation that causes HD&#44; without motor symptoms&#44; utilizing the Symptom Checklist 90 &#40;SCL-90&#41;&#44; and to correlate with the burden and proximity of the disease&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A sample of 175 participants in a HD Predictive Diagnostic Program &#40;PDP-HD&#41; was divided into HEP carriers &#40;39&#46;4&#37;&#41; and NPEH non-carriers &#40;61&#46;6&#37;&#41; of the HD-causing mutation&#46; By means of mathematical formulas&#44; the disease burden and proximity to the manifest stage in the PEH group were obtained and it was correlated with the results of the SCL-90-R&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparing the results obtained in the SCL-90-R of the PEH and NPEH&#44; the difference is observed in the positive somatic male index&#44; where the PEH obtains higher average scores&#46; The correlations between disease burden and psychological distress occur in the domains&#59; obsessions and compulsions&#44; interpersonal sensitivity&#44; hostility&#44; global severity index and positive somatic distress index&#46; A low correlation is observed between the burden of disease and the scores obtained in psychological discomfort&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In general&#44; we found that the PEH group obtained a higher score in the dimensions evaluated with the SCL-90-R&#44; showing a relationship with the burden and differences due to the proximity of the disease&#46; Higher scores on the SCL-90-R dimensions in carriers of the HD gene may suggest an early finding of psychological symptoms in the disease&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Obsesiones y compulsiones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;1&#44;298&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;194&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Sensibilidad interpersonal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Significanci&#243;n p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Malestar psicol&#243;gico seg&#250;n SCL-90-R entre PEH y NPEH</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">FIV&#58; factor de inflaci&#243;n de la varianza&#59; GSI&#58; <span class="elsevierStyleItalic">Global Severity Index</span>&#59; PEH&#58; portador con enfermedad de Huntington&#59; PSDI&#58; <span class="elsevierStyleItalic">Positive Symptom Distress Index</span>&#59; PST&#58; <span class="elsevierStyleItalic">Positive Symptom Total</span>&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable criterio&#58; Carga de la enfermedad &#40;CAP&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Modelo general&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables predictoras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Coeficiente estandarizado &#946;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FIV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hostilidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;362&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ansiedad f&#243;bica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#44;563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Psicoticismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Modelo de regresi&#243;n m&#250;ltiple entre carga de enfermedad &#40;CAP&#41; y dominios de los s&#237;ntomas seg&#250;n el SCL-90 en el grupo PEH</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Los valores mostrados son medias<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaciones est&#225;ndar&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; EH&#58; enfermedad de Huntington&#59; M&#58; media&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Cerca<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>estimado en &#60;<span class="elsevierStyleHsp" style=""></span>9 a&#241;os para el diagn&#243;stico de EH&#59; Medio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>entre 9 y 15 a&#241;os para el diagn&#243;stico de EH&#59; Lejos<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>m&#225;s de 15 a&#241;os para el diagn&#243;stico de EH&#46;</p>"
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            0 => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cerca</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medio</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lejos</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Kw&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Somatizaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;967&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;083<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obsesiones y compulsiones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;968&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sensibilidad interpersonal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;502&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;039<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depresi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;905&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;052<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ansiedad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hostilidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ansiedad f&#243;bica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">6&#44;218&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ideaci&#243;n paranoide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;282&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Psicoticismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;342&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;tems adicionales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;29&nbsp;\t\t\t\t\t\t\n
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