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Acta Médica Costarricense

versão On-line ISSN 0001-6002versão impressa ISSN 0001-6012


MILLAN-GONZALEZ, Ricardo; CARTIN-BRENES, Mayra; RIVERA-CHAVARRIA, Ana Leonor  e  ARGUEDAS-QUESADA, José Agustín. Measurement of the concordance in the selection of antidepressants between costarican psychiatrists that do not apply and apply the Psychopharmacological Reasoning Algorithm. Acta méd. costarric [online]. 2019, vol.61, n.1, pp.22-30. ISSN 0001-6002.

There is a high comorbidity between medical surgical diseases and depression. There is no current systematic approach to guide how to select an individualized treatment under these circumstances.


To analyze the concordance between psychiatrist that do not use and those who use the Psychopharmacological Reasoning Algorithm to choose the treatment for 3 clinical cases of depression and medical surgical diseases.


Three case vignettes of anonymous real depressed patients with medical surgical diseases were presents to both groups. Group A made the selection of the antidepressant using their personal criteria; group B made the selection applying the Psychopharmacological Reasoning Algorithm.


There was no concordance on the drug among the 22 psychiatrists in the group that only applied the clinical criterion (kappa = -0.0154, p = 0.3851), whereas concordance was statistically significant in the group of 24 psychiatrists who applied the Psychopharmacological Reasoning Algorithm (kappa = 0.016, p <0.01). The concordance between groups A and B was 25% in the case 1, 16.67% in the case 2 and 20.83% in the case 3. The biggest majority of the psychiatrist that used the PPRA considers it useful (87.50%), applicable (83.33%) and with the possibility of impact the clinical practice (91.67%).


The Psychopharmacological Reasoning Algorithm increased the concordance in the selection of antidepressants made by Costa Rican psychiatrists in 3 clinical vignettes of depressed patients with a medical surgical disease, when compared to personal criteria. The concordance in the selection of the antidepressants in the 3 cases between both groups is low. The Psychopharmacological Reasoning Algorithm is a tool considered useful, applicable and with a possible impact in clinical practice.

Palavras-chave : Psychopharmacology; Consultation Liaison Psychiatry; Psychosomatic Medicine; psychopharmacological reasoning.

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